Q. My 1-year-old daughter has a white patch in one of her eyelids and forehead. What is it?
Hi doctor,
My one-year-old daughter is having some kind of white patch in one of her eyelids and forehead for two months. It does not look like a complete white patch and I can see some brownish area in the center of the patch. There is no dryness. We are applying moisturizing cream since after three months of her birth. It is not increasing in size and it remains stable. Previously, discoloration was not visible but now it is visible. Tanning on other parts of the forehead has made the white patch to become more visible. I have attached the image taken three months back. She does not have this similar patch on other parts of the body. Occasionally, we use Hydrocortisone cream 0.01%. The pediatrician advised us to use Hydrocortisone cream 0.01% and Miconazole nitrate 0.02% twice a day for two weeks. If there is no improvement, the pediatrician told me to consult a dermatologist. I need an expert opinion. Kindly suggest.
Hi,
Welcome to icliniq.com.
From the pictures provided her, (attachment removed to protect patient identity) your daughter seems to have two possibilities. Your daughter can have nevus depigmentosus and childhood vitiligo. As it is confined to one-half of the midline and remains stable for a long time, then your daughter seems to have nevus depigmentosus. Hydrocortisone is too mild to elicit a response. I suggest you apply Fluticasone cream once a day in a tiny amount. You can apply it in the night after your child sleeps. If it is vitiligo, it starts to show a response in a month. In the case of nevus, there will be an absence of response. We can decide its further course of treatment based on the response.
Thank you doctor,
I have some unclear observations. Can nevus depigmentosus occur in association with poliosis? I can see some discoloration in eyebrow hair. Can it be childhood vitiligo? I cannot see any demarcated borders, especially in the light brown patch in the middle of the forehead and on the white patch on the side of the eyes. Can this be early-stage vitiligo? Is it common to have a colored patch inside the white patch for vitiligo? I have some re-pigmentation of white patch present in her forehead. Can it be a marginal repigmentation? Can it be pityriasis alba? I have attached the image. I am unable to get Fluticasone cream here. As it is confined to one-half of the midline, can it be segmental vitiligo? I am not sure about the stability of the white patch. It is not increasing in size but it is getting decreased and there are changes in color in the middle of the white patch.
Hi,
Welcome back to icliniq.com.
Regarding poliosis, it is not a specific sign. It can occur in both conditions. Regarding borders and segmental nature of the lesions, both of them can have similar features. The most crucial point that points towards nevus depigmentosus is that it remains confined to the same place for a long time and in vitiligo, there are different shades of brown shown in it. So I suggested taking Fluticasone cream once daily at night for a month before proceeding further.
Thank you doctor,
I am convinced of your diagnosis. I cannot get any steroid creams here. I am planning to consult a dermatologist. What are the tests to be taken to confirm nevus depigmentosus or vitiligo other than wood's lamp and steroid creams?
Hi,
Welcome back to icliniq.com.
Even under the wood's lamp, both of them show similar features. Both of them can be differentiated by their history. Taking a therapeutic trial of a moderately potent steroid like Fluticasone is the best way to proceed further.
Thank you doctor,
If it is vitiligo, is it fine to wait for a few months to proceed further? Will early treatment helps to have better results?
Hi,
Welcome back to icliniq.com.
Childhood vitiligo responds well to topical treatment irrespective of when you take it.
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