Question:

Initially self-diagnosed as Tinea Versicolor. After using prescribed anti-fungal treatment several times there is no noticable change. Has been a persistent problem for many years – no recollection of when it started. Looking only I wonder if it’s melasma but my face is clear. Pics attached.

Answer

Many Thanks for using my online consultation service, which I hope you will find worthwhile. From what I understand you have had these white flat patches coalescing together, on the trunk for many years. I believe they are not itchy or scaly (dry and flaky)? Please confirm.

Also please confirm that the patches were not preceeded by any other skin problem (like a fungal infection or psoriasis). Also please confirm whether the lesions are getting worse or better with time and apart from your trunk have you got them elsewhere?

Please remember that my diagnosis/ treatment might change depending on your responses to the questions above.

However, on first impressions you seem to have a relatively common but often underdiagnosed condition called progressive macular hypomelanosis. No one exactly knows what causes it but it usually tends to go away on its own after the age of 40! (yes, I am afraid so). It is a completely harmless condition for which no treatment is necessary. It is thought to be a variant of two other conditions Pityriasis alba and idipathic guttate hypomelanosis, but this link is not proven. Research suggests that the disease might be driven by a yeast infection (propionobacter acnes)  Hence, the treatments that have been reported to help include using clindamycin 1% lotion along with benzoyl peroxide 5% gel in combination with UVB phototherapy (usually for about 10-12 weeks). However the disease can come back after you stop treatment and therefore you would have to decide whether to just ignore this harmless condition or go for treatment. Using the lotion and gel is completely harmless and you could certainly try that in the first instance. Phototherapy does carry the risk of skin cancer, but the risk in asian skin after one course (20-30 treatments), is negligible.

I have hyperlinked the technical terms I have used and do see the info links. Many thanks for using my service once again and hope to hear from you soon.

Regards

Dr.Sasi Attili.  MBBS, MRCP (London), CCT in Dermatology (UK)

Consultant Dermatologist