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White patches on neck, dorsum of hand. On steroids and immunosuppressant ointment. Not cured. Any treatment?

Sir, i am myself a 3rd year postgraduate student in Department of Anatomy . I am having white patches : on my nape of neck, dorsum of right wrist joint and one in the interdigital cleft of 2nd and 3rd fingers.AI showed to one dermatologist of my institute but he has prescribred me steroids, trimpo fprte and immunosuppresant ointment, with UV exposure. Since last one year i am taking the treatment and some spots which were small have gone but new ones have appeared but there is no relief in the bigger ones. Can u please tell me what should i do?
Asked On : Wed, 20 Jun 2012
Answers:  3 Views:  118
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Dermatologist 's  Response
Hi...dear Dr.Navson..,
Thanks for choosing HCM..,
Why U are frustrating ....don't worry my friend..,
Be sportive and positive..,
VITILLIGO...As U know, it is chronic depigmented genetically.,
determined problem..,So no cure but easily controllable..,
So be positive..,
Now U had segmental type vitilligo..,
hence medical treatment response is very slow..,
Now very good treatment is available in surgical side..,
Dermabrasion, needling, Intralesional very diluted steroids..on the
affected areas.,
Terisch skin grafting,
Fractional co2 LASER..,
Melanocyte cell transfer over the affected areas..,
wll give good respond in short time..,

Answered: Thu, 21 Jun 2012
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Dermatologist Dr. Mostaque Mahmud's  Response
Hi Doctor,
I think you know everything about your condition if it was confirmed as vitiligo.
Acrofacial/ and segmental type of vitiligo is sometimes resistant to all treatment and management is somewhat frustrating.
1. You are on right way of treatment
2. You could add tablet Melanocyl 2 tab at morning and after 2 hours apply melanocyl cream on affected area and expose under sunlight for 5-10 minutues for 1 month.
3. You can apply a Steroid + calciprotrein combination ointment once at night for one month
We need a follow up after 1 month.
With regards.
Answered: Thu, 21 Jun 2012
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Cosmetic & Plastic Surgeon Dr. Mayank Singh's  Response
Hi navson ,
Thanks for your query on healthcare magic
What you are talking about is most probably Vitiligo which is a condition that causes depigmentation of sections of skin. It occurs when melanocytes, the cells responsible for skin pigmentation become non functional. The cause of vitiligo is unknown, but research suggests that it may arise from autoimmune, genetic, oxidative stress, neural, or viral causes.
There are two types of vitiligo- Non segmental and Segmental
In non-segmental vitiligo (NSV), there is usually some form of symmetry in the location of the patches of depigmentation. New patches also appear over time and can be generalized over large portions of the body or localized to a particular area. . NSV can come about at any age, unlike segmental vitiligo, which is far more prevalent in teenage years
Segmental Vitiligo (SV) differs in appearance, etiology and prevalence from associated illnesses. Its treatment is different from that of NSV. It tends to affect areas of skin that are associated with dorsal roots from the spine and is most often unilateral. It spreads much more rapidly than NSV and, without treatment, it is much more stable/ static in course and it is associated with auto-immune diseases and a very treatable condition that responds to topical treatment.
Regarding your concern :
Kindly continue the treatment you are being given by your dermatologist , it is the absolute treatment to be given till your condition becomes STABLE and no new patches develop.
Once it stablizes kindly contact any qualified Plastic surgeon for taking care of all the large and small patches.
The surgical treatments what are possible for your condition after it stabilizes are :
1) Dermabrasion and Ultra thin Skin grafting ( over grafting)
2) Excision and closure of smaller patches in the resting skin tension lines RSTL followed by Fractional CO2 laser to remove the scars completely
3) Melanocyte transfer over the patches after dermabrasion

The results are very satisfying , so kindly donot panic.You are going to be a qualified anatomist yourself.Pathology do occure in our body but they are treatable to a very great extent .If you have any further queries kindly post again
take care
God Bless

Answered: Thu, 21 Jun 2012
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