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Took fraxel laser treatment for acne problem. Got pigmentation on forehead. Now?

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Practicing since : 2006
Answered : 2015 Questions
hello Doctor,
My height is 5'6" and my weigh is 43 kg. I m married right now with one yr baby.
I have this acne problem since 2001 means almost 12 yrs hv been passed but my position is still the same. It was in 2008 when i consulted a doctor and she adviced me for glycolic peels and fraxel laser treatment. I spent around lakh over such treatment. she had also adviced me for some antibiotics and in 2010 may, i found a good skin. I was very happy that time n during that time I got engaged, Before that in 2009 XXXXXXX because of under-weight problem I consulted a gynae and she adviced me for some injection name metadac 75 which is a steroid, but I was totally unaware about that, I took around 8 injections of that n as a result of it.. in a month i found myself bit plump but not beautiful, ias if my face got swollen, and the disaster was that my voice became hoarse, which is still like that. i was in the process of getting acne pimples at regular basis. As I told u earlier in feb 2010 my acnes stopped n my skin cleared day by day. till may 2010 my skin baceme crystal clear. then i got engaged in XXXXXXX but during that time I again started with that vicious cycle,, my problem was so bad that during that time till I got married in nov 2010 my face was so much full with acne that one cannot find even a liitle space clear. In XXXXXXX 2010 after engagemet when I visited doctor she gave a glycolic sitting to me n suddenly my nasobial fold got pigmented n she made fraxel laser over that, it was a complete disaster. Now I m married n last yr only I hv delivered a baby. just after 4 months of marriage I got pregnant during that time my acnes stopped but after delivery it again started, now my difficulty is that
I hv an irregular period problem and before my cycle I always get 4 5 acnes, these days I m getting cystic acnes also with transparent water inside. I have stopped lactating, my face is full of acne marks, which r going with very slow speed and also I used to get 5 6 acnes before my periods.
now as I m over with the pregnancy n all I want to start isotretinoin course. I hv already consulted gynae she has adviced me for yaz for my harmonal disbalance, but along with that i want to go for isotrtinoin course just to get rid of this problem permanently of active pimples as well as marks.. still I would say my skin is not that bad but still i want a clear face and also i want to know about that XXXXXXX over nasobial fold which becomes dark if i XXXXXXX any skin peeling cream over that area, although it better than before but still that area is dark n also sensitive ,I also have pigmentation problem on side of foreheads..
I request you to advice me i should go for isotretinoin or not. i really want to go for that. please advice
Thu, 7 Feb 2013 in Skin Hair and Nails
Answered by Dr. Kalpana Pathak 34 minutes later

Thanks for writing to us.

From the description you have given, you are probably having nodulocystic acne with hormonal derangement.

Firstly use of isotretinoin and hormonal pill is suggested in such type of acne as it gives a better result than either of these used alone. So you need to start with both isotretinoin and yaz.
Isotretinoin is a wonder drug for acne but it has to be taken with caution in females. Pregnancy should completely be avoided when on isotretinoin and even on stopping it, avoid conception at least for three months after stopping the drug. To have good results and prevent recurrence continue isotretinoin at least for 6 months even if your skin clears completely.
Use of salicylic acid based face wash along with topical creams like adapalene and nadifloxacin will help in acne.

Your concerns of hair fall, pigmentation could be related to your hormonal problem.
To treat hair fall minoxidil 2 percent solution twice in a day can be used.

Your nasolabial pigmentation could be due to post inflammatory hyperpigmentation after peeling session. However I would like to know if you had dandruff problem in scalp along with dryness in your nasolabial folds. As there is a condition known as seborrheic dermatitis, which is associated with pigmentation and scaling in nasal folds.

Wait for acne to subside, then you can take salicylic acid peels or Glycolic acid peels to reduce acne spots and pigmentation.

Hope that answers your query. Should there be more query, feel free to contact us.
Take care.
Above answer was peer-reviewed by
Follow-up: Took fraxel laser treatment for acne problem. Got pigmentation on forehead. Now? 56 minutes later
Thanks doctor,
yes ,I think nasolabial pigmantation is due to PIH as i has crusting over that part 20 to 25 times means for complete one and a half year but now I hv stopeed applying any cream over that area but still if sometimes i get a lot of dryness over that area sometimes it again irritates n becomes brown with a little crusting. now that area is bit bit fine but still slight pigmentation is thr. i only apply moisturiser over that area but please doctor suggest me some good medicine for that also. and one thing as I told you i had undergone with so much of peels lasers n topical creams nw my skin is very thin, i just want you to suggest me after taking isotretinoin my skin will not become more thin??? and yes i do have a lot of dandruff problem and evn somtimes I get dryness over nasobial fold.

I also request you to advice me anything for my weight , my weight is very less according to my height and i really want to gain weight atleat 8 to 10 kgs. and evn i want to improve the size of my breasts as after prenancy my breast size is reduced to 32. during pregancy it became 34 due to which i look very thin. i really want to maintain good figure as well as skin . please advice.
Answered by Dr. Kalpana Pathak 41 minutes later

As you have mentioned that you have severe dandruff along with off and on scaling of nasolabial area, it could be seborrheic dermatitis that has led to pigmentation of nasolabial area (also known as seborrheic Melanosis). To treat the same, use a medicated anti dandruff shampoo every alternate day over the scalp. Also apply antifungal steroid based lotion over scalp and in nasolabial folds (candid b lotion), once in a day. This would cure dandruff and also treat pigmentation of folds.
Using a salicylic acid based face wash too would not only act on acne but would treat pigmentation to some extent too. You can use a mild moisturizer like cetaphil to keep your face hydrated.
Taking isotretinoin too would help in dandruff. Do not worry; peels, isotretinoin etc if taken under proper follow up and guidance of dermatologist are completely safe. As whatever treatments I have suggested are all prescription drugs, a prescription from a dermatologist is required for your well being.

As far as gaining weight is concerned, weight is also determined by hereditary factors. You can make certain lifestyle changes to gain weight like
1) Eat food with high protein content such as meat, liver, eggs, cottage cheese beans, pulses and peas, and foods with high carbohydrates such as potatoes, rice etc
2) Include dairy products like milk, cheese, yogurt etc in your diet.

3). Take snacks high in calories though healthy like smoothies, milk shakes, muffins, dried fruits, juices etc.
4) Take three meals along with snacks two times in a day.
5) Exercise daily, do some weight training to build muscle mass
Gaining weight is as difficult as losing weight, it might take some time. So be consistent with your regime. These are just general recommendations; however you may go for a personalized diet chart to help you more.
Hope that answers your query. Take care.
Above answer was peer-reviewed by
Follow-up: Took fraxel laser treatment for acne problem. Got pigmentation on forehead. Now? 1 hour later
Thanks doctor,

as u suggested the candid B Lotion,, can I apply this at nasobial fold and over scalp both?? and u wrote that it is a steroid but earlier i told u that i am allergic to steroids. after having any type of steroid my nasobial fold gets irritated and sometimes crusts so please suggest i should go with taht or not and also suggest me any good anti dandruff shampoo.. one more thing i would like to tell you that i hv pigmentation over both the sides of forehead and which i hv observed that before while fraxel laserv treatment it became dark now i am bit afraid that if i ll do isotretinoin couse will it again go dark? and my doc has not asked me for any blood test and my doctor is in noida and nw i hv relocated to bangalore so i can reach him in 3 4 months. so what should i do with blood tests because he dnt asked me for any tests but i read online that doc ask u to go under some test while isotretinoin course please guide me regarding the same and also i want to ask that i am a professional lady and need to put make up (concealer and foundation)at regular basis so while isotretinoin course, is it possible that i can apply makeup daily, it is somehow my need to apply makeup regularly.. please advive.. thanks
Answered by Dr. Kalpana Pathak 2 hours later
Thanks for writing back.
1) you can use candid b lotion over your scalp and nose without any side effects. However once the scaling and crusting over your folds is gone, stop using it.
2) use nizoral or keraglow AD shampoo every alternate days
3) isotretinoin treatment would not increase your forehead pigmentation.
4) before starting isotretinoin, we rule out pregnancy and get a liver profile and lipid profile test done. So the same can be done in your case.
5) isotretinoin will make your skin dry, use a good moisturiser and sunscreen that suits to your skin. If skin is properly hydrated, using a mild water based foundation would be okay. However if the skin gets dry with isotretinoin, avoid any cosmetic products.
6) look for a good dermatologist in Bangalore as a regular follow up with a dermatologist and a gynaecologist is required in your case to monitor the use of medicines in your case.
Wish you a healthy flawless skin! Take care.
Above answer was peer-reviewed by
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