Brief Answer:
Treatment for dull skin with patches

Detailed Answer:
Hello XXXXXXX

Betamethasone can cause lot of side effects like rosacea, pimples and sensitivity to sunlight if used for long duration. How long did you use it and how many days back did you stop it ?

If you can upload a picture of your skin and the patches I will be able to guide you better.You have a feature to upload the images by yourself at the right side of the query page, please utilize that. You can also send the image as attachment to YYYY@YYYY , with the subject as 'Attn: Dr. Johny Chacko'.

Cleanser, toner , moisturiser and sunscreen is a good skin care routine you should follow daily. Wash your face with a cleanser twice a day. Apply toner only over the oily forehead, nose and chin area and apply moisturizer over the dry cheek and jaw areas. Apply a sensitive range sunscreen all over the face after the moisturizer and re-apply every 3-4 hours in the mornings.

There are cosmetic procedures to make your dull lustreless skin and uneven skin tone better.
Micodermabrasion exfoliates the dead and dull skin. Chemical peels can even out your skin tone. Mesotherapy with meso drugs like glutathione and vitamin c will help in giving glow. For these procedures you need to contact a dermatologist practicing cosmetology.

Your diet should have a lot of water to hydrate the skin, fruits XXXXXXX in vitamin c like oranges, lemon and XXXXXXX in vitamin A like papaya and carrots.

Hope I have answered your query. If you have any clarifications I will be happy to help.

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Brief Answer:
Suggestion for improving skin

Detailed Answer:
Welcome back XXXXXXX

Thanks a lot for the pictures. It helped. In your case from the distribution of the pigmentation I think of XXXXXXX causes, not just external.

In my practice If a similar case comes I will rule out XXXXXXX causes like hypothyroidism, diabetes and insulin resistance. I usually do the following blood tests
Serum Vitamin B12
Thyroid function test
Serum Fasting blood sugar
Serum Fasting insulin
Serum postprandial insulin
Serum postprandial sugar

If any of the above is abnormal we need to tackle that and your pigmentation will improve.

Toe fingers and fingers of the hand show the same pattern of addisonian pigmentation.
Are you a vegetarian ? Strict vegetarians usually have a higher chance of vitamin B12 deficiency.
Even though you feel your daily routine involves very less sun exposure you need to apply sunscreen as a daily habit.
AHA glo face wash, Body shop's toner and Elovera moisturizing cream are good in my experience.
Do not start any vitamin supplements before the blood tests as it will affect the results.

For getting these tests I think you will need a doctors requisition. You can consult your dermatologist for the same.

Hope I have answered your query. If you have any clarifications I will be happy to help.
Take care

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Brief Answer:
Yes, mucosal pigmentation can be addisonian.

Detailed Answer:
Hello XXXXXXX
Yes addisonian pigmentation can have mucosal pigmentation including gums, buccal mucosa, lips and rarely tongue.
One more additional test of help will be serum AM cortisol ( for screening addison's disease). ACTH stimulation test is the ideal test for addison's but I usually screen it with a cortisol test in my practice.
Continue the routine of cleansing, toning, moisturizing and sunscreen application. If these reports are normal you may consider the cosmetic procedures recommended earlier.
I recommend a soup from pumpkin and carrot two days a week to my patients. I call it 'glow soup'. It is quite simple to make. Boil peeled pumpkin and carrots. Mash it in mixer after boiling. Add salt to taste and tadka.
Hope I have answered your query. If you have any clarifications I will be happy to help.
Wish you good health

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