Brief Answer: Got the photo Detailed Answer: Hello, I got the photo. I had already replied to your earlier query. May be there was a slight delay in you receiving the answer. I am attaching the answer given to you in the other query in brackets. (Thanks for the photograph. I usually see such a distribution of pigmentation in Vitamin B12 deficiencies, Anemia and Hypothyroidism. I also see a lot of sunlight induced tanning very evident over the exposed areas of neck, forehead and nose. I will recommend you to do a thyroid function test, Hemoglobin and Serum vitamin B12. If hypothyroidism, B12 deficiency and anemia is there we should treat that for the pigmentation to become better. Are you a vegetarian or non vegetarian ? Any problems with digestion and bowel habits ? Do you drink a lot of alcohol ? I will recommend you to take B'complex and vitamin C supplements daily. Start these after getting the blood test. Avoid excessive sunlight exposure. Apply a sunscreen over face and neck on a daily basis during mornings and reapply after every 3 hours. Wash your face with a face wash containing gycolic acid twice a day. If you can get 4-6 sittings of chemical peels done by a cosmetic dermatologist every two weeks it will help. A nonsteroidal non hydroquinone lightening cream containing kojic acid can be applied at night over the dark areas. Drink plenty of water. Include more fruits and vegetables in your diet especially citrus fruits and anything with lots of color.) Even I feel that it is not because of any serious illness. Vitamin B12 deficiency, Anemia and hypothyroidism are minor ailments which can go unnoticed. It is better to rule them out as in my experience a lot of people with similar distribution of pigmentation had the above. Hope this helped, Take care.

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