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Are the white spots on my skin vitiligo or idiopathic guttate hypomelanosis?

Q: I am a 50-year-old brown skinned man. During the preceding couple of months, 8-10 white spots, 2-4 mm in diameter, have developed on my right shin, right thigh, left forearm, near left palm, left side of waist, and abdomen. In addition, some pale and many black/dark brown spots have also appeared on both my legs, thighs, forearms, waist and abdomen. Till now, the total number of light coloured/pale spots is 10-12 and that of black/dark brown is 15-20. There is no significant increase in the size or number of the white spots during the last one month. However, the number of light coloured and black spots has gone up a little. Almost all spots are smooth and not causing any discomfort. I have consulted two dermatologists. One says it is vitiligo. However, the other says it is idiopathic guttate hypomelanosis (IGH), a common problem of middle-aged people and has not recommended any treatment for it. I am totally confused and under severe psychological stress of vitiligo and dont understand what to do. I haven't taken the treatment for vitiligo. What should I do? What is the difference between IGH and vitiligo? Is there any test to determine whether the white spots are of vitiligo or IGH? Can the white spots of IGH spread on the face, hands etc. like vitiligo? Is there is any harm in starting the treatment for vitiligo even if it may be IGH? Will starting treatment for vitiligo prevent the spreading of white spots? If it is vitiligo, can the delay in starting its treatment be harmful?

A:In all probabalities, you are likely to have idiopathic guttate hypomelanosis with seborrhoeic keratoses. Even seborrhoeic keratoses lesions, when they fall off leave behind hypopigmentary spots. These spots generally remain small in size (mm) and restricted to shin area of the leg. They do not increase in size and do not show trichrome at the margin of lesions. All of them will be of uniform size, an unusual feature for vitiligo. I would like you to consult any other dermatologist to confirm this and not take vitiligo treatment.

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