What could cause persistent white patches on my skin?

Hi,

It is a difficult situation for you. However, I need the following information from you,

• When did you first notice these areas of unevenness?
• Where are they?
• Are they spreading or are they stable?
• Are they red, scaly or itchy?
• Do you have a personal or family history of such skin problems or of autoimmune diseases?
• Have you been out in the sun recently?
• What treatments have you tried and how long have you been taking them?

Please upload good quality images of the affected areas so we can have a more accurate assessment.

In the meantime, protect yourself from the sun by applying SPF 50+ sunscreen to unaffected parts and Vaseline (petroleum jelly) to affected areas.

Once I receive your medical history and photos I will be able to give you a more accurate evaluation and advise you on the best treatment plan.

I hope this helps.

Thank you.

Hi,

Welcome back to icliniq.com.

Thank you for your detailed feedback and for sharing clear images as well as information on your supplements and meds; I sincerely appreciate it.

Based on your history and the photographs you provided, the most likely options are:

• Idiopathic guttate hypomelanosis (IGH).

• Post-inflammatory hypopigmentation (PIH).

• Early vitiligo.

Tinea versicolor (a fungal infection) seems improbable given the absence of scaling. This is also why ketoconazole did not help the patches. Tinea versicolor patches frequently begin on one part of the body and extend to the trunk, arms, or face. Patients frequently detect fine scaling or a "dust-like" substance while rubbing or washing, which contradicts your history.

About the possible diagnoses

Idiopathic guttate hypomelanosis (IGH)

This is a common and innocuous disorder that causes little white spots to form on sun-exposed areas like the forearms and shins. It is assumed to be associated with chronic sun exposure and natural skin aging.

• Not contagious.

• Not related to systemic disease.

• Typically asymptomatic (no itching or discomfort).

• Treatment is usually not required unless there are cosmetic problems.

Vitiligo

Vitiligo develops when pigment-producing cells (melanocytes) are killed, resulting in well-defined white areas that may gradually grow.

• Not contagious

• Could be autoimmune in nature.

• It can be progressive in some circumstances.

• The goal of treatment is to halt progression and promote repigmentation with topical medicine or phototherapy.

Confirming the diagnosis

To distinguish between these disorders, I recommend seeing a dermatologist for an in-person consultation using a Wood's light. This is a simple and inexpensive examination that examines the skin with a specific light. If the patches improve under the lamp, this confirms the diagnosis and rules out other options.

Treatment plan

• You may continue using your current supplements.

I recommend starting with:

• Tacrolimus 0.1% ointment.

• Apply a small coating to the afflicted regions twice each day.

Continue for one month, then follow up.

• Tacrolimus is an excellent treatment for early vitiligo, PIH, and, in certain cases, IGH. If present, it promotes repigmentation and regulates immunological function.

If you notice:

• Patches grow rapidly.

• New patches are appearing elsewhere.

• Then, more testing would be required to rule out progressing vitiligo, and additional treatments (including oral medicines) could be considered.

• Sun protection is very important.

• White regions have less melanin and are more prone to sunburn.

• Apply SPF 50+ sunscreen to any exposed areas.

• Reapply every three to four hours if outside.

• Use strict sun protection.

I hope this helps to resolve your concerns. Please feel free to post updates or ask any more questions; I would be pleased to assist you. Your comment is always appreciated.

I hope this clarifies your concern.

Please feel free to reach out if you have any further questions.

Have a great day ahead

Hi,

Welcome back to icliniq.com.

Yes, I recommend that you begin taking the prescribed medication and stick to it for at least a month.

However, if you observe the appearance of new white patches anywhere on your body, or if the size of existing patches increases, you should see a dermatologist as soon as possible for a Wood's lamp examination to rule out vitiligo.

• If the problem is post-inflammatory hypopigmentation (PIH) or idiopathic guttate hypomelanosis (IGH), you should see gradual improvement and a return to your normal skin color within a month.

• You may continue to take your supplements as they are beneficial.

• Please keep an eye on the patches and do not hesitate to contact us if you detect any changes or have any questions.

I hope this information was helpful.

We appreciate your comments and use them to make patient care better.

Thank you; we hope your daughter has a rapid and smooth recovery.