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What causes itchy white patch on lower leg?

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Posted on Mon, 30 May 2016
Question: Hi, I have this white patch on the bottom part of my leg. I got it 6 or 7 months ago and it started off very itchy and I used to scratch it a lot. Now it's just a white spot with some redness around it, which is not going away, but doesn't itch anymore. I've been to a dermatologist and at first she said it was eczema. She also did a biopsy of my skin and the results came back normal. I went back to the dermatologist last week and now she's saying it could be vitiligo. I thought vitiligo doesn't itch. I have no family history of vitiligo. Please help. Thanks.
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Answered by Dr. Asmeet Kaur Sawhney (55 minutes later)
Brief Answer:
Could be either vitiligo or lichen sclerosus et atrophicus

Detailed Answer:
Hi
Thanks for being at healthcaremagic
I have reviewed the attached photograph.
It doesn't look like eczema.
It can be either vitiligo or lichen sclerosus et atrophicus.
I need to ask you few questions:
What were the biopsy findings of the white patch?
Did you have the white patch from the beginning or it started afterwards?
Is the texture of the affected skin normal or it is slightly wrinkled?
Which oral medication is given to you?
Kindly revert back with the answers.
Regards
Dr Asmeet


Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Asmeet Kaur Sawhney (25 hours later)
Hi, Thank you for the reply. I had white patches from the beginning and it was very itchy. Now the white spot has improved. I've attached some pictures. You'll see the improvement from the pic taken in Feb and the ones taken this month. I also attached all the reports and a prescription I was given. I was given CLOBETASOL PROPIONATE .05% OINTMENT and TACROLIMUS .03% by one physician. I was also given RIBOSONE TABLETS to take orally for 2 months and VITILINUS OINTMENT by another doctor. I haven't started taking any of these meds. I want to be sure of the diagnosis on vitiligo. I'm really confused and don't know what to do. I keep getting different diagnosis every time. I need some answers. Thank you for your help.
doctor
Answered by Dr. Asmeet Kaur Sawhney (4 hours later)
Brief Answer:
Seems to be vitiligo

Detailed Answer:
I have reviewed all your reports as well as the photographs.
According to me it is vitiligo.
Vitiligo is usually non itchy. Your itching can be explained by the biopsy report of lichen simplex chronicus which is an intensely itchy disease of the skin.
I would recommend you to use clobetasol propionate cream and tacrolimus ointment.
Moreover as there is no progression of the existing patches and appearance of new patches you can avoid oral medication.

Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Asmeet Kaur Sawhney (2 hours later)
Thanks for your prompt reply Dr. Sawhney.
I just have a few more questions for you.
1. Does this mean that I have both vitiligo and lichen simplex chronicus?
2. I was told by my doctor that taking Ribosone tablets for two months will bring out more white patches faster, if I have vitiligo. I don't know if that's something I would like to do. Does this Ribosone have any effect on vitiligo? I'm a little confused.
3. If I don't take any oral medications, will it make my vitiligo worse?
4. My doctor hasn't done a Wood's Lamp examine on me, should I suggest to have one done?
5. If I do have vitiligo, should I have a Wood's Lamp examine done on my whole body to see if I have any more patches on any other body parts. I've heard that sometimes Wood's Lamp can detect some patches are not detectable by naked eye.
6. I was suggested Photo Therapy by my doctor. Should I start photo therapy on the spot that I have? It seems to me that the patches have improved. The doctor has said that also. Is photo therapy necessary?
Thank you.
doctor
Answered by Dr. Asmeet Kaur Sawhney (10 hours later)
Brief Answer:
Answers below

Detailed Answer:
1. Yes according to the biopsy report and the photographs you have attached you seem to have both: vitiligo and lichen simplex chronicus.
2. I don't have much experience with these tablets but I haven't heard of any medication that can bring out the vitiligo patches. I would recommend you to not go for it since your white patch is already showing improvement.
3. Vitiligo has a unpredictable course. You need to keep the white patch under observation. If it remains static and no new lesions appear you can avo oral medicines.
4. Yes you can go for wood's lamp examination. It will further confirm the diagnosis.
5. Yes you can go for woods lamp examination on entire body to find any patch which is not detected on naked eye examination.
6. Since your spot is improving with topical medication you can avoid phototherapy. It is not necessary looking at the single spot you have.
Above answer was peer-reviewed by : Dr. Sonia Raina
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Follow up: Dr. Asmeet Kaur Sawhney (5 days later)
Hi Dr. Sawhney,

I went to another dermatologist and he did a wood's lamp test on my whole body, as you suggested and he didn't find any other patches other than the one on my leg. He has given me VITIX TABLETS to take orally for 2 months and two other ointments, SORITAR (10% coal tar) to apply at night time and ELIDEL CREAM to apply during the day. Please let me know if you're familiar with these medicines, especially Vitix, and if I should be taking it. Thanks.
doctor
Answered by Dr. Asmeet Kaur Sawhney (1 hour later)
Brief Answer:
You can start with the medicines prescribed

Detailed Answer:
Hello
Yes you can take vitix tablets as they are antioxidant tablets and don't have any side effects.
I have used elidel cream in patients of vitiligo which has good results but I haven't used coal tar ointment for the same condition. I won't be able to comment on the use of coal tar in vitiligo.
You can still start with the medicines prescribed to you.
Wish you good luck.
Regards
Dr Asmeet
Above answer was peer-reviewed by : Dr. Naveen Kumar
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Dr. Asmeet Kaur Sawhney

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Practicing since :2007

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What causes itchy white patch on lower leg?

Brief Answer: Could be either vitiligo or lichen sclerosus et atrophicus Detailed Answer: Hi Thanks for being at healthcaremagic I have reviewed the attached photograph. It doesn't look like eczema. It can be either vitiligo or lichen sclerosus et atrophicus. I need to ask you few questions: What were the biopsy findings of the white patch? Did you have the white patch from the beginning or it started afterwards? Is the texture of the affected skin normal or it is slightly wrinkled? Which oral medication is given to you? Kindly revert back with the answers. Regards Dr Asmeet