Chicken pox scars can be devastating. Know it’s Prevention and treatment.

A lady aged 32 entered my cabin. On being questioned about her skin concern, she busted into tears. 

She suffered chicken pox a month ago. This left a lots of marks especially on her face. She couldn’t accept this sudden change on her beautiful face. 
I was imagining what if I were in her place. Yes, it could be devastating. Beauty gone overnight is no joke.

Good part is I could console her that with medical science, we can cure her scars upto 70 percent . It didn’t sound like music to her ears. She  wanted them gone totally. I continued with my coy selling trying to bring her attention to acne scars in her face. She had them since long which somehow never bothered her . Well if can make these chicken pox scars as light as these acne scars which never bothered you till now, will it be okay ? 

Nothing could console her. I know only the real results will. But as she left the chamber I just wished she had visited me earlier. I could have put her on medicines which would have made chicken pox rashes leave lesser scars. Thus, I thought of penning down this article so that others don’t have to ungersi the same ordeal. Here is the list of don’t during chicken pox. Follow them if you don’t want your loved ones to undergo same :

1. Don’t keep touching your chicken pox marks.

2. Use an antibiotic ointment on them to avoid superseded bacterial infection. This prevents scarring upto an extent. Secondary bacteria infection means more destruction and thus 

3. Start antiviral treatment early . Again this ensures lesser viral kid thus lesser destruction of underlying skin . 

4. May be a course of oral steroids only as prescribed by a dermatologist could reduce the inflammation  and thus scarring . 

Even after following above mentioned measures , some scarring is bound to happen. After accomplishing the first goal of making chicken pox rashes leave minimum of scarring, next starts the treatment of scars. 

Rule number one: Start the chicken pox scar treatment early. Earlier the better. Reason being  immature scars responds better. 

Their are various modalities available for treating chicken pox scars. Choice of treatment depends upon the depth, size and site of scar . 

1. Oral course of retinoids prescribed for three months helps. 

2. Microneedling sessions are a great help. They boost skin to produce new collagen and elastin production. Yes it’s a safe. It’s comfortable since done after local anaesthesia. 

Microneedling

3. PRP. It stands for platelet rich plasma. Person own is withdrawn. Processed and growth factors separated. These growth factors are then. Injected into skin. This helps skin to heal better. 

4. At times, especially when scars are old, surgical excision is the best way. The damaged skin is excited and sutured. Suture used is the thinnest possible so it hardly leaves any marks. Idea is to make scar look less visible.

Remember whichever the modality nobody on earth can erase chicken pox scar or any scar for that matter by 100 percent. Reduced appearance by upto 70 percent is expected. One can achieve the same in safe manner. And whatever results one achieve stay for life . 

Before I close the article would like to mention of a couple who visited me recently. A man with a very beautiful wife came for consultation. Man wasn’t happy with one or two chicken pox scars on her very beautiful wife’s face. Scars were hardly visible. Wife was least bothered by same. And I was left wondering does this guy love her even by a bit or is she just a trophy to be showcased in front of world . 

Do care about what actually is bothersome and what can be and should be treated. Because does matter . But at the same time don’t  get finicky about beauty. You are much more than your outer self . 

With love and care Dr. Anvika

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 BEST TREATMENT FOR PIMPLES SCARS: PERMANENT RESULTS IN SAFE WAY

No one modality would help treat pimples scars. Scars come in all sizes. They vary in depth, width, length and surface changes. Accordingly the treatment modality is chosen. Following treatments are available. Permutation and combination works best. So, let your dermatologist chose the best for you.

Remember:

  1.  Every scar can be made less visible but never invisible. Nobody can erase 100 percent appearance of scars. Improvement up to 60 to 90 percent can be expected depending upon the initial scar appearance.
  2. Improvement takes time. Number of sessions is required done at 15 to 30 days interval.So around 2 to 8 months can be required for improvement.
  3. Procedure is rendered comfortable by prior application of numbing creams. So don’t worry about pain factor.
  4. Make sure to get it done by a qualified dermatologist only. For only a dermatologist would be having an in depth knowledge of all the modalities. Never get it done by Ayurvedic doctor or a spa.

Various treatment modalities for scar treatments are:

  1. Shouldering of Margins: The margin of the scars are ablated or burnt out. So that punched out scar becomes saucer shaped. Thus it’s less visible. Brown crusts are formed for few days post treatment which falls off owns it’s own.
  • Surgical Excision and Suturing: The scarred skin is cut and margins sutured together. Thinnest possible suture is used so it doesn’t leave suture marks. Sutures are removed after seven days.
  • Fractional Radiofrequency:  Micro needles and Radiofrequency both gets inside skin. They break the old scar tissue and stimulate skin to form new collagen. As new collagen forms it keeps filling the scars from beneath. As bricks form walls, collagen is the main building block of the skin.
  • Derma roller: Derma roller is a small hand held devicewith micro needles all around. It’s rub on skin in to and fro direction. Needles piercing the skin break the old scar tissue. Also micro injuries to skin stimulate the skin to form new collagen. Thus, healing the scars.
Dermaroller
  • Derma pen:  Derma pen is a hand held device with projects out micro needles in skin. It also works on the same principal as derma roller.
  • PRP: PRP stands for platelet rich plasma.Person own is taken, growth factor separated from it.Growth factors are injected into scars.
  • Co2 ablative Laser: Co2 fractional laser burns or ablates skin in multiple channels in criss cross pattern. New skin fills the ablated skin columns. Thus, healing the scars.
  • Non ablative laser: Non ablative laser are milder version of ablative laser. They also ablates the skin in multiple channels in criss cross pattern. But is lesser strong stimulus as compared to ablative ones. Thu post healing time after every session is less compared to ablative ones.

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Xantholesma : Fat over eyelids is treatable

XANTHOLESMA : FAT ON EYELIDS

Eyes  are gateway to one’s inner self.  It better be beautiful. Fat deposits around eyes may spoil their beauty . Lets  know everything about them .

WHAT IS XANTHOLESMA?

Deposition of fat on eyelids skin, both upper and lower is called Xantholesma.

HOW DOES IT HAPPEN?

There is no reason behind it. Many may be having high cholesterol levels in blood. But the deposition in skin can happen with or without high cholesterol deposition.

HOW CAN IT BE REMOVED?

There are multiple ways to remove a Xantholesma.

Best modality in my last 10 years of experience has been surgical excise and suturing. Under local anesthesia the skin containing fat is removed and sutured. Sutures are removed after 7 days. It’s safe since surgery is just limited to skin.

Laser ablation or ablation with radiofrequency or chemical ablation with 70% TCA are other modalities. These later modalities may not treat every time and run the risk of leaving a fibrotic scar. Also chances of recurrences on the same place are very high.

Advantages  with surgical excision is, recurrence never happens on the same place. And for sure the lesion would be gone.

Xantholesma : Sutures are hardly visible after the treatment.

HOW MUCH TIME DOES SURGICAL EXCISTION TAKE?

Depending upon the number of xantholesma lesions and their width, it can take anywhere between half an hour to an hour.

WHAT IS THE DOWNTIME OR AFTER CARE POST SURGICAL REMOVAL OF XANTHOLESMA?

Slight pain and swelling may or may not be there for next few days. A course of anti inflammatory and antibiotics is prescribed by the doctor. Person can return to work, the next day. There is no rest period involved.

IS THE SURGICAL EXCISION FO XANTHOLESMA SAFE AROUND EYES?

Yes, absolutely. Since treatment involves only skin. We are not going deeper than that. Surgery is rendered very safe. It doesn’t have any long term after effects.

WILL XANTHOLESMA REMOVAL HURT?

No, since done under local anesthesia, procedure is rendered comfortable. 

WILL  PILLS OR CREAMS NOT WORK FOR XANTHOLESMA REMOVAL?

No, no oral pills or creams would work to remove Xantholesma.

CONCLUSION :  Fat deposits on eyelids is calledXantholesma. They may appear without any cause or due to high bloodcholesterol. Surgical excision done under local anesthesia is the best cure.Laser or chemical ablation can be done but are not very successful.

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5 TYPES OF BLACK SPOTS ON FACE

WHAT ARE VARIOUS TYPES OF BLACK SPOTS ON FACE?

Black spots on face can be either types:

1.Freckles: Scattered multiple tiny brown to dark brown flat spots. They occur mainly due to sun exposure in fair individuals. Genetic predisposition also play a very important role in there occurrence. They mainly occur in fair individuals.

Freckles 

2. DPN: Dermatosis Papulosa Nigra : Scattered multiple tiny, slightly raised above skin surface. They mainly occur in darker races. 

DPN: Before After 

3. Moles: Can vary in size from 0.5 mm to 5 mm. Occurrence is usually without any cause. They is no reason behind their occurrence. 

Moles : Before After 

4. Sebborhoeic Keratosis: Black spot raised above skin surface, rough and irregular to touch. Sun exposure and ageing the main causative factors. Thus, seen in older age groups.

5. Lentigens: Jet black, well defined flat black spots.

All are harmless skin conditions. People seek removal only for cosmetic concerns.

WHY ARE BLACK SPOTS FORMED FORMED?

Black spots are formed because of either of the following reasons:

  1. Sun exposure
  2. Ageing and Passing years
  3. Genetic tendency to get them
  4. They may occur without any cause in many

HOW CAN THEY BE TREATED?

Single session of laser can cure them. Either Co2 ablative laser or radiofrequency would do. Both ablate the spots with precise heat. Very large moles may require surgical excision. 

Swelling and redness seen immediately after black spot ablation with laser. 

CAN’T CREAMS AND PILLS REMOVE BLACK SPOTS?

No, because creams don’t penetrate deep enough into skin to remove them. Neither are they that strong to ablate a black lesion. Also when creams and lotion are used to burn something on skin, we cannot control their penetration into skin. Lasers are controlled, thus a better option.  

IS IT SAFE TO REMOVE BLACK SPOTS WITH LASER?

Yes, absolutely provided done by a dermatologist using high quality laser.

IS IT PAINFUL?

No, since done after application of numbing creams.

WILL BLACK SPOTS ONCE REMOVED RECUR?

The ones removed won’t recur but the new ones can come,since causative factor can’t be removed. But the new ones come at very slowspeed. It’s not that one got black spots removed and within a month new onescame. New ones takes 1 to 3 years to come.

IS THERE ANY POST TREATMENT HEALING TIME?

Yes, immediately after the treatment there is redness and swelling, which goes off in one to two hours. Black crusts are formed at the points where laser is given next morning. They fall off own it’s own in 4 to 5 day’s time. Leaving behind clear skin.

CAN ONE DO ANYTHING TO PREVENT RECURRENCE ?

Nobody can stop ageing. Sun protection can help up to a certain extent to prevent new ones from coming. 

CONCLUSION: Black spots on face can be of various types. Single session laser would help you get rid of them. Creams and pills don’t cure them.

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Salicylic Acid : Chemical Peel Uses

                                                               WHAT IS SALICYLIC ACID?

It’s a beta hydroxyl acids. Available in market in white crystal forms.

HOW DOS IT HELP SKIN?

It works on skin in following way:

  1. Salicylic acid gets into the oil glands and reduces oil production. Thus helps clear off acne.
  2. It kills the bacteria causing acne.
  3. It exfoliates the superficial dead layer of skin. Thus, opens the clogged pores. This helps in treating comedones and acne. Also helps in treating pigmentation. That’s because the increased pigment in superficial dead layer is also removed.
  4. By exfoliating the superficial dead layer it brings a natural clarity and glow to skin.

FOR WHAT SKIN PROBLEMS IS SALICYLIC ACID PRESCRIBED?

Salicylic acid is prescribed for: melasma, general skin glow, acne , acne marks .

WHAT CAN BE THE SIDE EFFECTS?

If higher concentration is applied, it may burn the skin. Even when right concentration is applied the wrong way, skin burns might happen. This emphasizes the importance of getting peels done from a dermatologist. And not at saloon and spa.

WHAT ARE THE PRECAUTIONS?

Avoid bleach 5 days post salicylic acid peel application.  After that one can go ahead with peel.

Avoid saloon facials for 5 days post salicylic acid peel.

Pregnant ladies should not use skin care products using salicylic acid .

CAN ONE NOT GO OUT IN SUN AFTER SALICYLIC ACID PEELS?

It’s not that one cannot go out in sun. But avoid direct sun bathing for 5 days post salicylic acid peel like on beach holiday or sun bathing in winters. One can go out in sun to do routine work.

WHAT ARE SKIN CARE PRODUCTS IN WHICH SKIN CAN GET BENEFIT OF SALICYLIC ACID?

Facewashes : Face wash containing 1 to 2 percent salicylic acid are easily available as OTC.

Creams and gel: Creams and gels containing 1 to 2 percent salicylic acid are available on dermatologist’s prescription for home care use.

Chemical peel:  Salicylic acid in 20 to 30 percent are done at dermatologist clinic at 10 days interval.

WHAT ARE THE BEST SALICYLIC ACID PEELS?

Various Salicylic acid peels are available by different brands. But the best are the ones which are freshly prepared. At our clinic every time a fresh salicylic acid peel is made for every patient.  Salicylic acid peels absorbs  moisture from air and gets diluted. Thus it’s efficacy decrease every time the bottle is opened. This explains why a freshly prepared peel is the best.

Salicylic Acid Peel
                       salicylic acid peel

WOULD CONTINUOUS USE OF SALICYLIC ACID PEEL  LEAD TO THINNING OF MY SKIN?

Absolutely not . Peels removes superficial dead layers of skin. which are eventually replaced by a new layer formed underneath.

                    salicylic acid peel

 

BLOG – DR ANVIKA

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DIFFERENCE BETWEEN BOTOX AND FILLERS

Botox and fillers are all together different things serving a different purpose.

 

WHAT  ARE BOTOX AND FILLERS MADE OF:

BOTOX: Botox is a protein available in powdered form in a bottle.

FILLER: Filler is transparent gel made of hyaluronic acid. It’s available in pre filled syringes.

Filler: Transparent gel containing syringe

 

 

 

Botox: Powdered form in a bottle which after adding  to saline water  is loaded into syringes.

 

BOTOX AND FILLERS SERVE DIFFERENT PURPOSE

BOTOX: Botox is injected into the muscles to relax them.  When muscles contract the overlying skin is thrown into fold giving rise to wrinkles. When muscles relax post botox, the overlying skin also relaxes giving a smooth wrinkle free appearance.

Botox: Erases lines which come while making facial expression

BOTOX RESULTS

 

FILLER: It’s a transparent gel available in pre- loaded syringes. When young, face is like a ripe grape, as we age, it loses volume and shrinks to become a raisin. So the wrinkles and volume loss is filled with transparent gel giving an instant filled up affect.

Filler : Used to fill depressions

 

FILLERS IN UNDER EYE REGION

 

 

 

BOTH HAVE DIFFERENT LONGEVITY

Filler effect lasts for 12 to 16 months.

Botox results last for 4 to 6 months.

BOTH GIVE THE RESULTS AT DIFFERENT TIMINGS

Botox results are visible at 7 day post injection.

Fillers give instant results.

SIDE EFFECTS OF BOTOX AND FILLERS

Both are safe provided done using high quality products and done by an experienced person having complete knowledge.

Botox done properly doesn’t have a side effect. It can create problems only when not injected into the right muscle. The near by muscle which we didn’t intent to get relaxed gets relaxed by botox migration or direct injection into it. For example: while trying to relax forehead muscle, upper lid muscle may get relaxed and may lead problems in eye opening. But the good part is, the effect anyways wanes off in 3 to 6 months.  And injecting into wrong muscle doesn’t happen when done by an expert. So nothing to worry.  Such cases are rarely reported.

Fillers: Mild swelling and bruising might occur post injection. It goes off in few days time. Rarely filler might get into blood vessels and occlude them. It might stop the blood supply to concerned region and lead to ulcer formation in that region. But all this can be prevented by timely intervention. Hyaluronidase can be injected on suspicion of such things. It immediately dissolve the filler and release the blockage.

 

BLOG – DR ANVIKA

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GLUTATHIONE – SKIN WHITENING TREATMENT

Fair skin is considered a mark of superiority. It’s an obsession among st dark Asian races. No wonder research is at peak to find wonder molecule for fairness. Glutathione is the latest breakthrough in this regard.

Glutathione is a natural anti oxidant which is produced in liver with help of three amino acids- L-cysteine, glycine, and L-glutamate.

Giving glutathione to a patient suffering from cystic fibrosis lead to an accidental discovery of it leading to fairness.

Fresh fruits, vegetables, and nuts are natural sources of glutathione. Tomatoes, avocados, oranges, walnuts and asparagus are some of the most common edibles that help to increase levels of glutathione in the body. Whey protein is another rich source of glutathione.

WAYS OF CONSUMING GLUTATHIONE

Glutathione can be consumed in various ways:

Oral tablets: to be taken 1000mg per day for three months, then given a break of two to three months. Restart for another two months.

Efficacy after oral consumption is questionable as various studies shows variable absorption into blood. Glutathione once consumed needs to be absorbed through intestine into blood. Its absorption through intestines is questionable, thus inject able forms is preferred.

Sublingual sprays: better than oral and cream form since there is direct penetration into blood, bypassing the intestines.

Injections: To be given intravenously, once a week a minimum dose of 1200 mg, for at least ten weeks.

Glutathione Injection

Creams: Doesn’t seem to be promising as penetration into skin is questionable.

Soaps: Doesn’t seem to be promising as penetration into skin is questionable.

Glutathione Soap

 

HOW DOES GLUTATHIONE WORK AND WHAT RESULT CAN ONE EXPECT?

Various internal and external factors lead to formation of oxidants in body. Oxidants are the main culprit leading to diseases, ageing and wear and tear in body. Glutathione is the main scavenger of these oxidants. Thus it’s called master antioxidant. By depleting the oxidant load in body, its makes one feels more energetic. Also one can appreciate the skin glow and brightness.

As far as its results in skin whitening are concerned, results are variable.

WHAT IS THE MOST EFFECTIVE WAY OF CONSUMING GLUTATHIONE

Injections are the most effective way, since 100 percent of the drug is available

WHAT ARE THE SIDE EFFECTS

Oral glutathione capsules are considered generally safe by US FDA.

Inject able glutathione is not given approval by US FDA for its safety. That means enough scientific data is yet not available to consider it safe. Though, considering the demand for these injections, they are given rampantly all across the globe. In my personal experience and the experience gathered from my colleagues, we dint come across any major side effects. All we came across were temporary urticarial red rashes, and breathlessness. Breathlessness may have been caused due to slight vasodilatation which glutathione causes. However, here is the list of side- effects which might occur due to glutathione injections.

Thyroid imbalance, kidney failure, Steven Johnson syndrome : it’s an allergic skin reaction where the entire skin slowly peels off almost like that of a burn injury patient.

WHAT IS THE MAINTENANCE SCHEDULE

There is no fixed protocol for same. After 10 to 20 i.v. injections, one can consume oral glutathione to maintain the results or get few injects every 3 to 4 months interval.

 

BLOG – DR ANVIKA

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TCA : CHEMICAL PEEL USES AND BENEFITS

WHAT IS TCA PEEL?

TCA stands for trichloro acetic acid. It available in white crystals forms.

 

HOW IS TO BE DONE?

A thin and even layer of TCA peel is applied all over face. Immediately a burning sensation is felt. It goes off in 2 to 3 minutes. A white frost is formed. White frost turns black next day. These black crusts keep falling in next 3 to 6 days.

          TCA : WHITE FROST

CAN ONE DO TCA  AT HOME?

Never ever try doing it at home. Done properly it’s a miracle chemical, gone wrong it can burn the face. So it’s very important to get it done by an experienced dermatologist who is using high quality TCA peels.

 

WHAT IS THE RECOVERY TIME?

Black crust forms the next day. They keep falling own its own for another 3 to 6 days time.

                 TCA : CRUSTS

 

IS IT SAFE?

Yes provided done by an experienced dermatologist, who has complete knowledge about TCA peel.

              BEFORE TCA
AFTER TCA SINGLE SESSION  : DETANNING , GLOW AND REDUCED SKIN MARKS CAN BE APPRECIATED JUST AFTER SINGLE SESSION. 

WHAT ARE THE USES OF TCA PEEL?

It can be used to treat melasma (chiyaan), black spots left after acne, to remove tan .

             BEFORE TCA

AFTER TCA : SINGLE SESSION , SOME CRUSTS PEELING OFF CAN STILL BE APPRECIATED AT THE SIDE OF EARS.  VISIBILY REDUCED TANNING AND MARKS.

WILL PEELS THIN MY SKIN?

No, they don’t. New skin keeps forming from beneath to replace the superficial layers. It’s an ongoing process, which continues throughout life.

 

CAN ONE GO OUT IN SUN AFTER PEELS?

It’s better to avoid sun for a week post treatment. Especially direct sun bathing and beach holiday. For general work one can go out in sun after taking proper sun protective measures like covering face with scarf or sunscreens.

HOW MANY SESSIONS ARE RECOMMENDED?

We recommend around three sessions scheduled every 15 days apart.

ARE THE RESULTS PERMANENT ? 

In case done for acne black marks , they wont recur.  Melasma can recur . It’s advised to take a single maintenance session once every three to four month after initial three sessions.

    MELASMA RESULTS AFTER TCA

 

 

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VITILIGO TREATMENT: MICROPIGMENTATION

 

WHAT IS MICROPIGMENTATION

Micropigmentation is a technology where colors are filled in superficial layers of skin. They are natural colours . Put into skin with help of a machine. The colours remain there for around 12 to 24 months.

HOW MICROPIGMENTATION DIFFERENT FROM TATTOO

Tattoo colours have metals in them. Colours used in micropigmentation are natural. Also the needle width is too large in tattoo as compared to ones used in micropigmentation. Micro pigmentation needles are very fine.

Micropigmentation looks very natural as compared to a tattoo result.

IS IT PAINFUL

It’s done after local anesthesia, thus is rendered comfortable for person.

HOW MANY SESSIONS ARE REQUIRED?

Two sessions done a month apart.

FOR HOW LONG DOES THE COLOUR STAY

After the initial two sessions colour stays for 12 to 24 months. Post that a person requires a single touch up once every two months.

ARE THERE ANY SIDE EFFECTS

The technology doesn’t have side effects. But almost similar colour match is important.

WHAT CAN MICROPIGMENTATION BE USED FOR

Micropigmentation can be used to cover vitiligo patches, scars, stretch marks, to give natural pink colour to dark lips.

HOW IS COLOR MATCHING DONE

It’s done by hit and trial. Various shades re mixed till one reaches the shade similar to person’s natural colour.

HOW MUCH TIME DOES IT TAKE

Time required depends upon the area to be covered. It can take somewhere between half an hour to three hours.

VITILIGO TREATMENT WITH MICROPIGMENTATION

WHAT ARE THE POST CARE INSTRUCTIONS

There might be little swelling and pain post procedure for few days. It goes off completely in few days.  A topical antibiotic and moisturizers are prescribed.

                    Micropigmentation Lips

CAN ANYBODY WITH VITILIGO GET IT DONE

No. In case vitiligo is active and still spreading. Then micropigmentation is not the answer. Micropigmentation is advised when vitiligo is stable i.e. no new patches have occurred since a year.

 

 

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HYPERPIGMENTATION TREATMENT 

Hyperpigmentation means darkening of skin. There can be various causes for same. Tanning , pigmentory demarcation lines, melasma, hormonal imbalances, vitamin B12 deficiency. Finding the cause is the first step towards treatment. Once the dermatologist pin point the cause various oral and medical creams can help. Various procedures too help a lot since they penetrate deeper into skin.

HYPERPIGMENTATION TREATMENT

Various treatment modalities for hyperpigmentation are:

Skin lightening Creams containing  hydroquinone, azaelic acid, retinoids. They should be used only on dermatologist’s advice. Drawback of creams is that they can penetrate only upto certain depth into skin. Thus they help in clearing superficial pigmentation. But fail to clear the deeper skin pigmentation.

Laser: Nd :Yag Q switched laser can help. Make sure to get it done by a USFDA approved laser only. Never by a cheap laser. Enquire about the quality of laser and Google it out to find if it USFDA approved or not.

IPL can also help, but Nd:Yag Q switched laser is far more effective.

Peels: TCA peel or salicylic acid peel would help. Peels take off the superficial dead layer of skin. Thus, the increased pigment embedded in them also goes off.

PEELS

Oral tablets: Tranexemic acid, vitamin E and C, oral anti oxidants are integral part of the treatment. Haldi or turmeric is the strongest antioxidant in the world. Taking two tablets (1gm in total) empty stomach in morning is advised.

Mesotherapy: Mesotherapy means injecting skin lightening agents into skin. This ensures that 100 % of drug has reached the skin. Creams only certain percentage penetrates. After consumption of oral tablets also, only a little percentage reaches skin. Thus, mesotherapy is very effective. Tranexemic acid is injected into skin at once fortnight intervals.

Make sure to consult a dermatologist  only for skin lightening treatment . Because a skin specialist is the right person to make the correct diagnosis. And to chose the right treatment options from the various treatments available. Apart from above mentioned medicines following things has also to be kept in mind .

mesotherapy

Sunprotection: Protection from UV rays is must to keep pigmentation in control. Do cover yourself with scarf or wear broad brim glares to protect yourself from sun. Sunscreens with SPF 30 should be applied.

UV RAYS INCREASING PIGMENTATION

Weight Reduction: A type of facial pigmentation called acanthosis nigricans presents in form of thick black velvety skin. Obesity and diabetes is the main cause. It responds to weight reduction and by keeping the sugar levels in check.

Vitamin b12 deficiency too can lead to overall skin darkening. Finding the serum B12 levels and taking the supplements in case found low is the solution.

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