Q: There are very tiny white patches on the foreskin of my penis. I do not have these on any other part of my body. The doctor told me it is the developing stage of vitiligo. He prescribed me the following medicines: clobetasol propionate, gentamicin sulphate cream, fluconazole 200 mg tablets and touch forte trioxsalen 25 mg tablets. He asked me to get a ten-minute exposure to sunlight after taking the last two medicines. Are these medicines meant for treating vitiligo? Should I use psolaren manaderm ointment, levoz tablets or tacroz gel? Will these patches spread to the rest of my body? I am in the hospitality industry and I cannot afford to have a skin disease. How do I get rid of my vitiligo problem?

A:Vitiligo can begin over the genitalia. But it is possible that there is something else and not vitiligo, for example, white patches can occur in lichen sclerosis etatrophicus (however, the skin is abnormal in some other ways) or it may be post-inflammatory hypopigmentation. The outcome in each varies and so does the treatment. Of all the drugs mentioned in the query, fluconazole and getamicin in the cream has no role in treatment of uncomplicated vitiligo; former is an anti-fungal and the latter is an antibiotic. Personally, I do not like to use a potent steroid on the genitals unless absolutely necessary. On the genitals and face, I avoid topical psoralens, because blistering can occur if patient is not careful and then this can be very uncomfortable for a few days. It is advisable to begin with milder and fewer medicines. If response is unsatisfactory or if there are unacceptable side effects, change the medicine or its dosage, and if necessary step up the medication. Vitiligo is very unpredictable. It can spread rapidly in some or it may spread slowly over a long period of time. In some, only a small area is affected while in others extensive areas get involved. It can stop progressing on its own. Thereafter, it may remain stationary for the rest of life, or may activate again. When and how many times, this will happen, nobody can predict. Most people respond to treatment. In some, the response is excellent, in some partial, and in an occasional case it can be a total failure. As long as the patches are not on exposed visible areas of the skin, one need not even take treatment, as this disease by itself does not produce any physical discomfort or adversely affect health of the individual. In the worst scenario, when patches are on visible areas and do not respond to treatment, one can carry on with one's profession (hospitality or another) by concealing them with camouflage make-ups now available commercially.