How to treat a dark neck that does not fade with chemical peels?

Hi,

Welcome to icliniq.com.

I understand your concern.

I have gone through the history and image (attachment removed to protect the patient's identity) provided from your end. It appears to be Acanthosis nigricans. Acanthosis nigricans is hyperpigmentation of the skin that may occur at multiple locations but most often is seen in the neck area and the nape of the neck area. They may also be with black in multiple other areas and are usually caused due to multiple factors, including cholesterol, diabetes which you have already mentioned to be negative in your test results; therefore, they may be ruled out. They can occur due to excess sun exposure, imbalanced diet, hormonal imbalances within one's body including changes in the androgen levels as well as female hormone levels. The most common cause is genetic susceptibility, where similar conditions usually run within the family and may be transmitted genetically. They do not necessarily have to be accompanying lifestyle conditions like diabetes and cholesterol but may be seen in the case of such conditions. They may also occur as part of one's regular skin phenomenon. Another common reason for the same is in case of obesity as well as sudden weight gain or sudden difference in weight. During pregnancy and postpartum, they may also be seen due to sudden hormonal variations within our bodies. Reducing the intensity of hyperpigmentation in the case of Acanthosis nigricans may be time-consuming. It may require multiple efforts in the form of medication and procedures to eliminate them. Even though complete reduction of the same may be a cumbersome task, as most often complete remission of the same may be difficult, the intensity may be reduced using medications and procedures that are done consistently.

As you have mentioned undergoing chemical peel treatments, chemical peels are usually done in sessions of at least six every two weeks for best results. Any less than that may not show the desired result. Since you have also mentioned that the pigmentation has gotten darker following the procedure, they may require treatment with more intense procedures, which may be detailed below.

I would suggest the following:

1. Procedures including laser techniques using queue switch lasers are more helpful than chemical peels as laser beams can penetrate the skin and destroy the melanin production, thereby regularizing the skin melanin release. Laser techniques are also done in sessions effect at least six every three weeks and may require an in-person consultation with the dermatologist to undergo the procedure

2. Tablet Glutone 1000 mg (Glutathione tablets) may be taken once daily after food at night for at least one year to show the best results. Due to these tablets being photosensitive, sun exposure on the following day of intake of this tablet is not advised. In case of some exposure, putting a perfect layer of sunscreen is always advised to protect your skin from getting more pigmented. In the case of pregnancy, postpartum, and during lactation, this medication is to be avoided as they are potent.

3. Capsule Evion 400 mg (vitamin E capsule) may be taken at night after food along with gGutathione tablets for the best effect for at least two months daily. They help in hydration as well as reducing the pigmentation of the skin

4. Tablet Ascorbic acid 500 mg may be taken in the morning after breakfast for two months. I advise you to avoid consuming milk, scorching food, and scorching drinks during this tablet, as they may result in abdominal discomfort for some individuals. They are then used with Glutathione, and vitamin E capsules are beneficial and reduce hyperpigmentation's intensity.

The medications mentioned above are In the generic name, and the brand names have also been mentioned. In case of unavailability of the brand names mentioned above, any brand with the gendered name that has been included with the same may be purchased. Vitamin E capsules and Ascorbic acid tablets may be continued by taking a break of one month after every two months of intake. When accompanied by vitamin E and Ascorbic acids, Glutathione has the best effect.

5. Elosone HT skin cream (Tretinoin, Mometasone, and hydroquinone) may only be used at night in a skinny layer on the affected area. This is an extreme cream and therefore is to be used with caution. The smallest amount possible of the cream may be applied in a skinny layer on the affected area. This is also a photosensitive medication; therefore, it is recommended to use a good layer of sunscreen in the morning to prevent some exposure as much as possible. This cream may be used only for a total period of ten days. And then stopped. If they continue to be used, they might show the opposite effect.

6. Glutathione cream (GT-Mine cream ) of any brand available in your country of residence or any glutathione brand available online in a cream consistency may be used after the period of ten days of the usage of the above cream. This medication also needs to be used in a minimal quantity in a thin layer on the affected area. And maybe used for months together. The above creams are also mentioned In their generic and brand names. However, in case of unavailability of the brand name, which may usually be available online, any brand with the above ingredients may be purchased.

7. Neutrogena (Avobenzone, Homosalate, Octisalate, Octocrylene, and Oxybenzone) sunscreen or any sunscreen with SPF (sun protection factor) 50 may be purchased and used daily in the morning, applying at least 20 minutes before going out and as part of the skincare routine in the morning, even if at home. They are to be reapplied every 2 hours from 9:00 AM to 5:00 PM as this is when the ultraviolet radiations are the most and may cause skin damage.

8. Avoid oily and fried food, sweets, red meat, spicy food, milk, and dairy products. Make sure to consume more fruits, vegetables, fiber, and at least 12 glasses of water daily in a 250 ml glass size.

As I have mentioned earlier, the reduction of hyperpigmentation is a time-consuming process. Therefore, consistency with the medication is keen, and listing the medication is required to be used for a short period, as mentioned. In addition, kindly undergo the laser procedure, which is more apt for skin hyperpigmentation.

Hope the above details have provided clarity and were informative.

I hope I can help. Stay happy, healthy, and safe.