Brief Answer: upload am image of lesions Detailed Answer: Dear XXXXXXX Thanks for writing back. I think I need to give you an unbiased and my individual clinical opinion. For the same, please send clear and good resolution images of those light colored spots over elbow and lips. Send me the pics and I shall try to clear all tour doubts in detail. I have my reservations with diagnosis of p XXXXXXX over lips. Waiting to see the pics. Regards

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Brief Answer: details below Detailed Answer: Hi, Thanks for writing to us. I have seen the attached images. Though you have sent good quality images but still the hypopigmented spots are not much appreciable. I would like to confirm if your child has hypopigmentation of inner side lower lip. Also I would like to know if the lesion over elbow was initially bigger in size and now with treatment it has repigmented with few discreet hypopigmented spots left. Personally I have not seen or heard of P XXXXXXX involving lips. P XXXXXXX is commonly seen over cheeks, around mouth or eye. We can label lesions over elbow and lips as post inflammatory hypopigmentation. PIH can develop over these areas after trauma, eczema, any other preceding skin lesion etc. Even dry chapped lips can finally heal with hypopigmentation. Another diagnosis has to be previtiligo( an initial stage of vitiligo where lesions are still hypopigmented instead of depigmented.) Is it possible that your doctor labelled these as post inflammatory hypopigmentation or P XXXXXXX just to allay your anxiety or keep you stress free as the diagonisis of vitiligo itself has made you quite anxious. I can understand your concern as it involves your child. Now if you ask me, I will keep two differentials Post inflammatory hypopigmentation and previtiligo. As I had already discussed in previous post we treat any case of hypopigmentation or depigmentation in same way whether its due to trauma, burn or chemical injury, vitilgo or following any skin disease. So the treatment provided should not make you more concerned thinking that these drugs are only used in vitiligo. We use steroids, tacrolimus, melanocyl in number of skin conditions like pigmentation disorders, psoriasis, eczema etc. Melgain can be used in any hypo or depigmented disorder. Now to answer your questions specifically The treatment has to be continued till lesions repigment completely. It can be given for a month to an year. Melgain as I mentioned contains growth factors and peptide and can be used for any hypopigmented or depigmented spot irrespective of cause. We usually treat P XXXXXXX initially with steroids and emollients but if hypopigmentation persists we can use steroid, tacrolimus, melgain, melanocyl, even phototherapy to induce pigmentation. So irrespective of what your dermatologist has labelled, his treatment is perfect. A good doctor not only provides an apt treamtent but also counsels the patient properly. I still feel that may be your doctor didn't use the dreaded word vitiligo to keep you anxiety free. Now as your child has hypopigmented spots, it has every chance of resolving completely. Even if we consider it as previtiligo, response to treatment is good in children and in lesions over face. So I would just say that do not worry about the diagnosis, just continue with the treatment advised as he has prescribed best medicines available for a hypopigmented skin lesion. Your child will definitely respond beautifully to the treamtent provided. Take care

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