Tinea Versicolor or Pityrisis Alba?

I have white spots on my skin and have been two different diagnoses.  Here's the history:

Started getting white spots on my upper arms and in the bend of my elbow after a bad sunburn one winter (Puerto Rico and January skin do not mix).  It usually starts out a little bumpy and flaking a bit until it just turns into a small patch that's white, flat, and smooth.  Dermatologist said this was eczema and noticed some on my back as well and gave me Elidel cream.  It has prevented many of these spots from sprouting up as they have the past three winters, but a few are still there.  They go away the second I get my first tan of the summer (meaning blend in with the rest of my skin rather than staying white and standing out).

Went to my GP today and she noticed spots all over my back.  They do not itch or flake (no scales), and I'm not sure if I have had these the past few years or not (I don't look at my back!).  She diagnosed it as Tinea and prescribed Nizoril, but I told her my dermatologist said it was eczema...her response: "Perhaps.  I'll give you this prescription anyway."  It looks pretty mild, whatever it is (or maybe I'm just that pale).

I know these things are treated very differently, so I'd like some other opinion on what it is.  One or the other, or both??

[Bhupinder Kaur, MD]

Hello,

From the picture and the symptoms(non itchy and non flaky),it looks like pityriasis or tinea versicolor. It is a common skin infection caused by the yeast Malassezia furfur. This skin disease commonly affects adolescents and young adults, especially in warm and humid climates.

Factors that can cause the fungus to become more visible include high humidity and immune or hormone abnormalities.Treatment involves topical and oral antifungal medicines.

I think that you should go ahead with the topical antifungal that your GP has prescribed for you.If however the symptoms persist then pls get a biopsy done and get a second opinion from another dermatologist.

Hope it helps.Take care and pls do keep me posted on how you are doing and if you have any additional queries.