Brief Answer:
details below
Detailed Answer:
Hi,
Thanks for writing back.
I will answer your questions specifically.
Antioxidants alone do not reduce pigmentation but have an indirect role in preventing sun damage, improving skin texture and tone.
Vitamin C intake as 500 mg twice daily can be taken. Combination of procyanathidin with tranexemic acid is available(pinodin tx tablets) in recommended doses for melasma and can be taken two times in a day. Similarly collagen and
hyaluronic acid is available in recommended dose combination and should be taken two times in a day( tablet collahyal). Procyanathidin and tranexemic acid are said to have role in reducing pigmentation while collagen and hyaluronic acid present in
connective tissue of skin maintain good skin texture and prevent skin ageing but has no role in reducing pigmentation. Personally, I do not prescribe collagen oral supplements as it has a questionable role as an antiageing product.
I have seen the images attached and still her skin looks dry at places that is why
I had advised that she should use
hydrocortisone cream( mild steroid, suitable for face for few days).
Even though she has used HQ 8% and
tretinoin 0.05 %, I would suggest that she apply HQ 4% mixed with tretinoin 0.1% in night as the combination would be stronger than creams applied alone as when these medicines are combined and applied, these potentiate each other's effect. Moreover even if you plan to take sessions of peels or lasers, daily topical cream application is required as a priming agent to achieve better results with peels or lasers and to maintain the results achieved so far.
Sunscreen use as said earlier is mandatory to prevent tanning over face and other exposed areas.
Personally, i would have done glycolic acid(50%) or
trichloroacetic acid ( 10 percent to 20 %) peels over your daughters face.
Similarly for other exposed body areas glycolic peel 50 percent to 70 % would be required. Glycolic acid 30 percent is too mild. Combination peels like glycolic acid combined with yellow peel gives good results too.
Lactic acid 90 % is used in pigmentation cases. I prefer this peel only as a maintenance therapy and in cases where people have sensitive skin. Personally I havent received encouraging results in melasma with this peel.
I know you have tried everything but still I. would advise that you give my treatment suggestion a try.
As far as lasers are concerned, Q switched laser offers good results in pigmentation. So if you plan further sessions of laser, just stick to q switched laser.
As Far as pre and post care with peels are concerned.
Prior to peels, all the topical medicines should be stopped atleast five days to a week before peels and should be restarted again after a week of peeling session
No parlour procedure like threading, bleaching should be done prior to peels
After peels,
use a good sunscreen and moisturiser daily.
Avoid sun exposure
Avoid salon procedure for a week
Avoid applying make up
Avoid bleach and scrub over face
Avoid cooking meals for a day or two as direct heat from burner may irritate skin
Avoid strenuous exercise or
excessive sweating for a day or two as sweat too may irritate skin
Avoid any other procedure like laser etc immediately after peels.
Basically the most important post peel care is strict sun avoidance and use of sunscreen.
Hope this answered your query.
Take care