Partial pigment loss or Vitiligo ??

[CurryNLR]

Dear Dr. Rockoff:
We live in NJ. 2 months ago, we noticed a white spot on the left eyelid of my 8 year old daughter. Child is bron in USA.  Her complexion is average.  We are from India.  At the suggestion of Pediatrician, we started applying Hydcortisone Cream, USP 1%.  White spot expanded and became like a small island in the form of a patch on eyelid.  But, no itch.  No other white spots on body, and no Vitiligo family history.  After 2 months, when we noticed a whitish spot below same eye, we consulted Dermatologist.  Upon 1 min. exam, derma. suspected early stages of vitiligo, but encouraged saying reversal is possible.  and priscribed 2 medicines:

1. Protopic (tacrolimus ointment) 0.1%: Mon thru Thu Twice daily
2. Cultivate Cream, 0.05% (fluticasone propionate cream): Fri, sat, sun: Twice daily  

Today is 6th day of cream application. We believe that Brightness and intensity of whitish patch seems to be diminishing somwhat. I sometimes feel that her skin is becoming slight pinkish (may be returning to natural color ? not sue !). Her skin is pale now on eyelid, we can see blood vessels. Dermatologist will see her AFTER 4 weeks.  

But, she comes out of the bath tub, the whitish area stands out....somewhat readily visible.  I am thinking, it stands out may be because, that eyelid area is soaked with water for few min.  Hence, I get a doubt.  Was the cream simply camouflaging the whitish area ? or, is she really responding to the cream.  Honestly, we think, BOTH are occurring.

Questions:
1. Can she be exposed to sun now ? (even though there is not a lot of sun now a days !)
2. Does this sound like Vitiligo to you ?  Can this be a partial pigment loss scenario due to some kind of  irritation ?
3. If it is a partial pigment loss, what is the average period for white patch to go away ?
4. If it is vitilogo, is it reversable in early stages for children...?

We are under stress, but have faith in doctors and your opinion.    

[shradha]

A related discussion, partial pigmentation since birth was started.

[treyw33]

the doctor said i do have vitiligo and i'm useing  the cream protopic for 2months now and its still the same no diffrent and they say there isn't any thing out there to help it is that true? there has to be something?

[CurryNLR]

Thanks for your reply.  3 questions please.

1. Is Vitiligo reversable in early stages on face ?

2. If it is indeed a partial pigment loss, how long it may take to get the pigmentation back using Protopic usage ? 1 mo, 2 mo, 6 months ?

3. Also, at what point, you suggest to have the Dermatologist shine Woods light to differentiate if it is a partial pigment loss or vitiligo ? After 1 month of Protopic treatment, or 3 months or anytime ?

-CurryNLR

[Alan Rockoff, MD]

I think that vitiligo is the likely diagnosis.  Protopic is a good choice, but takes several weeks for benefit to be seen.  Patches of vitiligo are in general not more sensitive to the sun, even though they ought to be, so regular use of sunscreen as you would elsewhere and anyway.  It is impossible to predict whether the vitiligo will appear elsewhere, so there's little I or anyone can say that will allay your anxiety completely.  But as I think you'll see that in most cases this condition does not become widespread, and it can often be controlled, especially on the face.

Best.

Dr. Rockoff