Brief Answer:
Image not received. Kindly upload again

Detailed Answer:
Hello. Thank you for writing to us at HealthCareMagic

I have gone through your query.

Based on your description and the product that you are using, this seems like a Hyperpigmented Scar.

The ingredients present in this cream is a combination of tretinoin+mometasone furoate+hydroquinone.
It is a gold standard combination to bleach out excess pigment/ hyperpigmentation.

However, unfortunately I could not see any Image. I received one attachment k.jpg, but it is an empty file.

Kindly try and take another picture and upload again.

Regards

---

Brief Answer:
Melasma; Rx includes sunscreens+pigment reducing agents & Chemical peeling

Detailed Answer:
Hi.

I have reviewed the Image.
I can see hyperpigmented patches on both cheeks. This is Melasma. It is not a scar.

Melasma, is more common in females but it can be seen in both sexes.

It is idiopathic in most cases (i.e no known cause), however, pregnancy, oral contraceptive pills and regular intake of pain killers are some well known causes,

It presents with light brown to dark brown patches/ pigmentation mainly on convexities of face i.e those areas on face that would normally receive the most amount of sun e.g malar prominences, dorsum/ bridge of nose, commonly.

Sometimes forehead, upper lip and chin may also be involved.

Therefore, Sun protection is an essential part in the management of Melasma.
I suggest a broad spectrum sunscreen, that which offers both UV B as well as UV A protection.
A sunscreen with minimum spf 30+ or more is considered to be broad spectrum. A lot of broad spectrum sunscreens are available OTC e.g Neutrogena dry touch ultrasheer sunscreen/ sunblock, has an SPF of 50+ and is quite good.
Sunscreen should be reapplied every 2-3 hours and in adequate amounts i.e 3 ml Or 1/2 tsf for both face and neck, throughout the day.

Besides sunscreens and sun protection, pigment reducing agents like kojic acid, hydroquinone, tretinoin, glycolic acid, azaleic acid, arbutin, mometasone furoate etc are available on prescription, either alone or in various combinations.

The mechanism of action of these pigment reducing agents is either exfoliation of existing melanin Or inhibition of synthesis of new melanin Or both.

The product that your wife was using is a combination of tretinoin+hydroquinone+mometasone.
This combination is known as Kligman's formula and is a gold standard combination for treatment of melasma.

While hydroquinone and mometasone furoate inhibit synthesis of new melanin, tretinoin exfoliaties existing melanin.
Tretnoin also enhances penetration of hydroquinone, thus potentiating its action.

However, this combination is a prescription product.
It should never be used without supervision of a dermatologist and never for more than 6-8 weeks regularly.
This is because it contains a potent steroid e.g mometasone furoate and regular use of it can cause side effects of steroid abuse like skin thinning, redness, sun sensitivity, hirsutism (increased facial hair) and acne.

I usually give this combination only for initial 4-6 weeks in my patients and once desired initial response is achieved with this combination I switch over to other safer options like kojic acid, glycolic acid, hydroquinone, azaleic acid for maintenance of improvement.

Treatment takes time and patience. Your doctor may modify treatment depending on response.

I suggest that you visit a dermatologist in your vicinity for the needful.

She may also opt for a few sessions of chemical peeling from her treating dermatologist.
Glycolic acid chemical peel is quite useful for Melasma and can be combined with topical treatments that I mentioned above.

One thing to remember is that melasma may recur and if she stops everything it will definitely recur.
Therefore, maintenance of improvement is important in melasma with regular sunscreen use and one of the skin lightening cream e.g kojic acid or glycolic acid based cream and/ or maintenance sessions of chemical peeling.

Regards

---