Dark patches with uneven skin tone after derma peeling 5 years ago? What caused it? (Photo)

It sounds like you're experiencing post-inflammatory hyperpigmentation (PIH), a common condition where the skin becomes darker after an inflammatory event, such as a chemical peel. Here are some insights and suggestions:

Understanding PIH: Post-inflammatory hyperpigmentation occurs when the skin overproduces melanin in response to inflammation or injury. This is more common in individuals with darker skin tones, such as those of South Asian descent.

Initial Improvement with Treatment: The improvement you noticed with hydroquinone (HQ) is typical, as HQ is effective at lightening hyperpigmented areas. Isotretinoin can also help by reducing acne and subsequent inflammation.

Recurrence of Dark Patches: The return of the dark patches after switching to a kojic acid cream could be due to several factors. Kojic acid is generally less potent than HQ, and discontinuing HQ might have led to a rebound in pigmentation. Additionally, environmental factors like sun exposure can exacerbate hyperpigmentation.

Management and Prevention:

Sun Protection: Ensure you use a broad-spectrum sunscreen daily, as UV exposure can worsen hyperpigmentation.
Consistent Treatment: Discuss with your dermatologist about possibly resuming HQ or considering other treatments like azelaic acid, retinoids, or chemical peels with caution.
Regular Follow-up: Regular visits to your dermatologist can help monitor your progress and adjust treatments as needed.
Permanent vs. Temporary: While PIH can be persistent, it is often not permanent. With appropriate treatment and sun protection, many people see significant improvement over time.

Consider scheduling an appointment with a dermatologist to discuss your concerns and evaluate the most suitable treatment plan for your skin type and condition.