How do I treat my stubborn pigmentation?

Hi,

Welcome to icliniq.com.

I understand your concern.

From your description and the picture attached (attachment removed to protect the patient’s identity), the pigmentation you are experiencing appears to be melasma, which is a chronic, hormonally influenced, and sun-sensitive condition. Melasma is very stubborn and usually does not improve with random creams unless a structured, long-term treatment plan is followed.

Melasma often persists when sunscreen is not used regularly, hormonal triggers such as stress, heat, and sun exposure continue, only lightening creams are used without proper rotation, or when treatment is stopped too early. Melasma typically requires at least eight to 12 weeks of consistent therapy.

Regarding your current treatments, Glutathione tablets are not very effective for melasma. Alpha arbutin serum, Azelaic acid, and Fexi (Fluticasone Propionate) cream can help, but melasma usually needs a combination approach for better results.

It is also important to check your serum iron levels, as low iron is strongly associated with persistent melasma, and correcting it through diet or supplements can significantly improve your skin condition.

A simple and effective daily routine can support your treatment. In the morning, use a gentle face wash, apply a Vitamin C serum (10 to 20 percent), and use a broad-spectrum sunscreen with SPF 50 (sun protection factor). Reapply sunscreen every two to three hours if you are outdoors, and try to avoid direct sunlight, kitchen heat, steam, and gym saunas.

At night, use only one product per day. You may choose a combination of Hydroquinone two percent, Tretinoin 0.025 percent, and a mild steroid, which is the most effective option, but it should be used for only six weeks and then stopped. For maintenance, you may use Azelaic acid 20 percent or Tranexamic acid five percent serum on alternate nights.

If topical treatments are not giving adequate results, medical procedures can be considered after discussing with your dermatologist. Oral Tranexamic acid (250 mg twice daily for two to three months) is very effective for resistant melasma, but it should be avoided if you have clotting disorders or are taking birth control pills. Chemical peels such as Glycolic acid or Salicylic-mandelic peels help reduce superficial pigmentation.

Daily sunscreen use is the most important part of treatment. Avoid harsh scrubs, facials, and bleaching. Expect gradual improvement, as melasma fades slowly but consistently with the right plan.

I hope this has helped you.

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

Thank you.