Hi!,

Thank you for posting the query,

Betnovate is a steroid cream (betamethasone ) & it has a anti-inflammatory action on skin.I am happy that you had applied it only once ,since its a potent steroid cream and should not be used on face, even though it works good on any kind of allergies.

Because of its anti-inflammatory action it can leave a hypo-pigmented patch(white patch) on skin once the actual lesion has healed. This would become normal to skin color on its own but may take some time .You should just use a good moisturizing cream over the area couple of times a day.

Since face is an exposed area of the body the chance of recovery would be fast and good.

Hope I have answered your query, Should you have additional concern regarding the same ,I would be happy to address it.

Please accept my answer in case you do not have further queries.

Regards,
Dr.Bharat chawda XXXXXXX specialist, Dermatology.

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Hi,

Thank you for the follow up.
As I believe that more information can help a physician arrive at an accurate diagnosis, I would request you to answer the following questions:
•     There are different varieties in Fotona laser like Nd:Yag ,Er:Yag etc. Which one you had undergone and for which condition?
•     If you had undergone Q-switched Nd:Yag laser, then which wavelength was given to you (532nm or 1064nm)?
In any case, redness can be normally expected following laser treatment. At times doctors sometimes prescribe a steroid cream to take care of the redness, but steroid withdrawal can again lead to rebound redness. So it is better to avoid steroid cream, but if at all a steroid cream is required, then a mild steroid cream (like hydrocortisone) can be used for only few days.

The safest option following laser treatment is using an Aloevera cream which would gradually take care of the redness. If the redness is severe, then a vitamin K cream can also be used if available. If the above two options are not available, then it is advisable to just stick with a moisturizer cream and a sunscreen daily.

In any case, using a sunscreen is a must since you have undergone a laser for pigmentation. Don't leave the skin as it is as direct sun rays would lead to hyper-pigmentation.

I would not recommend Ezerra cream either.

I thank you again for submitting your question. I hope you found my response to be helpful and informative. If you have any additional concerns, I would be happy to address them.

Please accept my answer in case you do not have further queries.

Regards,
Dr.Bharat chawda XXXXXXX specialist, Dermatology.

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Hi!XXXXXXX,

Thank you for writing back,

Since the type of laser used in not known and the condition which you previously had in also not known ,it would be difficult to guess the out come of laser.

If you had undergone laser for melasma (pigmentation over cheeks ) ,then the results are always very depressing.

In any case you should not repeat the laser session .Wait till it heals properly.We usually wait 6 weeks before going for a second session.

Yes there are time when while healing post laser(redness) there is brownish pigmentation(PIH-post inflammatory hyper-pigmentation) .And this is the reason we recommend strict sun protection and use of sunscreen.PIH usually goes off by itself ,but take at-least 4-6 months time .You can speed up the recovery using hydroquinone cream over the brown patch.

But since at present there is redness I think you should either use elovera cream or just a moisturizer (Sunscreen being the must).

Vit E is an anti oxidant ,might not harm you ,but won't help much in redness either.

Vit C would help only to reduce brown pigmentation ,but not on redness.

Since Vit K is also not available, you can just stick to a moisturizer/Alovera cream/vit E cream and a sunscreen .

Also that your doctor is not helpful,you can consider consulting and showing some other laser specialist .Looking at the lesion clinically and assessing is very important here .One of the experts in lasers whom I know is Dr.Niwat Polnikorn in Bangkok whom you can consider meeting personally.

I hope that the suggestion would be helpful. In case you need further guidance you can write back to me .I would be happy to help you.

Please accept my answer in case you do not have further queries.

Regards,
Dr.Bharat chawda XXXXXXX specialist, Dermatology.

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Hi XXXXXXX,

Good to hear from you again,

I am happy to see that somebody so far is linked with Manipal. Manipal has always been very close to my heart. Actually I did my post graduation from Manipal in dermatology . I did my under-graduation from a different state. In any case, what is your husband’s name? The world is a small place and I might just know him.
Laser has always been my favourite topic, so I love answering anything related to this subject. You can ask me any number of times, I would be happy to help you out.

Regarding use of hydroquinone, it is never given so early in the course of laser. It is given only when patient lands up with a PIH (post inflammatory hyper-pigmentation).PIH usually happens only when redness has subsided. It is true that if hydroquinone is used early then it would aggravate redness.
In fact hydroquinone can be used much before undergoing a laser treatment as a priming agent. It takes care of the extra tanning of skin.

I think you can use Vitamin E and a sunscreen at the moment and just wait and watch. An alovera cream can also help in the same way. If at all there is any relapse of pigmentation, then you can start with hydroquinone cream .

Well, I don't know anybody personally in Malaysia who is in to lasers. But you can Google a dermatologist who is also involved with lasers. A dermatologist would be in a better position to help you in your case.

As far as hair loss in females is concerned there are number of reasons .It can be due to
•     Stress
•     Familial
•     Hormonal disorders
•     Deficiency of iron/haemoglobin or zinc and copper.
One needs to take a combined approach here i.e. supplementing you with iron, zinc and biotin in oral form. Locally, you can use minoxidil solution (2%) over the scalp twice a day.
Also, improve your diet by adding lots of XXXXXXX vegetables, protein, fresh fruits etc. Good sleep and plenty of water also help a lot.

I wish and hope that you recover soon.

Wish you good health.

Regards,

Dr.Bharat Chawda XXXXXXX specialist, Dermatology.

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Hi XXXXXXX,

Thank you so much for the compliments .You have been a nice patient too and liked interacting with you. I'll try to be in touch with you through facebook.

I think I've a short memory, unfortunately, I can't recall your husband’s name. In any case, I would be very happy to XXXXXXX you any time when you are here in India.

As far as getting in touch with Dr.Niwat is concerned you can follow this link

There is one centre in Singapore by the name Nation skin centre, which is also of good repute if it suits you .There is a long list of doctors there, but you can consult Professor GOH Chee Leok there. He is an expert in lasers. You can check this link:
WWW.WWWW.WW sg/showpage.asp?id=19

I hope this information helps you.

Wish you good health and good luck.

Regards,

Dr.Bharat Chawda XXXXXXX specialist, Dermatology.

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Hello.

I will definitely try to contact you whenever I visit Malyasia. It would be pleasure to XXXXXXX you and your family.

Now, as far as dark circle is concerned, it is always very resistant to treatment. I can say that it is something which can destroy the reputation of the most reputed doctor. But there still lot of options.

I think you have already tried good options like chemical peeling and microdermabrassion. Vitamin c and hylarunic acid are also good for the same. There are various reasons for dark circles like stress, lack of sleep, iron deficiency (low hemoglobin level), lack of water intake, sun exposure, familial, etc.
One has to work on all these factors. Also use a good SPF sunscreen daily thrice.

You can also try tretinoin cream and hydroquinone cream at night, but you need to be careful using it as it can cause redness and peeling of skin.

Lasers is also one good option. Since there are various types of lasers available for pigmentation, I would suggest you to go for Q-switched Nd:yag laser. Under experienced hands lasers have some good chances for the results. If you are planning to go to Bangkok to XXXXXXX Dr.Niwat, you might as well get the laser done there. I am sure they would be having Q-switched Nd:yag laser with them.

Try to get good sleep and drink plenty of water, this would increase the hydration of the skin below the eyes.

Hope this helps you. Please accept my answer in case you have no follow up queries.

Wish you and your husband good health.

Regards,

Dr.Bharat Chawda XXXXXXX specialist, Dermatology.

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Hi!XXXXXXX,

I have to appreciate you that you really keep yourself updated regarding the level of treatments and side effects of the creams.

Microdermabrassion is not a good option for pigmentation ,in-fact its out dated now a days.Also that it should not be immediately followed by laser .There should be a interval of at least 4-6weeks between the two.

The charges in my hospital (or in India) would depend upon the type of the laser used .Normally for a pigmentation over cheeks would cost INR 2000/- Rs per session ,but would vary from city to city.

On the laser area you should apply vit c or hylorunic acid only if the brown pigmentation has set in .Otherwise just a sunscreen and a moisturizer is good enough.You can use Vit E also over the red area.

Now regarding hydroquinone being banned in some of the countries is absolutely right because of its tendency to cause de-pigmentation and sensitivity to light.But this holds true only to those who use a very high concentration (20%).The cancer part is yet to be proved in humans.
Over use of this cream has also shown to cause ochronosis which means rebound pigmentation and darkening of skin .It has been banned in japan , Australia and Europe for this reason.But the cream is very popular in Asian countries and has been used in our country too with good result and we haven't come across any such side effects.A 2% cream is used as an OTC in US.

I would advise you that you can use it comfortably ,but just don't over use it.And the 4% cream would be slightly higher for the under eyes ,instead use a 2% one.Use it at night time only ,and don't forget to use a good sunscreen in the day time.

As far as hair loss is concerned ,zinc ,copper,biotin & iron are good but then won't help to reduce the oiliness of scalp.You need to use a good shampoo twice a week for that.You can change you shampoo ,but increasing the dose of vitamins won't help at all. Neither would change in eating habits help here.

If it is really annoying you then probably oral retinoids can help you .Now I would like to make one thing very clear that it would be a off line indication of oral retonoids ,since it is actually used for acne (pimples) and to reduce the oil from the face.It does work on sebaceous gland to make ones face dry.I've tried on few patients with similar complaints as yours and had pretty good results.But retinoids has to be taken very cautiously and needs lots of precautions while on it.So kindly consult your dermatologist for this off line indication and only take if he recommends you.A very low dose is what I prefer in such a case.In my practice its a very day prescription for acne patients.

I thank you again for submitting your question. I hope you found my response to be helpful and informative.

Good luck,

Regards,

Dr.Bharat Chawda XXXXXXX specialist, Dermatology.

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