Dark stains around mouth for getting monthly outbreaks

[redandpurple]

Hey guys,
Last year I started getting outbreaks on my mouth. These outbreaks started to happen monthly and sometimes twice a month. They always appeared on the same place and because of the recurrent outbreaks my skin started to stain. I went through a Valacyclovir treatment and now the outbreaks are controlled. However the stains are still there, I thought they would disappear eventually but its been quite a few months since my last outbreak and they are still there and even look a bit darker than before. I've tried using cremes with hydroquine and many home remedies but they don't seem to do much, the skin peels a bit but its too superficial and does not remove the stained area. Please help, I can't go out of my house without having to wear a lot of makeup and its horrible. People ask about it if they stain is noticeable and I don't even know what to say. I'll try anything. Thanks :)


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[Dr.Deepak]

Hi Naomi, welcome to DermaTalk. The picture is not that clear, if possible post a clear picture in a normal daylight without modification. So, u r are talking about the round black spot near mouth or are there other multiple spots too. The one near on the mouth does resemble FDE (Fixed Drug Eruption), but any way you said you had herpes outbreak on the exact same location, is that right? So lets assume its post inflammatory hyperpigmentation.

So what topical medications have you applied beside hydroquinone?

There are several topical depigmenting products like Hydroquinone (HQ), retinoids, kojic acid, arbutin, azelaic acid and licorice extract etc. that can be applied alone or in combination to achieve good results. Combination works better than single. If low strength is not working good one can shift to high strength, but remember, if the pigmentation is beyond epidermis (ie. deeper to the dermis) these topical agents will not response well. You may need mid-to-high potency chemical peels (http://www.cosurg.com/chemical-peels-for-improvement-of-facial-ageing/) to get it removed.

So if you are only using HQ then go for combination products.

You may go this way first:

[A] hydroquinone+tretinoin+steroid
[B] Kojic acid+arbutin+licorice extract

You may apply these combination alternating A & B every night for 3-4 weeks and see if that works..I'm not sure about the brand names of this product in your country but these products are often combined this way.

REMEMBER: The most important part is to avoid sun, so always apply broadspectrum sunscreen on SPF 30+.

If nothing works chemical peel or lasers may be the other options.

[redandpurple]

Hello Dr.Deepak!
Thank you for answering so quickly. :h6: I should have provided a bit of more information. I have tried the following things:
- Kojic creme and soap (the soap was way too harsh on my skin)
- Epiduo (recommended by a doctor)
- Le'Dermis Skin Fade Cream (with hydroquine)

All of these things made the area where the stains are and all the area around it extremely red, irritated and swollen. I used them though and the skin peeled, however the peeling did not make any of the dark stains fade, it was too superficial.

The darkened area feels more sensitive than the rest of my face and every time I get an outbreak I get it there. When I get an outbreak the darkened area gets very sensitive and tingles and then the outbreak happens, I haven't let an outbreak progress lately because as soon as I feel an itch or a sting I take Acyclovir and it stops it. But every time I get an outbreak it goes like this: the spots get darker and irritated and itchy, the lips next to the darkened area get very swollen and I get cold sores on that side of my mouth. I have also tried home remedies like lemon and honey but they haven't worked. What concerns me the most is that I've searched on the web for people with similar stains to the ones I have and have found nothing like that. Is the dermatologist the one that performs the chemical peels? How long will it last? Will I be able to get out of my house or does the area get really bad? I took better photos and added them below: (as you can see by the photos, my lips have also gotten a bit darker on that side)

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Thank you so much for your help. :p