How do I manage spots on my nose and neck despite skincare?

Hi,

Welcome to icliniq.com.

I understand your concern.

Based on what you have described and the attached picture (the attachments were removed to protect the patient's identity), the most likely cause of the dark pigmentation on your nose and neck is chronic allergic rhinitis with repeated friction and inflammation, leading to post-inflammatory hyperpigmentation (PIH).

Daily morning sneezing, nasal itching, and repeated rubbing or wiping with handkerchiefs, tissues, or even unconscious touching cause repeated micro-trauma to the skin around the nose and sometimes the upper neck. This constant inflammation stimulates melanocytes to produce excess pigment. Although your sinus surgery improved structural issues, it does not cure the underlying allergy, so the sneezing and inflammation continue. This is why creams like Aziderm (Azelaic acid) may help temporarily, but the pigmentation keeps returning because the trigger remains active.

Another contributing factor may be allergic shiners and frictional melanosis, which are commonly seen in patients with long-standing nasal allergies. Sun exposure further worsens pigmentation, especially on the nose, even when sunscreen is used irregularly or when sweating causes it to rub off. Neck pigmentation can also be aggravated by repeated scratching, mild eczema, or contact irritation from collars, perfumes, or soaps.

The key point is that pigmentation will not improve permanently unless the allergy is controlled first. Skin creams alone will continue to fail if the underlying allergy is not addressed.

Controlling sneezing and allergic symptoms is the most important step. Unless the allergy is effectively managed, the pigmentation will keep recurring regardless of how many creams are used. You should continue care under an ENT (ear, nose, and throat) or allergy specialist for long-term management.

Equally important is completely avoiding friction over the affected areas. Repeated rubbing or wiping of the nose, even gently, can significantly worsen pigmentation. Try not to rub or scratch the skin. If needed, use a very soft cotton cloth and dab gently rather than wiping. Keep your nails short and be mindful of unconscious touching. Avoid harsh soaps, scrubs, loofahs, rough face towels, or aggressive cleansing of the nose and neck, as these can further irritate the skin and trigger more pigmentation.

For safe correction of existing pigmentation, since Aziderm alone has not been sufficient, a structured combination approach is recommended. At night, apply Kojivit Plus cream (which contains Kojic acid and Glycolic acid to help treat resistant pigmentation) in a thin layer over the face and neck once daily at bedtime, five days a week. On the remaining two nights each week, apply Aziderm 20 percent cream in a thin layer to the pigmented areas. This regimen should be continued regularly for eight to 10 weeks to achieve gradual and steady improvement.

In addition, you may apply Amlactin lotion (Ammonium lactate) to the neck and body during the daytime, as lactic acid helps moisturize the skin and keep pigmentation under control. Use a broad-spectrum sunscreen. Apply generously to the face and neck, and reapply every three to four hours when outdoors or sweating.

Follow this routine consistently for eight to 12 weeks to see visible results. Once the pigmentation is controlled, switch to Aziderm 20 percent twice weekly for maintenance, and continue the same preventive measures for the body.

I hope this has helped you.

Please feel free to reach out to me again for further queries.

Thank you.