Can this be dermatitis? Should I take biopsy?

[bibi_pooh]

Dr.,

One day in April this year, I went to shopping mall in the evening and after I came back home, I found that there is a dark black patch (about 1cm square size) on right hand side of my forehead. It is not itch and no pain feeling.  I went to a dermatology after a week, and she said it is developing something and nothing I should worry about.  She said it should disappear in 3 weeks to 3 months.  In the diagnosis, she described it as "dermatitis unclassified".   About 3 days later, I started to feel very minor itching and she old me over the phone that I can use Cortaid to help.  I use Crotaid for bout a week, it did not help the itchness, but give me several small acne, then I stop using it, and hoping my problem should go away soon.  

After a month in May, I started to feel on/off burning on the edge of the spot.  I sent to see her againg this time, the diagnosis is Dyschromia.  About the burnning, she did not say anything.  All she said is that there is no infection, so she cannot gave me antibiotic.  Since I concern about the look, she prescribed Triluma  to me.  But I did not use it since I still trust her first diagnose.

In mid June, the dark patch still there not getthing any better or worse.  The bunning sensation is a little better.  I went to another derm, and again this doctor prescribe Triluma.  And said that the spot is "mostly" from sun.  I asked if this is malasma or solar lentigo, however, this doc said it could also be post inflamme hyperpigmentation.  

I am so confused bout the two diagnoses, but since both prescribe triluma, I started to use it in early July.  After using the cream for bout 3 weeks, I went back to see my original doc.  This time, she told me to stop using the cream since she sees that my skin is thinning (which I already saw it in the very beginning).  And since the dark patch still persist, she wants to take a 3mm biopsy!  I asked her if this is sun spot, she said it does not look like one for her.  Though the affected area still sensitive, it no longer feel burn or pain.  I am concern about taking biopsy since there would be scar left.

What would be your advise? 1.Does this sound like dermatitis to you or it is sun spot?  2.What would biopsy tell in this case?  
3.Is steroid induce skin thining reversible?  Since both Cortaid and Triluma have the ingredient.  4. Can dermatitis hyperpigmentation last very very long time?

I'll find another deramtology to exame again, but if you can answer my questions appreciated.

thanks!

[Alan Rockoff, MD]

I don't think a biopsy is needed, from what you've said--everything points to post-inflammatory hyperpigmentation, which means extra pigment that comes after some inflammation, in your case the irritation/eczema you started out with.  ("Dyschromia" just means change in color.)  This kind of pigment takes months to fade, and creams like TriLuma don't speed the process up much, if at all.  I usually advise people to just wait it out.

I am skeptical, by the way, that TriLuma has caused atrophy ("thinning") of the skin.  I've never seen that with this medication, whose steroid component is not all that strong.  But skin atrophy is reversible, in any case.

I suggest you ask your doctor whether it might not be better to wait, rather than put a small hole in such a visible piece of skin.  Nothing in your story suggests that you have a dangerous skin growth--it just came on too fast.

I say all this from a distance, of course.  You really need to talk about this with people who've seen you in person, like one of the two dermatologists you've consulted.

Take care.

Dr. Rockoff

[Alan Rockoff, MD]

Nope.

Dr. Rockoff

[bibi_pooh]

One more question, is it likely to develop steroid induced stretch marked from my use of the steroid topical?  I also see some darker lines on my affected area. best regards!