Patient's Query
Hi doctor,
My daughter has skin lesions that started last year. They are on one side of her body. Initially, she got eczema-like small red rashes, for which we applied Corticosteroids. Later, we observed whitish patches developing on those spots.
Initially, the GP thought it could be tinea versicolor and suspected it could also be vitiligo. He referred us to a skin specialist. Then, the skin specialist thought it could be hypopigmentation. After a month, at the next appointment, she thought it could be vitiligo and started with Tacrolimus and Corticosteroid cream.
Even before we started applying this Tacrolimus, we saw some repigmentation in some areas, but it was slow repigmentation. We were confused as to whether it was vitiligo or not, and also, as we are applying strong creams to a six-year-old girl.
Do you have any long-term issues? We want to have a second opinion. I live in a city where it is very difficult to get skin specialist appointments. They are given every three to six months.
Could you please help us diagnose and treat the skin patches? I can send in the photos. I uploaded the photos. They are all on one side of the body (right side).
On the one hand, it started four months ago with a small white patch and gradually increased in size, and then we are seeing some repigmentation, slowly, very slowly, to normal skin color. On the chest, it also started around the same time this year and has not increased, but it is stable. On the neck, it started early last month, and it is not that whitish (a little less brownish).
As said, the doctors have diagnosed different conditions (postinflammatory hypopigmentation, tinea versicolor, and finally vitiligo) so far, and we are confused.
Could you please look into this and help us? In all these spots, we applied Corticosteroids last year for eczema (hand, neck, chest, and back) at the same spots where the white patches started and have grown bigger now.
The only spot where we have not applied Corticosteroids but observed a white patch is the eye. Over the last three weeks, we started seeing a white patch on the right eye as well.
Kindly help.
Hi,
Welcome to icliniq.com.
I have gone through your history and clinical photographs (attachment removed to protect patient identity). From the present situation, it looks to be vitiligo. Since it is on one side of the body, it can also be called segmental vitiligo.
Tacrolimus is the right medication. Wood's lamp examination helps to diagnose vitiligo. Yes, in some places, there is repigmentation, which is a good sign. Did anyone in the family have vitiligo?
I hope this has helped you.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
No one in the family has vitiligo. Are there any long-term issues with applying topical Corticosteroids and Tacrolimus 0.1 %? The doctor suggested using them for a minimum of three to four months to see the response. Are there any newer techniques in dermatology that can be used on the face and neck to stop the growth and repigmentation?
And is there anything we can do at home to diagnose it properly? Under Wood's lamp, how will it be exactly? Doctor appointments are time-consuming here, and we have to wait for three months at a minimum to get a skin specialist appointment.
I heard segmental vitiligo will grow for one to two years and then stabilize. Is this correct? Hopefully, they will stop growing soon.
Hi,
Welcome back to icliniq.com.
In vitiligo, the course of progression or remission cannot be exactly commented upon. There is no home test. Under the Wood's lamp, it looks chalky white in color with defined margins. Topical steroids should not be used for a long period.
It can lead to side effects like thinning of the skin, telangiectasia, and increased hair growth. It can be used under monitoring. There are multiple treatments available from oral medications after considering all parameters, or phototherapy, which also shows promising effects.
Kind regards.
Patient's Query
Hi doctor,
Thank you for the reply.
One final question. The patch on the hand seems whitish when we are inside the home, but looks a bit pinkish outside. The patch on the neck looks brownish instead of whitish, as you can see in the pictures. Is there any chance it is tinea versicolor?
Next time when we go to the hospital, we will ask them to do Wood's lamp (or) any other diagnostic testing instead of trying medicine directly on the kid.
Hi,
Welcome back to icliniq.com.
From the present images, it does not seem to be tinea versicolor. Also, it is unlikely to come in such a segmental manner. In vitiligo, it can be trichrome vitiligo too, where you get a white patch separated from the normal skin. But continue the application of Tacrolimus 0.03 percent.
I hope this helps you.
Please reach out if you have any questions.
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Answered byDr. Thakare Sampada Avinash
Medically reviewed byDr. K. Shobana
Same symptoms don't mean you have the same problem. Consult a doctor now!
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