Fungus and Vitiligo?

I have two ongoing issues with my skin.  Both have been present for approximately 10 years or more and I have not been able to see a dermatologist.  (unable to afford benefits or office visits)  I recently started a healthcare program, but I live in a busy area and need to be referred by my PCP and just getting to the GP will take two months.  I am not inclined to wait that long, having found this site and being sick and tired of my current skin condition.  I'm hoping you can advise me in the meantime.

First, when I was a freshman in college, I discovered scaly, slightly thickened skin on the back of my neck, along with slightly darker discoloration.  At the time it was suggested that the use of papaya in my shampoo could be the cause...switching shampoos did not help.  Since then, the scales have spread to behind my ears and up around my hairline (without the discoloration), meeting at the top.  I have a little in my eyebrows, as well as a small patch on the bridge of my nose where the scales are very thin and flaky.  It has also continued down my spine and across my shoulders somewhat.  Recently I have noticed that the scales and discoloration have formed under my bra strap, mimicking the shape.  The very slightly raised scales and discoloration cease at the top of my buttocks.  There are also small patches in the creases on either side of my back (beneath the bra), in my cleavage and within my pubic hair.  Recently, my pubic area has become infuriatingly itchy once or twice a day.  I also have thin, flaky scales covering about 50% of my breasts, but without the raised skin or discoloration.  Several isolated patches have appeared on the front of my shoulders above the breasts.  

I use moisturizing bath soap, drying thoroughly before applying a mild aloe lotion all over and powder in any creases.  Afterwards, the scales itch and I can peel them away easily in small pieces (especially the ones along the hairline), then the itching subsides.   They are quite thin, except on the back of my neck, in my cleavage and down my spine.  My mother mentioned watching a program where they described my condition as a fungus.  Is this the case and what can I do til I see a dermatologist? The itching in my pubic area is unbearable when it flares up and I am sick of having dandruff like flakes on my clothes from the broken scales.  I tried T-gel on my scalp and it made that itch horribly as well.

The second issue is much less pressing.  I seem to have lost nearly all of the pigment in my skin over the course of 10 years or so.  It started with a spot on my wrist the size of the tip of my pinkie finger...and has grown all up my arms and even to the areolae of my breasts.  Beauty marks and birthmarks are gone.  My hair is still dark and I have a dark patch on the side of my neck and one on each inner thigh. For God's sake, I glow in blacklight!  Is this vitiligo or something else?  ANY help would be immensely appreciated!!!

Thank you in advance!

[Alan Rockoff, MD]

It certainly sounds like vitiligo.  When it's that widespread, there really isn't much useful to do about it.

As for the former problem, the neck rash sounds like possible seborrhea, but the trunk discoloration could be fungus.  Basically, I don't know.  To deal with the itching, I suggest you try OTC hydrocortisone 1% and an anesthetic cream like pramoxine, also OTC.

Diagnosing this would probably take 1 visit, an outlay of perhaps $100.  Surely in 10 years you've made one discretionary purchase of that magnitude.  How about considering another....?

Dr. Rockoff

[Ann_Nonymous_71112]

A related discussion, White Patches and Vitiligo was started.