How can the white patch on my forehead be treated?

Question

Hello doctor,

I have had a growing white patch on my forehead for a month now. I visited my PCP and she thought it was either vitiligo or a fungal infection. She gave me a Ketoconazole shampoo and ointment. Then I visited a dermatologist to see if it was vitiligo. She used a wood lamp and she confirmed that it was not vitiligo and said I had seborrheic dermatitis. She gave me a steroid called Desonide. She also told me to keep using ketoconazole. I used the steroid and the whiteness of the spots went down but still, they are slightly present. The next day I shampooed and my patch had intermixed normal pigment and white spots in the same areas again. Now it has been a day since I showered and the white area is back to its original. The dermatologist asked me to come after four to six weeks. Currently, I am on Losartan 50 mg once a day, Ketaconozole 2%, and Desonide cream. All the blood tests have been performed three months ago and my vitamin, thyroid, and kidney reports are all good. However, I am concerned about the physical appearance and I feel like the patch is growing down on the sides of the hairline. I have attached few images for your reference. What do you think this is?

Answer 1

Hello,

Welcome to icliniq.com.

I have noted your concern and I have viewed the attachment images (attachment removed to protect patient identity). It certainly does not look like vitiligo. I will keep a possibility of postinflammatory hyperpigmentation secondary to an underlying seborrheic dermatitis.

I suggest you may continue with the Desonide cream for a few weeks and also apply topical Tacrolimus 0.1 % ointment twice daily. It is a prescription medication and it is effective for both seborrheic dermatitis as well as for postinflammatory hyperpigmentation.

Regards.