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Ask Dr. Nair Your Own Question
Dr. Nair
Dr. Nair, Dermatologist
Category: Dermatology
Satisfied Customers: 9190
Experience:  MBBS, MD (Dermatology, Venereology & Leprology)
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Is this vitiligo or something else? Let me start buy

Customer Question

Is this vitiligo or something else?
Let me start buy thanking you for reading this extremely hard to write email. I understand you are a busy man and would appreciate your assistance in this matter.
About 6 months ago, I was masturbating incorrectly. No lubrication, rubbed my penis against my sweatpants. I went to use the bathroom and noticed discoloration on my penis head and upper half. I started getting alarmed when I noticed that the discolored patches had not gotten any better.
I visited 2 different dermatologists in my area around 3 weeks ago.
They both told me that I have vitiligo. I tried to explain that I was pretty certain I did this to myself. However, the both assured me that they were sure it was vitiligo.
I was prescribed Tacrolimus 0.1% and Desonide 0.05%. I have been applying twice a day.
This issue is something that has been bothering me tremendously. My anxiety has increased and I cannot stop thinking about the issue.
Notes:
The edge whe
Submitted: 2 years ago.
Category: Dermatology
Expert:  Dr. Nair replied 2 years ago.
Hello,
Thank you for your question. My name is***** and I will do my best to provide a useful input.
Would a photograph of the affected area be possible at your convenience?
Customer: replied 2 years ago.
here
Expert:  Dr. Nair replied 2 years ago.
Thank you for the photographs. Did you have any sores or wounds in the areas that are now white before they became white?
Do you have white spots anywhere else on the body?
Customer: replied 2 years ago.
No - nothing before
Expert:  Dr. Nair replied 2 years ago.
Thank you for the information. Then this is Penile Vitiligo. The two conditions which can mimic it are PIH (Post Inflammatory Hypopigmentation) and LSEA (Lichen Sclerosis Et Atrophicus), however PIH is preceded by skin trauma or inflammation and LSEA shows atrophy of the skin, is not so widespread, and is accompanied by tightening of the foreskin which makes it difficult to retract.
Vitiligo can be triggered by something called a 'Koebner Phenomenon'- this is that new Vitiligo patches can occur in areas of skin irritation. So in that sense you may be right in your observation that rough masturbation triggered the patches.
Penile Vitiligo is a hard problem to treat - you are on the correct first line treatment. I would however recommend a stronger steroid cream than you are currently using - something like Mometasone or Fluticasone would be appropriate along with continuing the 0.1% Tacrolimus ointment and I would suggest discussing this with your doctor. It can take a few months before any signs of repigmentation.
The good news with Penile Vitiligo is that it is not as prone to spreading to other parts of the body as some other types of Vitiligo.
Pleased feel free to ask if you have any queries. I will be happy to continue further and do everything I can to provide you with the service you seek.
Customer: replied 2 years ago.
Is there anyway to speed up the process? This is affecting my day to day life - my anxiety is getting worse day by day. It looks like there is no skin there anymore.You mentioned it would be some time before I would see any improvement - does that mean it will look like nothing is changing for a few months?I am worried that I have permanently damaged myself
Expert:  Dr. Nair replied 2 years ago.
There are treatments which can speed up response, viz. NBUVB therapy and the 311 nm Excimer laser but neither are recommended for the penile area.
Yes it would be at least a few months before you see an improvement. I understand your anxiety but really trying your best to come to terms with this fact is about the best thing you can do for yourself right now.
Customer: replied 2 years ago.
Ok. How often have you seen cases like this? Is my case very severe? What can I do to speed it up? ( change any eating habits or anything like that)I appreciate your quick response
Expert:  Dr. Nair replied 2 years ago.
You're most welcome. Yes I have seen this many times. I'd say your case is moderately severe. Apart from avoiding too much friction on the area (use plenty of lubrication during masturbation & sex), there is nothing that you can do really to speed up the process.
Customer: replied 2 years ago.
How likely am I to see a full recovery?
Expert:  Dr. Nair replied 2 years ago.
Very hard to say. Only time can tell. I wish I could be more specific than that.
Kindly consider rating our interaction to enable me to get credit for my work with you. Thank you.
Customer: replied 2 years ago.
What can I do after the cremes - as far as surgical/ laser procedures?
Customer: replied 2 years ago.
Posted by JustAnswer at customer's request) Hello. I would like to request the following Expert Service(s) from you: Live Phone Call. Let me know if you need more information, or send me the service offer(s) so we can proceed.
Expert:  Dr. Nair replied 2 years ago.
Good Morning,
Apologies I am in Asia and so cannot do a phone call.
As for the information you requested:
The Excimer laser can be used to help repigmentation. However as I said the penis is a sensitive area and not many doctors will be comfortable using a laser there.
Surgery can be done though since it has a better chance of repigmentation. There are numerous surgical techniques - punch grafting, cultured and non-cultured melanocyte transfer, skin grafting etc. - which work. The pre-requisite for all of these is that medical treatment should have been tried for at least 6 months and not worked and the condition should have been stable for at least one year (as in not increasing in size or spreading to other parts of the body).
Kindly consider rating our interaction to enable me to get credit for my work with you. You can continue to follow up even after if required. Thank you.