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What causes discolored spots on the scalp, nose, face, chest, arm and back?

Answered by
Dr.
Dr. Asmeet Kaur Sawhney

Dermatologist

Practicing since :2007

Answered : 4237 Questions

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Posted on Thu, 25 Aug 2016 in Skin Hair and Nails
Question: I have been experiencing spots (discoloration) on my scalp, nose, face, chest, arm, stomach and back; these spots do not itch but keep spreading. I have tried several medications (tablets and creams: Nizoral Shampoo, Ketonazole Cream, Griseofulvin Tablets, Itraconazole 100mg Capsule) but no improvement. Finally decided to have a skin biopsy and the investigation/result shows Lichen Sclerosus. What's the meaning, cause and treatment options/medications? Thanks,
doctor
Answered by Dr. Asmeet Kaur Sawhney 2 hours later
Brief Answer:
Chronic disease, cause unknown, no permanent treatment available

Detailed Answer:
Hi
Thanks for being at healthcaremagic
I am Dr Asmeet Kaur Sawhney, a dermatologist.
I have gone through your complaints and lichen sclerosus is a chronic connective tissue disease of the skin characterised by white areas at any site of the body but mostly in the penile skin and foreskin in males and perineal skin in female.
The cause of this disease is unknown at present.
The disease occurs spontaneously in some individuals.
In some persons role of hormonal factors, autoimmune diseases, trauma and chronic balanitis have been related to the occurence of lichen sclerosus.
The disease is usually permanent and occasionally resolves spontaneously.
The signs and symptoms show relapses and remissions.
There are no confirmed effective treatments for this disorder although potent topical steroids, calcipotriol and topical tacrolimus and pimecrolimus have beed found effective in some persons.
Even phototherapy and oral mycophenolate mofetil has been found useful .
I hope this information is of help to you.
Regards
Dr Asmeet
Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar
doctor
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Follow up: Dr. Asmeet Kaur Sawhney 31 minutes later
Many thanks Doctor Asmeet.

My concern is that this pigmentation do not occur on my penile skin at all but rather on my face, nose, scalp, chest, arm, back and stomach. What more can you say about this?

What OTC (Over the Counter) drugs, creams and ointments would you prescribe? Is there any other laboratory tests/clinical investigation to be carried out?

Regards,

doctor
Answered by Dr. Asmeet Kaur Sawhney 30 minutes later
Brief Answer:
Biopsy is confirmatory, only emollients & cortisone can be used as OTC

Detailed Answer:
Lichen sclerosus frequently involves anogenital area in 85-95 percent of cases and extragenital sites are involved in only 15-20 percent of the individuals.
You have developed the less common extragenital lichen sclerosus.
Diseases like vitiligo, thyroid disorders, pernicious anemia and alopecia areata are most commonly associated disorders with lichen sclerosus.
Biopsy is confirmatory for the diagnosis.
No further laboratory investigations are required.
Only emmolients and cortisone cream can be used as over the counter medicines.
All the other treatment options fall in prescription category and you need to take treatment under the supervision of the dermatologist.

Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar
doctor
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Follow up: Dr. Asmeet Kaur Sawhney 28 minutes later
Dear Dr. Asmeer,

I also know that extragenital LS is typically asymptomatic. However, I am not comfortable with it at all. I wish you could feel my pulse!

Which therapy would you recommend; Which emmolients, cortisone cream and medicines (OTC) can be used or best suited?

Regards,
doctor
Answered by Dr. Asmeet Kaur Sawhney 10 minutes later
Brief Answer:
Unfortunately medicines won't be available as OTC

Detailed Answer:
Unfortunately there are no OTC medicines which will be effective in lichen sclerosus.
I can understand your condition but I am helpless as medicines won't be available as OTC.
Potent topical steroids or tacrolimus ointment or calcipotriol ointment can be effective but you can't get them over the counter.
At the most you can simply try using a lotion containing white soft paraffin on the entire body twice daily and hydrocortisone cream on the affected white spots twice daily but hydrocortisone is a very mild steroid which won't have any significant benefit in your case.

Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar
doctor
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Follow up: Dr. Asmeet Kaur Sawhney 48 minutes later

I would have loved to get the Tacrolimus or calcipotriol ointment. How can I get this particular ointment or cream? Do you have a platform for buying and shipping? You said I can use a lotion containing white soft paraffin. Can you be more specific on the choice of paraffin?
doctor
Answered by Dr. Asmeet Kaur Sawhney 1 hour later
Brief Answer:
No platform for buying or shipping of medicines

Detailed Answer:
No we don't have any platform for buying and shipping of medicines.
You need to get these medicines from the doctor.
White soft paraffin is the basic content of many moisturizers lile parasoft cream or venussia cream or moisturex soft cream or aquasoft cream.
You can buy either of the above,
All are equally good.
Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar
doctor
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