Brief Answer:
Kindly upload Images

Detailed Answer:
Hello XXXXXXX Thank you for writing to us

I have had one previous discussion with you, sometime back, regarding the same issue..

Light colored spots in children can be due to reasons like...
Post-inflammatory hypopigmentation, nevus depigmentosus, nevus anemicus, pityriasis XXXXXXX vitiligo, tuberous sclerosis etc

Most of these can be differentiated on clinical examination and patient's history.

Tuberous sclerosis usually presents as ash leaf shaped hypopigmented macules, epilepsy and/ or mental retardation in infancy and early childhood.
There may be a family history of tuberous sclerosis Or it could be due to a new mutation.

I request you to upload a few good quality images of these spots so that I am able to guide you better.

Kindly click a digital photograph upload at "Reports section"

Or else you may also mail me the photos at YYYY@YYYY
Kindly mention the subject line of this mail as "Attn Dr. Kakkar".

Regards

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Brief Answer:
Likely this is Nevus depigmentosus; not ash leaf macule

Detailed Answer:
Hi.

This looks like nevus depigmentosus (ND). It has serrated/ irregular margins. ND usually is stable and only grows proportionate to body growth.
Another rare possibility is that this is a vitiligo patch, specially considering that you have noticed a few new spots appearing on legs. Kindly also upload images of these other spots as well.

However, this spot is certainly not an Ash leaf macule.

Ash leaf macules are elongated, ovoid in shape. This shape is classical of tuberous sclerosis.

This is not an ash leaf macule. Your doctor has also ruled out the possibility of tuberous sclerosis.

Tuberous sclerosis is a syndrome. It is also associated with neurological signs like epilepsy Or mental retardation.
These neurological signs must also be considered before making a diagnosis is tuberous sclerosis

Melgain is basic fibroblast growth factor peptide. It is mainly used to re-pigment vitiligo.
It cannot treat ash leaf macule Or nevus depigmentosus but some doctors do try treatments to re-pigment nevus depigmentosus and may notice an improvement.

Regards

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Brief Answer:
New spots do seem to suggest vitiligo; not ash leaf macules

Detailed Answer:
Hi XXXXXXX

I have reviewed the Image.
The new Image also shows a single hypopigmented/ depigmented, small sized lesion, probably on her thigh.
This is in addition to the earlier white spot, that was on her knee.

Though, Vitiligo is rare at this young age, however, since she has 2 new white spots come up recently, therefore, i would now like to think more in terms of vitiligo rather than ND.
These are certainly not ash leaf macules of tuberous sclerosis.

It can be really difficult in an infant to differentiate whether a single white lesion is vitiligo Or Nevus Depigmentosus/ ND.
If it was a single stable white spot it would have gone more in favor of ND because ND is usually solitary and stays stable in size.
However, recent appearance of 2 new white spots in her now goes in favor of vitiligo rather than ND.

Regards

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Brief Answer:
You may use b-FGF & Fluticasone propionate cream for these patahes

Detailed Answer:
Hi.

Yes, it is more likely vitiligo considering that new spots have appeared recently.
It is certainly not an ash leaf macule.
The shape of an ash leaf macule is oval at one end and pointed at another end and it resembles a leaf, therefore the name.. ash leaf.
Melgain is basic fibroblast growth factor (b-FGF).
Yes, you may use b-FGF as advised by your doctor. Roll it over the affected area at night, let it dry and expose the affected skin to sunlight the next morning, for a few minutes (10-15 minutes).
I would also like to add a moderately potent topical steroid e.g fluticasone propionate 0.05% cream, once daily. You may use this cream during day time after sun exposure.
Treatment for vitiligo depends on the extent of involvement. Focal vitiligo patches such as these should respond to b-FGF and Fluticasone propionate 0.05% cream.
Response is slow and it may take 6-8 weeks for visible improvement. Therefore you need to be patient with treatment.

Regards

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Brief Answer:
Vitiligo is likely

Detailed Answer:
Hi.

I can't comment on why your doctor said that he/she does'nt think it to be a vitiligo... however, the treatment which your doctor gave i.e melgain, is for a vitligo!!

I am sure your doctor must have also kept a possibility of vitiligo.. Is your doctor aware of the appearance of new spots?

As I already said that there may be a diagnostic uncertainty in infants with a single white spot but appearance of 2 new white spots goes in favor of Vitiligo. ND is usually solitary. It does'nt spread.

I suggest you to continue with the treatment and follow up after another 6-8 weeks.
A vitiligo patch would respond to this treatment

Regards

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Brief Answer:
Vitligo would respond to treatment but ND won't

Detailed Answer:
Hi.

No, ND won't respond to any treatment. Vitiligo will respond to treatment. Therefore response to treatment can sometimes be used as a therapeutic trial in doubtful cases of vitiligo.

As far as the color is concerned Vitiligo is totally devoid of pigment i.e is chalky/ milky white in color whereas ND is hypopigmented rather than depigmented/ totally white but this difference in color is better appreciated in wood's light in a dark room rather than with naked eye.

Vitiligo may remain as a single spot but it will usually spread i.e either increase in size Or new spots may form.

Regards

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Brief Answer:
Follow up after 6-8 weeks of treatment

Detailed Answer:
Hi.

I reiterate that ND is usually solitary. If it were a solitary patch I would have still thought in terms of ND as I did in my first discussion.
However appearance of 2 new patches is what makes me think more in terms of vitiligo.

Kindly go through the following link for more details:

http://www.pigmentinternational.com/text.asp?2014/1/2/56/147041

White patches only one leg are seen in 'segmental type of vitiligo'.
Vitiligo is not a hereditary disease. In fact most of the affected patients do not have a history in family.

Course of vitiligo is unpredictable.. it may remain stable for years, Or may spread slowly Or very fast.
Treatment depends on the extent on vitiligo and whether it is spreading Or not.

For a few patches such as this only topical treatment is sufficient. If suppose it were to spread in future Oral treatment can be considered.

I think the best approach for you would be to continue with the treatment as advised and follow up after 6-8 weeks of regular treatment.

Regards

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Brief Answer:
b-FGF is generally considered to be safe in children

Detailed Answer:
Hi.

Yes, Melgain (b-FGF) is considered to be safe.
You can safely use it as advised though there are no controlled studies in children.
Side effects can be some irritation Or redness. You can keep a watch for these side effects. If there is redness Or irritation discontinue it and report it to your doctor.
Also use a topical moderately potent steroid e.g fluticasone propionate 0.05% cream, once daily.
Topical steroids are also first line treatment for a focal vitiligo patch such as this.

Regards

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