Brief Answer:
I suggest a few lab test

Detailed Answer:
Hello. Thank you for writing to us.

I have answered one of your earlier queries related to the same issue.

This type of differential hyperpigmentation can also be seen in Vitamin B 12 / methylcobalamin deficiency specially in those who are strict vegetarians; in hypothyroidism; diabetes etc.
These may then manifest as dark skin specially over hands/ knuckles, elbows and dorsum of feet.

You may take up a lab test for serum Vitamin B 12 levels, thyroid levels/ TSH levels, blood sugar levels etc to see if these could be responsible.

If Vitamin B 12 is found to be deficient this can be supplemented externally as tablet or capsule.
Similarly thyroid and diabetes need to be corrected if required and as revealed in tests.


In my last discussion I had suggested you to use topical hydroquinone cream as well as sun-protection/ sunscreen during day.

Are you using these? If yes, you may continue with these Or else you may also add a glycolic acid based cream in addition to hydroquinone cream (mix and apply both of these, once daily, at night).

Regards

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Brief Answer:
I would suggest you to try only topical treatments as suggest earlier

Detailed Answer:
Hi.

You will be surprised to know that NOT A SINGLE oral form of a product has been approved till date for skin whitening Or adding glow..
The desire to get fair and glowing skin is a global phenomena so naturally there are a lot of products available which claim to have skin whitening effects but none have been adequately tested and there is no strong scientific evidence of efficacy.

Nevertheless, Systemic skin whitening agents are available in the market as well as on internet (can be ordered online) e.g Glutathione, L-cysteine peptide, Tranexemic acid.
However, there can be serious side effects with these, even life threatening ones like Stevens Johnsons Syndrome and Toxic epidermal necrolysis. This has specifically been notified by FDA as a warning.

Many other oral preparations are also being marketed in XXXXXXX specifically for this indication.
The active ingredients in these products (tablets Or capsules) are mainly antioxidants like high dose of vitamin C, alpha lipoic acid, pine bark extract, lycopene, Glycyrrhiza glabra extract, bearberry extract, green tea polyphenol, grape seed extract etc in various combinations.
How effective these combinations are..No body knows!!

Even today the safest way to lighten complexion Or reduce tanning is to use external / topical agents like glycolic acid, kojic acid, arbutin, hydroquinone etc.
Sun protection with a broad spectrum sunscreen is also an important part of treatment.
I have already discussed these with you and I suggest you to opt for these rather than an oral form.

I am forwarding you a link of a study published in a scientific journal. You may go through it once and then decide for yourself.

http://www.ijdvl.com/article.asp?issn=0378-6323;year=2013;volume=79;issue=6;spage=842;epage=846;aulast=Malathi

I also noticed that you are using melacare on your face. This is a prescription product and should not be used on face for more than 1-2 months. It should not be used as a regular fairness cream.
This cream contains a potent steroid i.e mometasone furoate and regular use of it can cause skin thinning, redness, photosensitivity, acne and hirsutism (increased facial hair) in females.

Regards

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