I am a 36-year-old Chinese lady with tanned and uneven skin tone. I used to have pigmentation patches on both sides of my arms near my shoulders, back and legs when I was a teenager. The patches looked like tiny black dots and felt like goose pimples. The pigmentation got worse after I delivered my second son.

I also have ugly dark rings under my eyes that make me look haggard and old. These problems really trouble me!
I have heard of laser treatments and microdermabrasion, but which treatment best suits my skin problem? I would really appreciate some advice in this matter.
S.T.

Dear S.T.,
Your main problems are keratosis pilaris of the arms and shoulders, and dark eye rings. Keratosis pilaris is a common hair follicle problem, which can occur on the outer side of your limbs and is common in younger age groups. It can be pigmented and with raised bumps, as in your case.

eczemaHowever, keratosis pilaris can also affect up to 40 percent of adults, and is commonly associated with dry skin and ichthyosis (fish scale dryness). Keratosis pilaris is less commonly linked to atopic dermatitis (often called eczema) or asthma. In some instances, keratosis pilaris can run in the family.

Isotretinoin tablets can be helpful for this condition, however, in Malaysia, these tablets can only be prescribed by a dermatologist. Do seek a consultation and your dermatologist will decide if isotretinoin is what you need.
Dark eye rings are another common skin complaint. The pigmentation around your eyes could be due to many causes. Treatment for this includes bleaching cream, vitamin K cream, sunblock, hyaluronic acid injection to the pigmented area, or treatment with a laser such as the 1064nm Nd:YAG photo-rejuvenation laser.

Bleaching creams usually contain hydroquinone and kojic acid. The concentration of hydroquinone usually varies from cream to cream but for over the counter products the maximum concentration that can be obtained is two percent. However, bleaching creams prescribed by your dermatologist can contain a concentration more than four percent hydroquinone.

Hyaluronic acid injections can help to mask the pigmentation, making your dark circles appear lighter.