Unusual Pigmentation Loss

[willus]

I am 43 years old and have been an eczema sufferer since the age of 12.  I had been using Clobetasol Propionate Cream for over 20 years.  With that said, I’ll try my best to explain my skin problem.

This all started with an outbreak of hives, in the month of May.  I have had all types of blood and urine test done.  The cause of the hives was found to be pollen and dust mites.  

I first noticed the pigmentation changes in my skin around August.  The pigmentation loss is hard to describe.  On the skin just above my fingernails the pigmentation loss seems to be under the skin.  It first appears as a lighter color that then turns pinks very slowly.  You have to look very close to see the lighter color and this all depends on what type of light that is being used to view the area.  In afternoon sunlight you can see pinkness clearly.  In evening sunlight skin appears normal.  In florescent lighting you can see the loss of pigmentation very clearly.  When viewed, under a Wood lamp(black light) there is no reflection of any white just a slight difference in color from the surround skin.  The spots appear small, unusually shaped, and some slightly circular with a little darker color with darker center.  I also notice similar spots on my big toes above the nails and on head of my penis.

I have seen my GP, and two different dermatologists.  They each believe that the pigmentation loss is not Vitiligo.  Rather, it was caused by post-inflammatory hypo pigmentation.  They believed this to be the case is because sometime in late April I applied some Plaster of Paris, without wearing any gloves.  This may explain my fingers but, it does not explain my toes and penis head.

Can you give me any further information as to what might be causing my pigmentation changes.  I’ve been reading different articles for months.  So far, I have not found any concrete answer or anyone with similar symptoms.

[Alan Rockoff, MD]

If the Wood's light doesn't heighten the contrast with the rest of your skin, then I agree you don't have vitiligo.  The dermatologists' suggestion that these pigment changes are secondary to chronic eczema seems plausible.  Also, clobetasol can lighten the skin, at least temporarily.

Having said all this, I think you are looking at your skin far too carefully, noting minor pigment changes that don't mean anything.  For your own good, I think you should stop.

Best.

Dr. Rockoff