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What Do White Patches Indicate After Recovering From Lichens?

Posted on Thu, 2 Nov 2017

Question: My complexion is generally brown. About a year and a half ago I developed a strong itch on my leg. I went to see a dermatologist about 6 moths later & he diagnosed me with Lichen. He gave me a medication. I started to use the medication & the itching stopped almost immediately. So I stopped using the medication. Now I have a white patch in the area that I continuously itched for 6 months.

(1) I want to know if I should use any special precautions since I have that white patch on my leg? If I am out in the sun for an extended period should I put on extra sunscreen on that portion of my leg?

(2) I was recently in the sun for an extended period & I put some sun screen on that leg. I just noticed a small red dot in the area that is now white - is that any cause for concern?

Thank you.

Answered by Dr. Dr. Kakkar (43 minutes later)

Brief Answer:
Kindly upload a few images

Detailed Answer:
Hello. Thank you for writing to us.

I am Dr. Kakkar (Dermatologist). I have noted your concern
Perhaps you have a depigmentation secondary to inflammation (post inflammatory depigmentation that can sometimes happen in thick plaques of hypertrophic lichen planus) or it is due to use of potent topical steroids for an extended period of time. I request you to kindly upload a few images in "Reports Section" so that I am able to guide you better.

Regards

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Dr. Kakkar (30 hours later)

Dr I have uploaded 3 photos. Please let me know if you didn't receive them & thank you for your assistance

Answered by Dr. Dr. Kakkar (3 hours later)

Brief Answer:
Vitiligo

Detailed Answer:
Thank you. I have received the image.

I can see a depigmented patch of 'Vitiligo' with perifollicular repigmenation and repigmentation from the edges of the patch.
If the patch is normally covered with clothing than there is no need to use a sunscreen.
Over the patch, I suggest you to use tacrolimus 0.1% ointment, twice a day. Rub it in. It is a prescription medication. Treatment is long term and I suggest regular follow up at intervals.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Kakkar (1 hour later)

Dr. -

1. why do you recommend the use of tacrolimus 0.1%? what are your specific concerns?

2. for how long should I XXXXXXX this medications?

3. is there anything else I should watch for ?

Answered by Dr. Dr. Kakkar (12 hours later)

Brief Answer:
Tacrolimus

Detailed Answer:
hi.

Tacrolimus 0.1% ointment is a non-steroidal topical immunomodulatory drug that is used for inducing repigmentation in depigmented patches of vitiligo. Response is visible as early as 1-2 months but may take 3-4 month for compete repigmentation.. It has no side effects as such except a mild smarting sensation.
Vitiligo may progress and present as additional white spots elsewhere on the body or it may remain stable and be non progressive.

Regards

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Dr. Kakkar (34 hours later)

Dr I may be mistaken but it was my understanding that my white spots on my left leg - that I sent you pictures of - were a result of me scratching my leg excessively for a year before I started using the clobetasol & before the lichen diagnosis. I didn't think it was due to Vitiligo. Am I mistaken?

Dr do you also believe there is an increased risk of skin cancer in that part of my leg due to this condition? If so what can I do to prevent such an outcome?

Thank you for your assistance.

Answered by Dr. Dr. Kakkar (13 hours later)

Brief Answer:
Regarding vitiligo

Detailed Answer:
Hi.

Vitiligo can start at the site of trauma (koebnerization) - vigorously scratching due to an underlying eczema like lichen planus can induce vitiligo at the site of scratching.
There is no increased risk of skin cancer unless it is chronically sun exposed and untreated. Leg is usually covered with clothing for most part of the day so you need not worry about skin cancer.

Regards

Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Yogesh D