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Suggest Treatment For Hyperpigmented, Thick Patch Of Skin On Left Side Of Face
Question: XXXX
and form last 1.5 years Obagi nu derm, Hydroquinone 8%, ISOTREX and many more...
Note: Tested (No fungal infection)
in 2014 XXXXXXX Consulted with XXXXXXX skin clinic (http://harleystreetskinclinic.com/) with DR XXXXXXX and he advised to test for fungal infection(No fungal infection found) and he advised to use Obagi nu derm, completed 2 course, no improvement, later he advised to go for Co2 laser but to try Obaji blue peal before, havent tried any of this too yet.
Consulted XXXXXXX Curran and he advised to use Obaji but still didnt work and advised to apply Hydroquinone 8%, NO USE at all
http://www.askinclinic.co.uk/
Consulted Dr Ian Withcroft and he advised to apply ISOTREX (applying this form last 6 months) no improvements.
each Doctors have a different idea and different analysis but nothing is helping me.. all this products are only making the area softer instead of hard that is it.
Please help me I have lost all my patience...
and form last 1.5 years Obagi nu derm, Hydroquinone 8%, ISOTREX and many more...
Note: Tested (No fungal infection)
in 2014 XXXXXXX Consulted with XXXXXXX skin clinic (http://harleystreetskinclinic.com/) with DR XXXXXXX and he advised to test for fungal infection(No fungal infection found) and he advised to use Obagi nu derm, completed 2 course, no improvement, later he advised to go for Co2 laser but to try Obaji blue peal before, havent tried any of this too yet.
Consulted XXXXXXX Curran and he advised to use Obaji but still didnt work and advised to apply Hydroquinone 8%, NO USE at all
http://www.askinclinic.co.uk/
Consulted Dr Ian Withcroft and he advised to apply ISOTREX (applying this form last 6 months) no improvements.
each Doctors have a different idea and different analysis but nothing is helping me.. all this products are only making the area softer instead of hard that is it.
Please help me I have lost all my patience...
Brief Answer:
Acanthosis nigricans; Dermabrasion along with Tretinoin/ retinol peel
Detailed Answer:
Hello. Thank you for writing to us
I have gone through your query and I have also reviewed the Image..
In this Image I can see a hyperpigmented, thick patch of velvetty textured skin on left side of face.
-I guess this must be on both sides? Do you have at other places like on your neck skin?
-Do you have a bahit of constantly resting your hand against this side of face?
This resembles acanthosis nigricans, even though acanthosis nigricans is more common in body folds like neck, armpits, groin and on elbows, knee etc.
This is not a simple pigmentation and therefore unlikely to respond to any great extent with pigment reducing creams like hydroquinone or hydroquinone free formulations.
This needs to be managed just as acanthosis nigricans, as elsewhere.
If I was the treating doctor I would suggest you to use either tretinoin 0.05% cream Or better if you can take a few sessions of Retinol peel (Yellow peel). Retinol peel would be ideal.
Though you have been using isotrex gel (isotretinoin), which is a topical retinoid and is somewhat related to tretinoin, but it is not as effective as tretinoin in acanthosis.
In addition, I would also suggest you to take a few sessions of microdermabrasion/ dermabrasion which would help exfoliate thick, velvetty skin.
Acanthosis nigricans can be due to underlying insulin resistance and I would suggest testing for fasting and post-prandial insulin levels.
A tablet of metformin, once or twice daily, is also part of treatment of acanthosis nigricans as it helps correct underlying insulin resistance that can lead to acanthosis nigricans.
Regards
Acanthosis nigricans; Dermabrasion along with Tretinoin/ retinol peel
Detailed Answer:
Hello. Thank you for writing to us
I have gone through your query and I have also reviewed the Image..
In this Image I can see a hyperpigmented, thick patch of velvetty textured skin on left side of face.
-I guess this must be on both sides? Do you have at other places like on your neck skin?
-Do you have a bahit of constantly resting your hand against this side of face?
This resembles acanthosis nigricans, even though acanthosis nigricans is more common in body folds like neck, armpits, groin and on elbows, knee etc.
This is not a simple pigmentation and therefore unlikely to respond to any great extent with pigment reducing creams like hydroquinone or hydroquinone free formulations.
This needs to be managed just as acanthosis nigricans, as elsewhere.
If I was the treating doctor I would suggest you to use either tretinoin 0.05% cream Or better if you can take a few sessions of Retinol peel (Yellow peel). Retinol peel would be ideal.
Though you have been using isotrex gel (isotretinoin), which is a topical retinoid and is somewhat related to tretinoin, but it is not as effective as tretinoin in acanthosis.
In addition, I would also suggest you to take a few sessions of microdermabrasion/ dermabrasion which would help exfoliate thick, velvetty skin.
Acanthosis nigricans can be due to underlying insulin resistance and I would suggest testing for fasting and post-prandial insulin levels.
A tablet of metformin, once or twice daily, is also part of treatment of acanthosis nigricans as it helps correct underlying insulin resistance that can lead to acanthosis nigricans.
Regards
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thanks Dr. Kakkar for the analysis.
The pics I have updated was 6 months old when I was taking Obagi treatment ( I had updated that because the outer covering was out and the skin was clear to observation). please find the latest pic taken today.
1) Can I take take any test to get confirmed that I have have Acanthosis nigricans?
2) Could you please suggest a tretinoin 0.05% cream name with is available in United kingdom and how many times in a day can I apply?
3) If I go for Retinol peel (Yellow peel) or microdermabrasion/ dermabrasion can I still apply tretinoin 0.05% cream
4) How long would you think my skin gets to normal if I just apply tretinoin 0.05% cream?
My other skin medical history if that helps.
1) A doctor form Manipal had advised that I have polaris as my skin used to get very dry on my legs and it was itchy then the small patches used to form and one in 100 pimple use to not heal completely a small lump is to remain for years, I have two are 3 such marks in my body. (NOTE: this is not related to my cheeks mark issue)
2) One of the otheo had advised me I have hyper imobility syndrome. but the XXXXXXX consultat had ruled this out.
I have the below peels available in my area, could you please suggest would the below Spot peel or the Cosmo peel would suite or none of them?
http://www.thelasercentrejersey.co.uk/Treatments/#Skin-Rejuvenation
Spot Peel
A medium peel containing mandelic acid, idebenone, retinol and salicylic acid for treating pigmentation, pregnancy dark spots and melasma.
Cosmo Peel
A medium to strong peel of two strengths containing lactic acid, salicylic acid, retinyl and ascorbic acid for treating ageing skin, smoker’s complexion,wrinkles, acne scars and stretch marks.
The pics I have updated was 6 months old when I was taking Obagi treatment ( I had updated that because the outer covering was out and the skin was clear to observation). please find the latest pic taken today.
1) Can I take take any test to get confirmed that I have have Acanthosis nigricans?
2) Could you please suggest a tretinoin 0.05% cream name with is available in United kingdom and how many times in a day can I apply?
3) If I go for Retinol peel (Yellow peel) or microdermabrasion/ dermabrasion can I still apply tretinoin 0.05% cream
4) How long would you think my skin gets to normal if I just apply tretinoin 0.05% cream?
My other skin medical history if that helps.
1) A doctor form Manipal had advised that I have polaris as my skin used to get very dry on my legs and it was itchy then the small patches used to form and one in 100 pimple use to not heal completely a small lump is to remain for years, I have two are 3 such marks in my body. (NOTE: this is not related to my cheeks mark issue)
2) One of the otheo had advised me I have hyper imobility syndrome. but the XXXXXXX consultat had ruled this out.
I have the below peels available in my area, could you please suggest would the below Spot peel or the Cosmo peel would suite or none of them?
http://www.thelasercentrejersey.co.uk/Treatments/#Skin-Rejuvenation
Spot Peel
A medium peel containing mandelic acid, idebenone, retinol and salicylic acid for treating pigmentation, pregnancy dark spots and melasma.
Cosmo Peel
A medium to strong peel of two strengths containing lactic acid, salicylic acid, retinyl and ascorbic acid for treating ageing skin, smoker’s complexion,wrinkles, acne scars and stretch marks.
Brief Answer:
Treatment of acanthosis nigricans
Detailed Answer:
Hi.
1. Acanthosis nigricans is a clinical diagnosis. However, you may take a test for fasting insulin and post-prandial insulin levels. These levels may be raised in those who have insulin resistance; insulin resistance is one of the causes of acanthosis.
2. There has to be a gap between retinol peel and microdermabrasion of 7-10 days. Tretinoin cream too should be stopped for a week prior to dermabrasion Or chemical peeling as it can cause unusual redness to dermabrasion and chemical peels. Note: Tretinoin and retinol peel are basically similar in action but a peel is much more effective because of higher concentrations that are used in a peel.
3. Tretinoin used to be available as Retin-A 0.05% internationally. I am not sure if you would get it otc, without a prescription.
4. The cream alone would take longer. It may take weeks to months. In my view it would be better to combine peel with dermabrasion for faster results which can then be maintained with a cream.
Though both peels would be effective, however, a medium depth peel would be more effective. I would suggest you to go for a lower strength of cosmopeel and thereafter a higher strength, if required.
Peels should be done by the doctor or an assistant trained in chemical peeling and should not be tried on your own. Sunprotection with a sunscreen is a must with any peel
Regards
Treatment of acanthosis nigricans
Detailed Answer:
Hi.
1. Acanthosis nigricans is a clinical diagnosis. However, you may take a test for fasting insulin and post-prandial insulin levels. These levels may be raised in those who have insulin resistance; insulin resistance is one of the causes of acanthosis.
2. There has to be a gap between retinol peel and microdermabrasion of 7-10 days. Tretinoin cream too should be stopped for a week prior to dermabrasion Or chemical peeling as it can cause unusual redness to dermabrasion and chemical peels. Note: Tretinoin and retinol peel are basically similar in action but a peel is much more effective because of higher concentrations that are used in a peel.
3. Tretinoin used to be available as Retin-A 0.05% internationally. I am not sure if you would get it otc, without a prescription.
4. The cream alone would take longer. It may take weeks to months. In my view it would be better to combine peel with dermabrasion for faster results which can then be maintained with a cream.
Though both peels would be effective, however, a medium depth peel would be more effective. I would suggest you to go for a lower strength of cosmopeel and thereafter a higher strength, if required.
Peels should be done by the doctor or an assistant trained in chemical peeling and should not be tried on your own. Sunprotection with a sunscreen is a must with any peel
Regards
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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