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Suggest treatment for darkening of skin

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Posted on Thu, 14 May 2015
Question: Hello, I have lived my entire life in England and i am of XXXXXXX ethnicity. At a young age my skin was very light. Now that I am in 20s I have noticed as I have aged my overall skin colour has changed and is now very dark brown. Areas which are exposed most to the sun such as my face, neck and forearms are much darker than the rest of my body. At first i thought this could be due to sun exposure so I began to use sun protection cream to hopefully return my skin colour to normal. A few years have passed and my skin has still not returned to its original light colour. My tone is at least 5-6x darker than what it used to be. I feel very uncomfortable due to the changes of my skin and avoid the sun.

Summery -
- Overall darkening of skin, areas such as neck, face and arms have darkened the most
- The darkening is not patchy but uniform in colour and has the appearance of a XXXXXXX
- The body of my lips have become a lot darker now
- My skin is very sensitive to the sun
- My elbows and areas above the cuticle of nails have darkened
- I have also seen a lot of darkening on my gluteus

What I have tried -
- staying out of the sun and using sun block everyday
- Regularly exfoliating my skin
- Using lighting cream
- Controlling and balancing my diet
doctor
Answered by Dr. Kakkar S. (47 minutes later)
Brief Answer:
I suggest a broad spectrum sunscreen along with pigment reducing agents

Detailed Answer:
Hello. Thank you for writing to us

I have taken note of your query and I have understood it.

Tanning is your main concern.
I want to stress on the use of a broad spectrum sunscreen and effective use of it.
An ideal sunscreen should be broad spectrum i.e it should have both UV A as well as UV B coverage.
A sunscreen that I would suggest for you should have an spf of 50 or more.
It should be reapplied every 2-3 hours specially if outdoors and in desired quantity to be effective i.e 3 ml for face and neck, 3 ml for both arms.

Having said that.. A sunscreen would not remove already existing XXXXXXX It would only prevent further tanning Or re-tanning.

Regarding already existing XXXXXXX you may use a cream containing one or more of the pigment reducing agents like Glycolic acid/ Alpha Hydroxy acids; kojic acid; arbutin; hydroquinone etc.

Systemic skin lightening agents like tranexamic acid, glutathione, L-cysteine peptide etc have become popular in recent years and are claimed to lighten the skin.
However, none have been adequately tested and there is no strong scientific evidence of efficacy.

They are available in tablet or capsule form and can be purchased online.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. (13 minutes later)
Thank You Dr. Kakkar S for your help and reply.

One of my main concerns are the areas not exposed to the sun such as my gluteus and stomach which rarely get any sort of sun exposure. Those areas have also darkened, could this be due to some sort of hormonal change?

Regarding existing areas of darkness..

- if left for a long enough period will the darkening eventually fade by itself or will it remain its current colour

- are there any products you would recommend I could use

Thank you
doctor
Answered by Dr. Kakkar S. (1 hour later)
Brief Answer:
Upload Images; can try topical Hydroquinone + sunprotection

Detailed Answer:
Hi XXXXXXX

I would like to keep 2 more possibilities i.e Ashy dermatosis and Lichen planus pigmentosus, considering that skin darkening is also affecting sites that are normally covered.

I would request you to upload a few Images of the affected areas preferably before and after photographs for comparison.

You may upload images either at "Reports Section"

Or else

You may also mail me the image at YYYY@YYYY
Kindly mention the subject of this mail as Attention Dr.kakkar.

Skin color is a combination of constitutive pigmentation and facultative pigmentation.
Constitutive skin color is the natural, genetically determined color of the epidermis e.g the color of skin that is normally protected from sun i.e underside of upper arm.
Facultative skin color results from exposure to UV light and other environmental factors.
Skin lightening agents may progressively revert back the facultative color to the constitutive level and normally this color change will not go beyond the constitutive level.

You may try and use a hydroquinone based cream/ lotion once daily at night for a few weeks along with sun protection and regular use of a sunscreen, throughout the day.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. (43 minutes later)
Hi Dr Kakkar

I have uploaded some pictures up on my reports. The image of the difference in skin tone between my arms is the same sort of difference my neck has with my face. My face was originally the same tone as my feet. Over the last couple of years i have not had much sun exposure and stay out of the sun as well as broad spectrum sunscreen. thank you

Yours sincerely,

XXXX
doctor
Answered by Dr. Kakkar S. (1 hour later)
Brief Answer:
I suggest testing for serum Vitamin B 12 levels

Detailed Answer:
Hi.

I have reviewed the Images.
The most contrasting darkening is at elbows, dorsal hands/ feet with periungual accentuation and lips.
This type of pigmentation pattern distribution is suggestive of Addisonian hyperpigmentation and Vitamin B 12 deficiency (methylcobalamin deficiency) is a common cause.
This is in addition to the general tanning

I suggest you to get tested for serum vitamin B 12 levels. If levels are found deficient an Oral vitamin B 12 supplement can also be added

Is your oral mucosa i.e buccal mucosa and tongue also involved with pigmentation?

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. (1 hour later)
Hello

At glimpse within my mouth i can't really see any pigmentation. I already take oral multiple vitamin tables containing 1.0µg of vit b12 and eat a lot of chicken and milk.

My father shows similar sort of symptoms as i do in relation to the differences in skin contrast however within his mouth there is a lot of pigmentation. I don't know if this could be of any help. Thank you

Additional information

In January I went to the GP for feelings of fatigue, penile dysfunction, transient shortness of breath and need to urinate frequently. I had a blood test for levels of Vitamin D, B12, and thyroxine hormone. My results where first discussed with a nurse who said my levels of vitamin B12 where low and that I showed signs of anaemia. However when discussing the results with my doctor he said everything was fine.

XXXX
doctor
Answered by Dr. Kakkar S. (14 hours later)
Brief Answer:
I want you to be sure about the Vit B 12 deficiency

Detailed Answer:
Hello XXXXXXX

Since there were different views about Vit B 12 Levels previously therefore I want you to be more sure about that.

The dose of Vitamin B 12 that is normally prescribed for Vitamin B 12 deficiency and addisonian hyperpigmentation is much more that what you are taking at present i.e 1 mcg.

The therapeutic dose of Vitamin b 12 is approximately 1000 fold of the dose that you are currently taking (varies from 750 mcg - 1500 mcg per day)

The skin, may be the site of the first manifestations of Vit B 12 deficiency, highlighting the importance of vitamin B12 testing in the early diagnosis of this condition.

Kindly go through the link as well..

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. (15 hours later)
Thank you very much for your help and advice. I have found it very relieving and helpful. I have booked an appointment with the GP on 29/04/15 and will ask to get my Vit b12 serum levels tested. Would you like to be kept updated ?
doctor
Answered by Dr. Kakkar S. (23 minutes later)
Brief Answer:
You are welcome

Detailed Answer:
Hi.

Yes. Do keep me updated.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. (43 hours later)
Hi Dr Kakkar

Just out of curiosity if it is addisonian hyperpigmentation and Vitamin B 12 deficiency (methylcobalamin deficiency) i do have. Would my original skin tone return or would treatment just prevent further hyperpigmentation. Sorry for disturbing you thank you

XXXX
doctor
Answered by Dr. Kakkar S. (5 hours later)
Brief Answer:
Tone and pigmentation should improve

Detailed Answer:
Hi.

Yes, Tone and pigmentation should improve on Vitamin B 12 supplementation, if it is actually due to its deficiency.

Any more clarifications are most welcome.

Regards
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Kakkar S. (2 days later)
Hello Dr Kakkar

I mentioned our discussion. I had my GP visit today. No blood work was done but he looked at the previous blood test results I mentioned from above. All my blood readings where normal with slightly low levels of Vitamin D. He prescribed me with a vitamin D3 supplement of 500mcg, 2 tablets to be taken everyday for 10 days followed by once every month thereon after.

Regarding the darkening -

He didn't check to look at the difference in contrast after I mentioned it. I made him look at the pigmentation on my elbow. He said that there is nothing he can do and that the differences in contrast i mentioned are normal within the XXXXXXX ethnic group.
doctor
Answered by Dr. Kakkar S. (1 hour later)
Brief Answer:
It is his individual discretion

Detailed Answer:
Hi XXXXXXX

I don't think the pigmentation on your lips, elbows, dorsum of toes and periungual areas is simply ethnic in origin.

There was no harm in supplementing with high dose Vitamin B 12 for a month despite no detectable deficiency.
It was worth a trial because the pattern was so distinctive of addisonian hyperpigmentation

I have no answer for his decisions. You can continue as per his advice and follow up after sometime.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. (4 hours later)
Hi Dr Kakkar

I was not satisfied by the outcome of my visit. I am going in to revisit the GP again in 2 weeks. However within the next 2 weeks I'm going to get seen privately by a dermatologist as a second opinion. Is there any specific points you could possibly advise I mention during my consult?

Thank You

XXXX
doctor
Answered by Dr. Kakkar S. (15 hours later)
Brief Answer:
Keep me updated.

Detailed Answer:
Hi.

You can specifically ask your dermatologist to check for any Oral pigmentation?

Don't mention my diagnosis beforehand and let him/her examine and keep there own diagnosis/ possibility. What do he/she thinks this is due to?

Later you may mention my discussion with you and his/her opinion on that and the likelihood that this pigmentation would improve with Vitamin B 12 supplementation.

Keep me updated.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. (2 days later)
Hi

Thank you I will do. What are you thoughts of attempting to take over the counter Vit b12 (cobalamin) supplements of 1500mcg myself and checking for changes over time.

Thanks XXXXXXX
doctor
Answered by Dr. Kakkar S. (15 minutes later)
Brief Answer:
Methylcobalamin/ Vitamin B 12 supplementation

Detailed Answer:
Hi.

Yes, you can do that.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Dr. Kakkar S.

Dermatologist

Practicing since :2002

Answered : 9579 Questions

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Suggest treatment for darkening of skin

Brief Answer: I suggest a broad spectrum sunscreen along with pigment reducing agents Detailed Answer: Hello. Thank you for writing to us I have taken note of your query and I have understood it. Tanning is your main concern. I want to stress on the use of a broad spectrum sunscreen and effective use of it. An ideal sunscreen should be broad spectrum i.e it should have both UV A as well as UV B coverage. A sunscreen that I would suggest for you should have an spf of 50 or more. It should be reapplied every 2-3 hours specially if outdoors and in desired quantity to be effective i.e 3 ml for face and neck, 3 ml for both arms. Having said that.. A sunscreen would not remove already existing XXXXXXX It would only prevent further tanning Or re-tanning. Regarding already existing XXXXXXX you may use a cream containing one or more of the pigment reducing agents like Glycolic acid/ Alpha Hydroxy acids; kojic acid; arbutin; hydroquinone etc. Systemic skin lightening agents like tranexamic acid, glutathione, L-cysteine peptide etc have become popular in recent years and are claimed to lighten the skin. However, none have been adequately tested and there is no strong scientific evidence of efficacy. They are available in tablet or capsule form and can be purchased online. Regards