bilateral areola discoloration - sebaceous glands?

[Ctown]

Doctor,

I'm a 39-yr old male and have been extremely frustrated for the past 6-7 years due to progressive discoloration of both areolae.  I've had one dermatologist insist that it was vitiligo but two subsequent dermatologists have discarded that diagnosis and have concluded (after biopsy) that it was simply the buildup of sebaceous oil glands.  It actually looks similar to spots I have on my upper lip (Fordyce spots I think?).  I've previously tried cosmetic tattoos, but the ink faded away after a couple weeks (lending credence to the oil gland diagnosis in my opinion).  I've had treatment with some sort of pulse laser which also did nothing.  I've attached pictures under my profile...hopefully you are able to access these.  I'm at my wits end and would entertain any kind of reasonable cosmetic option short of major surgery.  

One other note.  I have a very mild form of MS and take a daily injectable medication called glatiramer acetate...not sure if that could be the cause of the problem?  

Any suggestions would be appreciated.

Much thanks

[Ctown]

Thank you Doctor.  When you look closely the pattern resembles Fordyce spots that I have on my upper lip and this is the theory of my of my dermatologist.  He also got a second opinion from the dermato-pathologist who examined the biopsy (he saw me in person as well).  Are there treatments or options for fordyce spots?  

regards

[Rohit Batra, MD]

Dear Ctown,

Thanks for your query.

Going by the pictures sent by you, the first differential diagnosis that comes to mind is Vitiligo but as that has been ruled out by biopsy it’s very unlikely. Still I would request you to get the biopsy examined once again.

Sebaceous hyperplasia found in areolar area is nothing abnormal. The change of color in the skin of areola has nothing to do with sebaceous hyperplasia. Change of color is caused due to the damage of melanocytes in epidermis. A rare condition that might cause such a picture is collection of fat droplets - xanthelasma and can be attributed to sebum glands.

Biopsy alone can give the best answer in your case and should be evaluated by a competent Dermato-pathologist.

Hope that this information helps and hope that you will get better soon.

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Best Regards,
Dr. Rohit Batra