What else could this be?

My daughter who is 8 1/2 has developed some depigmented skin on her belly about 1 inch in diameter, her leg a small area possibly 1/4 inch.  She also has on her back 5 small cafe au lait marks that are small and very difficult to see under normal light but visible under the Wood's lamp.  She has had one cafe au lait since birth and the others have seemed to appear since the summer. We spent almost everyday at the beach and we used gobs of sun screen.  After seeing a dermatologist she offered a possible diagnosis, that being Neurofibromatosis.  I really just wanted a tube of cream!!!  Well we have now had an eye exam to look for lisch nodules and also gliomas but nothing in the eye exam.  We now have an appointment with a geneticist and that will be in December.  My daughter is extremely healthy and bright and I also have two other children and they also have one or two of these "cafe au lait"  extremely small as well.  The dermatologist did scrape the white areas and found no fungi and told me it was definately not vitilago. She has a small area on the back of her shoulder that is slightly red and slightly scaley with a white hue around its periphery and I have been using OTC fungal cream on it twice a day for the last 4 days.  It appears to be doing some good. I am scheduled to see the dermatologist again on the 1st of November.  Sorry for the wordyness(is that a word?)of this but I wanted to give you as much info as possible.  Is there something else that could explain her "spots" besides a genetic condition? Like I said I am going through all the hoops to rule out or rule in, I would just like to have another opinion. Thanks for your time..........

[Alan Rockoff, MD]

Interested:

Thanks for your meticulous description.  The changes you describe sound rather subtle for the genetic conditions being investigated.   Then again, they certainly don't sound like fungus or vitiligo either.

Once the question has been raised, there's nothing to do but proceed with the evaluation you've already undertaken.  nevertheless, results my be inconclusive, and you may be forced to just wait while your daugher gorws up to see whether other skin or other issues develop.

The geneticist may have more insight into the spectrum of findings compatible with these various diagnoses, rather than the textbook descriptions most of us make do with.

Sometimes the hardest thing to do is wait.  But if the alternative is unneccessary or unhelpful tests, and if your childing is growing normally, waiting is best.  There are many skin pigment mirregularities which fit into no identifiable pattern.

Good Luck.

dr. R