I suffer from long standing facial pigmentation problems. Fairness creams have not helped. Is there any solution?


There are over 20 different kinds of facial pigmentation disorders and just as many causes. While most are diagnosed based on history and physical examination, certain pigmentation disorders may require a skin biopsy or allergy patch testing for a correct analysis of the cause and depth of pigmentation. A sunscreen is a must for any kind of pigmentation disorders. Even for the dark spots left from acne! Treatment options include skin care, topical creams and serums, oral medication, chemical peels and/or laser treatments using IPL or Q switched Nd:YAG laser.

I have freckles on my face. Can they be remedied?

There are over 20 different kinds of facial pigmentation disorders and just as many causes. While most are diagnosed based on history and physical examination, certain pigmentation disorders may require a skin biopsy or allergy patch testing for a correct analysis of the cause and depth of pigmentation. A sunscreen is a must for any kind of pigmentation disorders. Even for the dark spots left from acne! Treatment options include skin care, topical creams and serums, oral medication, chemical peels and/or laser treatments using IPL or Q switched Nd:YAG laser.

My lips are very dark. I am tired of trying to cover it up with lipsticks.

There are over 20 different kinds of facial pigmentation disorders and just as many causes. While most are diagnosed based on history and physical examination, certain pigmentation disorders may require a skin biopsy or allergy patch testing for a correct analysis of the cause and depth of pigmentation. A sunscreen is a must for any kind of pigmentation disorders. Even for the dark spots left from acne! Treatment options include skin care, topical creams and serums, oral medication, chemical peels and/or laser treatments using IPL or Q switched Nd:YAG laser.

I have had under eye dark circles since my youth. Nothing helps. As I am getting older, I have started to develop bags under my eyes as well. My eyes always make me look older than I am.

Some amount of darkening in the skin of the under arms, elbows, knees and pubic area is considered normal in all brown skinned women. But a deeper pigmentation could be the sign of anything from infection to allergies to hormonal imbalances. Treatment and prognosis (meaning, what result you can expect from the treatment) will depend upon the cause of the pigmentation. Select patients may need blood tests to rule out hormonal imbalances. Treatment ranges from skin lightening creams, exfoliating creams, chemical peels, laser treatment and/or oral medications. In some cases, just losing some weight is all that is needed. Some patients may need allergy patch testing to check if they’re allergic to soaps and detergents. If your pigmentation problems are worsened every time you shave or wax, then consider laser hair removal to permanently reduce hair growth in that area.

I am starting to develop lines and wrinkles on my face. I have light skin and I have never used a sunscreen regularly.

Most Indians, fortunately, do not wrinkle very poorly. But the rising UV Index in Bangalore, along with stress, pollution, imbalanced dietary habits, poor hydration, poor sleeping habits, smoking, drinking and/or drug abuse, is making men and women age faster than the older generation. Obesity and Anorexia are damaging to the skin. Too much sugar, and not enough fiber, antioxidants and healthy fats in typical urban diets can wreck your skin. Taking good care of your skin, starting from your early 20s, will reap rich benefits in your middle age. A good quality broad-spectrum sunscreen and a good moisturizer are the most basic, and still the best anti-ageing skin care, as long as you started using them early. Based on your age, lifestyle and budget, your dermatologist can customize the right skin care for you. Invest in good quality products for safe and visible results. Chemical peels, fractional resurfacing lasers, dermal fillers and mesobotox treatments work very well in treating facial lines and wrinkles. Combining skin care with procedural intervention gives the best results.

I have sensitive skin and I am afraid of chemical peels. But I want the same effect in a chemical-free manner.

Medifacials involves a protocol of deep cleansing, exfoliation, application of peptides and fruit acids, and thorough hydration. Comedones are extracted as well. You will experience an immediate brightening and smoothness on your face. The effects are greater and more long-lasting compared to the regular salon facial, as the ingredients and products used are partially medicated (also known as ‘cosmeceuticals’), are imported from USA and Australia. Infrared radiation is used to allow deeper penetration of the products. Vacuum suctioning is sometimes used to painlessly eliminate blackheads without using too much pressure or manipulation. There are different formulations used for tanned skin, pigmentation problems, acne, fine lines and wrinkles, undereye dark circles, skin plumping etc. Unlike medical treatments, this one-hour doctor’s facial is very relaxing and calming for the mind as well.

I wish I could make my stretch marks go away

Stretch marks affect 90% of all adult women and 30% of all adult men. However interest in stretch mark elimination has increased in the last decade, thanks to the “yummy mummy” fad. Medicated creams work best towards preventing stretch marks. Creams and chemical peels can also fade away fresh stretch marks which are still pink or purple in colour. Fractional resurfacing lasers and nonablative lasers, along with scar reducing creams, work well in improving the appearance of stretch marks by 60-70%. Patient selection is key. We cannot help every single patient as certain stretch marks do not show much improvement. Some patients may need to combine resurfacing lasers with skin tightening lasers or a tummy tuck surgery. Consult a dermatologist with special training as a laser physician, for proper assessment and advice.

I take good care of my skin but I still have a lot of open pores. Facials and steaming have not helped at all. What can I do?

Open pores do not have muscles that can make them shrink or expand! They are the result of ageing, sun damage, poor skin care, poor management of excessive skin sebum and oxidative damage to the skin. A good skin care routine starting from your 20s can help keep open pores away. This includes the right cleanser, toner, scrub, pore minimizing serums, a lotion based sunscreen and a water-based moisturizer. Consult an experienced dermatologist for customized skin care based on your skin type. Home microdermabrasions and chemical peels can help in some cases. They definitely help in controlling further damage. But in stubborn cases and with larger pores, fractional Q switched laser resurfacing has shown the most promising results.

I am young and my skin is healthy and problem free. But I would like to get an instant glow on my face before a party or an event. I am not happy with the results of a salon bleach cum facial.

There are plenty of beauty serums which can make your skin glow and sparkle without makeup in a matter of minutes. We also offer a range of face masks, chemical peels, party peels, photofacials and medifacials to achieve skin that looks amazing even without foundation or concealer. Some of these treatments must be done 5-15 days before an event to achieve maximal results, so if you working towards a timeline, then do inform your dermatologist.

I have had acne for several years now. Treatments have helped, but only temporarily. I am losing confidence in my doctors.

Acne, both in men and women, are ultimately controlled by hormonal fluctuations. Stress, obesity, i-pills, illnesses, certain medications and poor dietary habits can ruin your body’s hormonal harmony. Not everyone with acne suffers from a medically detectable hormonal imbalance, which can be corrected by an endocrinologist’s treatment. Customized skin care, antibiotics and anti-acne creams will definitely help, but they do not address the core issue. Acne is unpredictable. You may suffer from horrible acne for several months, followed by several months of perfectly blemish-free skin. Do go to Patient Information Leaflet > Medical > Acne for better understanding about your condition. Treatment is chosen based on your age, severity of pimples and physical indicators of hormonal imbalance. Treatment options become limited if you are pregnant or trying to conceive. In some patients, an endocrinologist and dietician may have to be involved for complete therapy. Treatments include skin care, medicated creams, antibiotics, hormonal treatment, Isotretinoin, medifacials, chemical peels, comedone extraction and/or laser and light based treatments. Acne may heal, leaving back marks and scars. But these can also be managed successfully with creams, chemical peels and laser treatments. Lifestyle modifications, stress management, weight control and good sleeping habits will also improve your overall condition. A balanced diet rich in fiber, antioxidants, probiotics and plenty of water is strongly recommended.

I am in my 30s-40s and I have developed acne for the first time in my life. My skin also feels red and flushed most of the time. Most creams and cosmetics end up irritating my skin. What's happening?

It sounds like you suffer from Rosacea. Does heat makes your face become hot, red and flushed? Are you noticing tiny broken red veins on your face? Do you seem to be developing acne as a adult for the first time in your life? You could be suffering from Rosacea. The key here is to avoid the triggers as much as you can – sunlight, coffee, alcohol and spicy food. If you suffer from chronic stomach acidity issues, consult a gastroenterologist to rule out a bacterial infection of the stomach (closely linked to Rosacea). Women with thyroid disorders or ovarian cysts may be slightly more prone to Rosacea. If you have been abusing steroid creams as a fairness cream, then this maybe the cause for your Rosacea. Sunscreen, anti-mite creams, anti-redness creams and customized skin care for sensitive skin – these are the mainstay of treatment. Antibiotics, laser treatments and Isotretinoin may be needed in refractory cases.

What does dermatology entail? Do you only treat cosmetic problems?

Some dermatologists only practice cosmetic and aesthetic dermatology. Chain Medispas do not have a clinical dermatology practice. Several general physicians and dentists also practice cosmetic dermatology, without acquiring an MD degree from a recognized medical college. However, ‘Dermatology’ as a qualification involves clinic dermatology, pediatric dermatology, infections, allergies, autoimmune skin diseases, venereology, Hansen’s disease (Leprosy), diseases of the hair, nails and oral cavity (not involving teeth and gums). At Skin.Health Advanced Dermatology Center, you will find dermatologists, and not cosmetologists. Dr Sunaina Hameed has several years of specialized training with Aesthetic Medicine under her belt, and the clinic offers a wide range of cosmetic treatments. However, Dr Hameed remains a physician first and foremost. 70-80% of her practice is based on clinical dermatology.

Bangalore has a lot of greenery with dry air. The climate is dry through most of the year, and it gets worse between November to April. Since Bangalore is several meters above sea level (compared to other South Indian cities), the radiation levels here are high throughout the year. Rapid urbanization and nonstop construction has increased dust and temperature levels in the city. This kind of environment makes Bangalore a hotbed for skin and respiratory allergies. Allergies are the penalty of modernization – Inadequate breast-feeding, air-conditioned and carpeted environment, obsession with hygiene and hand sanitization, and too much processed food. Most patients (or their parents) can figure out what they’re allergic to. But if you are allergic to dust mite and pollen (which is commonplace in any kind of environment), or if you suffer from multiple allergies, then you may need allergy testing to detect your allergens. Patch testing is used in case of contact dermatitis, and blood tests can detect allergies to food, dust mite, pollen, mold and animal hair, to name a few. Maintain a food dairy. A good dermatologist and/or allergologist can also suggest lifestyle modifications that can vastly improve the quality of your life without costing too much. In severe, refractory cases, sublingual immunotherapy provides the best shot at complete cure.

Almost everyone in my family suffers from minor and common place skin issues like dandruff, hang nails, cracked feet, damaged hair etc. Good dermatologists are hard to find and their fees is rather high for issues like this. Is there a way around?

Almost every one of my consultations veers into a general discussion on best soap, hand cream, facials, make up etc. This takes up too much of a doctor’s valuable time. As a result of this, there is never enough time to answer all queries, and educate patients to theirs’ or the doctor’s satisfaction. This is why I came up with www.facebook.com/yourfamilydermatologist in early 2014. This is a page dedicated to public information and education regarding skin & hair care, beauty tips, beauty myths, home remedies, health care advice and dietary advice for every member of the family. Please click ‘Like’ and find a goldmine of information for all your queries.

What is customized skin care?

Did you know there are 16 different skin types, each with different skin care needs? If you have acne, rosacea, open pores or pigmentation prone skin, your skin needs extra care. A child’s skin needs is different from that of an adult. Men and women have different skin care needs. Senior citizens have special skin care needs. Sensitive skin needs a careful and educated approach towards its care. Everyone needs a good cleanser, sunscreen and moisturizer. Lasers, facials and chemical peels can never replace the need for correct, daily skin care. Customized skin care involves a thorough examination of your skin by the dermatologist (naked eye examination with or without a skin and hair analysis device). This is followed by detailed history taking on your lifestyle and habits. Finally, the right skin care combination is prescribed for you, which suits your needs and limitations. It is always advisable to invest in high grade, good quality, fragrance-free, paraben free, hypoallergenic and non-comedogenic skin care. However if your budget is restricted, feel free to discuss this frankly with your dermatologist. We can still tailor a basic skin care routine that is inexpensive and easy to follow.

I have really dark skin. Are lasers and peels safe for me?

Yes, they are. As long as your dermatologist has the training and experience to safely treat darker skin tones. Most Indians come under this category. Skin of color cannot heal effectively from deep chemical peels or high energy laser treatments. So treatment may take more time and a few additional sessions to appreciate the best results. But you can still enjoy the benefits of chemical peels and aesthetic laser devices in a safe and pain-free manner. You will also have to very careful to follow the doctor’s instructions on pre-treatment skin preparation and post treatment skin care. An informed, cooperative and disciplined patient will clearly have the best results.

I am a Caucasian/Middle Eastern man/woman who has spent a few years living in India and/or other tropical countries. I worry about skin cancer. What is your advice?

Individuals with White/Olive skin, Green /Blue eyes and Red/Blonde hair, are at high risk for skin cancer. If you are a sun-lover who has suffered from several sun burns, have a lot of freckles, over 20 moles on your body, work with tars, or if skin cancers run in your family – these factors increase your cancer risk. Skin cancer is a broad term. There are pre-cancerous skin conditions, genetically acquired tendency for skin cancers, locally invasive cancers and highly malignant cancers. Not every skin cancer is black in color. And melanomas can occur in covered body parts as well, like the thigh or the sole of the foot. You must get a full body skin examination and mole mapping done every 2 years. Do it on an annual basis if you have had skin cancer before, or come in the high risk category. If a mole grows bigger, is irregular, has uneven pigmentation, itches, bleeds or ulcerates, that is a bad sign. Get your moles examined by a special lens called a dermatoscope. Suspicious moles must be measured, with sizes noted down. The lens images can then be sent to you via email, as a permanent record.

I have damaged hair. Can you help me?

This could be the result of nutritional deficiency, poor hair care, harsh shampoos, chemical treatments (coloring, perming or straightening).. or just bad water. Consult a dermatologist for examination and tips on how to care for your hair, home remedies, water softeners etc. Prescription shampoos, conditioners and hair serums work better than store-bought brands when it comes to caring for damaged hair. Vitamin and amino-acid containing pills can strengthen your hair from the roots. You may also need regular deep-conditioning hair spa treatments at the salon.

I have a lot of blackheads and whiteheads. I take care of my skin and use good quality creams but the comedones don't budge. How can I get rid of them?

Comedones (blackheads and whiteheads) can be stubborn and respond poorly to treatment. Medicated face washes can prevent further build up. Exfoliating scrubs and retinol based creams can soften and exfoliate some of them. The stubborn ones may need to be removed using chemical peels and a special instrument called a comedone extractor. Oral Isotretinoin is the most effective treatment for comedones. However, due to its side-effect profile, this medication is seldom used solely for the treatment of comedones. Deep seated whiteheads, also known as submarine comedones, may have to be extracted using radiofrequency puncturing, followed by pressure extraction.

I have suffered from scalp itching, eye watering and/or facial pigmentation for a few years. Allergy patch testing has confirmed hair dye allergy. I hate the orange hue of henna and I hate letting my gray hair show. I need answers..

Hair dye allergies are primarily a result of allergy to the dye called PPD (paraphenylenediamine). This dye is found in all black, brown, copper and burgundy colored hair dyes. Even in black henna. It is not the same as ammonia; so even ammonia-free hair dyes contain PPD. There is no way to cure a PPD allergy. One must simply avoid it to remain symptom-free. Natural henna is absolutely safe, though it may dry your hair. You can add coffee, tea leaves or indigo to gain a brownish hue. Vegetable based hair dyes mostly contain henna, indigo, catechu and/or manjistha. These are semi-permanent dyes which require repeated applications for complete gray coverage. They also wash off very easily. The Italian Optima NH-3 free PPD-free hair colors are an excellent alternative. They are used like regular hair colors, provide complete gray coverage in a single use and last long as well. They do not smell bad. They do not damage your hair. And a single tube can last several touch ups. There is no effective cure for gray hair, especially if more than 30% of your hair has turned gray.

When is the right time to get my daughter's ears pierced?

The earlier you get it done, the wiser. Babies between 4-8 months of age are less likely to struggle and the ear piercing can be done smoothly and without accident. The skin of young infants heals a lot faster as well. Wait for at least 4 months, so your child can get 2 tetanus shots before she gets her ears pierced. If you have not done it by then, you could always wait till your daughter is old enough and asks for it. Older girls are responsible enough to care for their own studs and keep their hands off it. You could get it done by a doctor who’ll use a skin numbing cream and the ear piercing gun for a fuss-free experience. You could also get it done by an experienced jeweller but carry a pack of frozen peas to numb the lobes, spirit swabs to wipe the lobe clean, and antiseptic cream to apply to the pierced area. Always mark the lobes first and ensure that you are completely satisfied with the position and symmetry of the markings. Gold, titanium and nickel-free stainless steel studs are the safest to use. Clean the pierced area with alcohol swabs and apply antibiotic cream for a week after the piercing. Leave on the initial stud for 2 months at least as the freshly pierced skin tends to contract as it heals. Prefer studs over hoops as the stem is thicker, so the hole won’t close up or shrink. Consult a dermatologist if you notice swelling, redness, pain or pus discharge which persists for more than 2 days after a piercing.

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