Hello Doctor this is Emmanuel Nice to hear from you, actually my skin is not extremely very dark but compared to a 'White skin' it is, I'm not very pinkish, but I'm fairer than the other dark people. If I come under bright lights I look fair I don't know what medicine changed my skin colour as I'm not good at medicine. My toes, feet, neck, Hands and other private parts like me penis are also dark, I've tried the Vitamin C Calamine lotion Multani mitti allovera face wash drank water used sunscreens accordingly these only work to certain extent and I feel these are meant for people who are looking to improve their complexion and not to restore the original skin colour. I actually look like a South Asain. It took some time may be about a month my complexion became dark. I don't have any other symptoms except for skin darkening and don't have any dark spots either Please advice me with the best medicine. Thanks & Regards Emmanuel

Hi Emmanuel,

Are you on any medications? For example antihypertensive medication. If so when were they started?

Also can you take a photograph of any of the darkened areas and one of an area where you think you color is normal.

•  colour
•  pigmentation

Hi Emmanuel,

Thank you for the photographs. The areas you mention - hands, feet, penis and scrotum are naturally darker than the rest of the body. The reasons for this are different. The penis and scrotum are darker because they have a very rich blood supply and this makes the skin darker. No treatment is required or indeed effective here. The hands and feet are darker because of tanning and also racial pigmentation (acral darkening). This can be treated with measures I will detail below but please note that I advise my patients who are concerned about acral darkening to just use a sunscreen (SPF 30 or more) on a regular basis (8 am and 2 pm) and try and ignore the problem. This is because treatment is often unsuccessful and even when successful involves a considerable expenditure of time and money. Benefit needs to be maintained with strict sun avoidance measures and well as fastidous sunscreen use on a long term basis.

For motivated patients treatment is usually started with medical bleaching creams like Kligman’s formula creams (Hydroquinone/Mometasone or Hydrocortisone/Tretinoin in various percentages). This is done once at night for 6-8 weeks after which the cream is tapered. Mometasone alone does not help as much and should not be used for your problem. Please note all these recommendations only relate to the darkening or the hands, feet and/or face and NOT to the genital area.

For patients who are not satisfied by the creams alone there are various procedures which can help:

Chemical Peels - these are fruit acids, alpha and beta hydroxy acids which are used in various combinations to peel away the superficial tanned layer of the skin. Peels may only have one component like glycolic acid or salicylic acid or multiple components like retinol, lactic acid, mandelic acid, pyruvic acid, phytic acid etc. Peels can be short contact or leave on peels. Short contact peels are applied on the skin for 5-10 minutes and then neutralized. Leave on peels are left on for 2-6 hours and then washed off. These work deeper and typically cause more peeling of the skin which can continue for 5-7 days after the session. Peel sessions are repeated 2-3 weekly for 6-8 sessions after which maintenance sessions can be given once in 6 weeks.

Microdermabrasion - this involves removing the superficial dead layers of the skin with a machine that uses aluminum oxide crystals and a vacuum device. Sessions are spaced just like I mentioned for peels. Chemical peels can be combined with MDA for a deeper effect, but this is only done for advanced peels in patients who have been taking regular peels for many months.

Mesotherapy - this is a technique popular in Europe (particularly France) and involves injecting vitamins into the skin. This can de done superficially (called the ‘nappage technique’) or deep (‘point to point’ technique). Various vitamins can be used in isolation or as vitamin cocktails (e.g vitamin C, glutathione).

Whichever method is chosen it is very important to minimize sun exposure as well as use a good sunscreen (SPF 30 or more) 2-3 times a day (e.g 8 am, 12 pm and 4 pm) irrespective of whether you are going out or not.

Information provided in this answer is only for general purposes and you must always discuss them with your own doctor before trying anything.

Please feel free to ask if you have any queries.

•  skin
•  chemical peel
•  sunscreen