Brief Answer:
I would like to revise my diagnosis to Pityriasis XXXXXXX

Detailed Answer:
Hello.

Thank you for the follow up query

I have reviewed the recent Image. It looks slightly erythematous/reddish in this image. In my view, it has not improved at all to antifungal. Rather it looks somewhat aggravated/inflammed in this picture.

Now, if you can refer back to my previous reply. I had kept a possibility of either Fungal infection Or Pityriasis XXXXXXX therefore I had also suggested you to go for a KOH scraping to look for fungal elements.

Clinically it is sometimes not possible to be sure about the diagnosis without laboratory help because they can look similar.

Based on the recent Image and lack of response to topical antifungals, I would like to revise my diagnosis to Pityriasis XXXXXXX I suggest you to use a topical moderately potent topical steroid e.g fluticasone propionate 0.05% cream, twice daily to this patch.

I guess you must already be using some topical steroid for vitiligo patches (may be either mometasone furoate or fluticasone propionate). Let me know which topical steroid you are using for vitiligo patches? Let me know the generic name(salt)?

You may use the same steroid over this particular patch as well. Surely it would improve on topical steroid. But this patch is NOT VITILIGO patch for sure!!

I will be waiting for any clarifications that you might have.

Regards

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Brief Answer:
Possibility of P. XXXXXXX

Detailed Answer:
Hi.

Ok.

I could make out that the Image which you posted a few days back, probably you used a little camouflage on the concerned patch (at the angle of the mouth) as well, therefore it looked a lot paler in the previous picture.
Whereas in today's picture it looks more red and aggravated. Therefore, this looks different from fungal infection, which i suggested last time.
I would definitely suggest you to use a topical steroid over this patch as well.

Are you presently on some topical treatment for vitiligo patches?

Regards

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