<s>[INST] Hello doctor,I am using lomela cream for one year (continuously 10-15 days in 3-4 months gaps only)  when i use this ointment only then pigmentation sign disappear/lighter but after some time it appear again.  Please advise me the method of use and has it any side effects for long time usage.  (I am 40 yr old Indian woman)Regards [/INST] Hi,Lomela cream contains hydroquinone,steroid and retinoic acid.I do not recommend hydroquinone containing cream in my patients,as it is a toxic chemical. It causes confetti like depigmentation which is irreversible. Long term use may cause ochronosis.Steroids might cause atrophy,acne,telangiectesia..etc.Retinoic acid might cause irritant dermatitis.I advise to use kojic acid an vitamin C containing cream. And wash the face with kojic acid and glycolic acid containg face wash.Take orally vitamin C,glutathion and nicotinic acid.You may get good result.you may consult dermatologist.Thanks.Dr. Ilyas patel MD </s>