Nevus depigmentosus

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Nevus depigmentosus is usually a congenital benign non progressive white macule (white patch or spot) with hypopigmentation. Nevus depigmentosus is stable in size and distribution, during the lifetime of the affected individual. The investigation on the histopathology and pathogenesis of this ailment is not complete and its cause is not fully understood.

Symptoms of nevus depigmentosus

These white spots appears as stable spots affecting any part of the body. However they have been found to affect the trunk, hands and feet often.
They do not grow in size. They are usually present from birth and in rare cases they are formed at a later stages of life.
These lesions appear round or oval and grow only with proportion to the growth of the person.
In rare cases certain neurological afflictions have been associated with this ailment; delayed development, seizure disorder and mental retardation have been associated.

Causes of nevus depigmentosus

These white spots are believed to form due to functional abnormalities of the melanocytes and morphological anomalies of melanosomes.
This results in the lowered pigment production in the affected area giving the characteristic pale white spots in the skin.

Differential diagnosis of nevus depigmentosus

Differential diagnosis for this disorder is done to rule out the possibility of affliction by vitiligo (leucoderma) and leprosy.
Unlike leucoderma the white patches or spots are usually present right from birth.
Leucoderma normally show hyperpigmented border to the lesions, whereas in this disorder there is no clear cut hyperpigmented border.
Vitiligo white spots normally grow in size and spread. In rare cases they disappear altogether.

In nevus depigmentosus disorder the white spots are stable and do not spread.
Vitiligo white spots normally occur around the orifices of the body like eyes, ears, nostrils, mouth, umbilicus and genitalia.
Nevus depigmentosus white spots are usually found on the trunk, hands and legs.
The back, chest and buttocks are the most common sites of affliction.

These white spots do not show any alteration of sensitivity or texture of the affected area.
In leprosy the white pale spots occur at a later stage of life and show mild inflammation, hair loss, shine in the skin and numbness. Histological study can differentiate leprosy.
The differential diagnosis for nevus depigmentosus includes hypomelanotic macules of tuberous sclerosis, vitiligo, and anemicus. Nevus depigmentosus on the belly

Treatment for nevus depigmentosus

Treatment is not necessary for this ailment. Use of sunscreen and avoiding exposure to sun is advised as the affected area may not pigment on sun exposure; increase in the contrast between the normal skin and the lesion area will affect the aesthetic appearance. There is also the danger of severe sunburn of nevus depigmentosus area on prolonged exposure to sun.

Sep 18, 2015

Skin care - Fordyce spots treatment and cure

White bumps on skin, lips, fingernails, teeth, tonsils and genitalia → Fordyce spots overview → Fordyce spots treatment and cure → Nevus depigmentosus
Fordyce spots require no treatment as they are benign and harmless. However for aesthetic appearance, treatment and complete cure is available.

Topical applications for fordyce therapy

The acidic form of vitamin A is Tretinoin and it is also known as ATRA (all-trans retinoic acid).
It is a medicine most commonly used in treating acne.
The topical form is available as gel and cream. For the cure of fordyce spots this ointment must be applied daily till the condition resolves.

Individuals with sensitive skin must use this cautiously and if any adverse reaction starts must discontinue immediately.

Women who are pregnant or who are planning a pregnancy should not use it as tretinoin is a teratogen and can cause fetal abnormalities.
They can only consider the therapy for fordyce spots after child birth.
Better results are achieved when tretinoin used along with AHAs (alpha hydroxy acids) which is another topical solution for acne.
Individuals undergoing therapy for fordyce disease with the above drugs should protect themselves from sun exposure as the treated skin can get severe sun-burn and sun poisoning.

Fordyce spots on the upper lips (enlarge)

Use of super pulsed laser therapy

For patients seeking improvement of aesthetic appearance from this condition, therapy with CO₂ super pulsed laser has been found to be very effective and safe.

Excellent results with complete re-epithelization was achieved.

No side effects were observed and in the medicated area no remnants of the fordyce condition were seen in 15 days.

Diathermy, liquid nitrogen freezing and TCA peels have been used for fordyce spots treatment and cure with varying levels of success.

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Milia treatment - milk spots cure - prevent milia

Overview > Causes, signs and symptoms > Milia treatment, cure and how to prevent milia
Milia treatment and cure in newborn babies is to keep the infant clean and well-fed and wait for the baby milk spots to cure by themselves.

Milia are harmless and may take long time to resolve in adults and in some cases may not resolve at all.
Fresh milia milk spots may appear again.
For aesthetic appearance if the affected individual wishes, the milia can removed.

In adults milia treatment, if required, is by exfoliation, dermabrasion, electrodesication, cryosurgery or simply removing the contents by incision and extraction.

Milia treatment and cure by exfoliation

There are a number of exfoliating creams and ointments available.
You can apply once in a day before going to bed.
 In some individuals these creams can cause rash like symptoms and take care to test the suitability of the cream for the treatment by applying it on a small area on your arm.

Alpha Hydroxy Acids containing creams and vitamin A derivative creams have been found to be effective.

Alternately dab and hold a fairly warm towel on the face for 5 minutes to moisten it and make it fairly warm.

This soaks up and softens the milk spots.
Keeping the face moist and warm use a exfoliating scrub to remove surface debris on the skin.
By this treatment the skin covering may loosen and open, causing the contents to come out.

Continue this treatment once in two days till all the milk spots resolve.
The skin on the eyelids is very delicate; take care not to injure it in scrubbing.

Microdermabrasion for the treatment and cure of milia

This is the procedure used in beauty parlours and beauty spas. It is better to have this procedure done by a trained Aesthetician.

Earlier abrasive crystals or wands having rough surface were used. With the advent of technology nowadays a variety of machines are available for microdermabrasion.

Effectiveness varies from person to person and machine to machine. As this procedure is usually priced high think twice before going in for this.

Milia treatment and cure by extraction

It will be better if this is done by a trained aesthetician or a dermatologist.

Face is first cleaned and dabbed with warm face cloth.

With sterile needle the centre of the bump is punctured and a small opening is made.

A gentle squeeze on the spot is made with a suitable forecep (made for such purposes) and the contents are removed. Some antiseptic cream is applied on the cut and it heals in a day or two.

Dermatologists sometime use electrodesication or cryosurgery for the treatment of milk spots.

How to prevent milia

In adults taking certain precautions one can prevent milk spots.

Use only tested skin care products from reputed manufacturers.
Avoid heavy makeup and do not smother the skin with heavy comedogenic lotions and face creams.

To prevent milk spots avoid prolonged sun exposure. If required to go out in the sun, use effective and light sunscreen.

If you are getting milk spots afresh, try periodical exfoliation to prevent milia from forming.

Take medical advice if milk spots are chronic as it could be due to some underlying disease or due to hereditary factor.

Hence for adults milia treatment and cure is possible and by taking precautions it is possible to prevent milia.

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Milk spots - Baby milk spots - Milia causes

Overview > Milia Causes, signs and symptoms >
Treatment, cure and prevention

Keratin (from dead epidermal cells) causes milia (small epidermoid cysts), when it gets trapped in small pockets on the epidermal surface as cysts/bumps, instead of getting exfoliated (sloughed off) naturally.

The symptoms of milia milk spots are that these small white bumps have no mouth (opening) and on abrasion redden on the edges leaving the central portion white.

Causes of milia in newborn babies

• This mild skin disorder of baby milk spots or milia show the signs and symptoms as small bead-like raised white bumps on the skin around nose, ears, eyes, cheeks and chin of newborn babies.
• In some babies these show symptoms like small bumps on the roof of the mouth, gums or genitalia.
• Milia is very common in newborn babies and its signs and symptoms are found in almost half of them. They usually appear 3-4 days after birth of babies and last for about 20-30 days and resolve naturally.
• In infants born prematurely the affliction is less and these oil seeds form late (after 2-3 weeks).
• In rare cases rough bedlinen and clothing has been found to induce the formation of this ailment.

Milk Spots (image by http://www.dermnet.com)

Causes of milia in adults

• Milk spots can also appear on adult body more often on the face with unknown reasons.
• Injured or inflamed epidermal region of the body also can form milia in some individuals due to set back in the skin exfoliating process.
• Among the common and less understood causes of milk spots are the cosmetics and hair care products containing chemicals.
• Facial creams sometimes smother our skin, preventing sloughing of keratin , dead epidermal cells and sebaceous matter.
• Comedogenic nature of some facial make-ups, moisturizers and sunscreens (contrary to their claims of being non-comedogenic) causes milia, especially on the eye lids.
• Some lip balms and lip sticks may be the causes of milk spots on the edge of lips vermilion border.
• Regular exposure to sun and aging also leads to this skin condition.
• Certain diseases like PCT (Porphyria Cutanea Tarda ) and epidermolysis bullosa can give rise to these bumps as the secondary disorder.
• Skin stress and trauma due to radiotherapy and dermabrasion and the use of potent topical corticosteroid, develop symptoms of milia in some persons.

Genetic familial dominant autosomal inheritance disorders have been found to be one of the causes of milia.

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Milk spots - milia - baby milk spots - small white bumps on skin

Causes > Treatment, cure and prevention
Milk spots also called milia, oil seeds or baby milk spots are benign cysts filled with keratin.
They appear as small whitish or slightly pinkish bumps on the skin.

The top most layers of skin die and exfoliate. Milia are actually dead skin trapped as small bumps in pockets on the skin without natural exfoliation.
They also arises in undeveloped sebaceous glands. No opening is visible in it.
They appear usually on the skin around eyes, forehead, cheeks, chin and nose; sometimes they may appear on the genitalia.

Baby milk spots may also appear on gums and the roof of infants mouth (Epstein's pearls).
Baby spots are usually associated with newborns and infants.
About half of the newborn babies develop these. Both boys and girls are affected equally.

In young children baby spots usually disappear within 15-30 days. In infants no treatment is necessary and there are no lasting effects.

However this can affect persons of any age. In older children and adults they may persist and may require removal.
In adults who are very particular about looks, these can be removed.
Removal by an aesthetician or dermatologist is advised.

Secondary oil seeds have been found to occur in persons with sensitive skin stressed by harsh chemicals and heat.
They can also occur on inflamed or injured parts of the body.
They can also arise after a treatment with topical corticosteroids.
Milia (milk spots) on eye lids
It is believed that the milia in some cases have hereditary predisposition and reports of dominant autosomal inheritance of this familial disorder have been documented.

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