Hyper pigmentation on shins & vitiligo on arms ...

I have had hyper pigmentation on my shins and arms near the elbow for years. I don't know what it is or how to get rid of it. My background is mostly European, but I also have Mongolian ancestors, and have olive skin. I take fish oil and vitamin e, and lots of other supplements. I also have what appears to be Vitiligo on my arms. Lots of white spots. Are these related?

[Bhupinder Kaur, MD]

Hello,
The hyperpigmented spots on shins can be due to hyperpigmentation skin but for the hyperpigmented spots and white spots on arms, pityriasis versicolor is an important possibility. Pityriasis versicolor (Tinea veriscolor) is a fungal infection caused by commensal yeasts in hot and humid conditions. They may be reddish brown, slightly scaly patches or ugly, depigmented areas that will not tan, especially in suntanned skin. They should be differentiated from seborrheic dermatitis and vitiligo.

Selenium sulphide lotion can be applied for around 10-15 minutes, rinsed off and re-applied daily for about a week. It is less messy and preferably easy to use than the Selsun and Ketoconazole shampoos which needs to applied on the patches of affected skin after an evening bath, left to dry the whole night and washed off the next morning. For widespread or stubborn infections, itraconazole tablets have shown good results in curative aspects.

It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your dermatologist. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.