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Skin Care and Diseases

Hypopigmentation of skin

06/15/2005

Question:

I am a multiracial female in my mid twenties (half black and half east indian). I have hypopigmentation spots (lighters spots) all over my lower back. My mother indicates that I have had this since I was much younger. I`ve been to a variety of dermatologists who have indicated it was everything from eczema to pitiriosis alba. It appears that the these lighter spots are spreading to my tummy and chest area along with more spreading up to my upper back. I recently had a skin biopsy to determine the problem, and the dermatologist found nothing there. Dermatologists have also told me that this is not a back fungus. Do you have any suggestions as to what this is. I think the problem I have when talking to a dermatologist is that they often don`t have experience dealing with skin like mine. Thanks for your help.

Answer:

Without examining you and reviewing the biopsy slides, it is difficult for me to be precise.  There are mixed racial individuals who have pigmentary mosaicism in which there are areas of lighter skin and darker skin intermixed.  There is usually not complete loss of color as in albinism.  It would be important to know what other members of your family have experienced.  In the case of Native American Indians and African Origin Blacks this mosaicism is almost predictable.  I do not know about the East Indies and African Origin Blacks but would suggest that that may in fact be the case.

In individuals who have slowly progressive pigmentary loss, ingestion of chemicals, such as unsuspected arsenic, may also lead to clinical changes.  The fact that your dermatologist found no clinical abnormality, in my opinion, favors the genetic origin of the process. 

It might be appropriate for you to visit with a genetic counselor in one of our larger Children's Hospital Institutions where they are familiar with this kind of phenomenon.

Pityriasis alba is usually associated with skin lesions that have been lightly crusted and inflamed.  Your presentation does not sound like it is post-inflammatory.

Good luck!  I hope you seek the care of a knowledgeable geneticist to help you in finding the cause of your pigmentary changes. 

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Response by:

Charles L Heaton, MD
Professor
College of Medicine
University of Cincinnati