Dear Doctor
What do I do?!?! Since I started wearing underwire bras the straps have been rough on my skin. I’m not wearing them too tight on my shoulders. The straps dig into my shoulders and now I have color loss. What should I do?
Dear Patient
The white patch on your shoulders where your underwire bra dig into the skin could be caused by either vitiligo or another condition known as postinflammatory hypopigmentation. These two conditions can be differentiated by a Wood’s Light examination by your nearest dermatologist.
Koebner Vitiligo
Vitiligo is a condition which affects the skin’s pigmentation and results in loss of the normal skin color.
Vitiligo can develop at the sites of trauma like cuts, burns and excessive friction. This is called the Koebner phenomenon.
Koebner Vitiligo Treatment
Vitiligo that affects just one area can be treated by using:
- Sunscreens
When out in the wearing and you are wearing clothes that expose your shoulders ensure that you apply Broad spectrum sunscreens that offer protection from UVA and UVB rays. The sunscreen should also have a sun protection factor (SPF) of 30. This is very important because the patches of skin that are hypopigmented (without their normal skin color) tend to develop sunburns without tanning.
Ensure that you also apply Broad spectrum sunscreens on other parts of your body that are exposed to the sun since sunburns can cause vitiligo to spread. Therefore make it a habit to wear wide brimmed hats and protective clothing with long sleeves and slacks that cover your legs.
- Topical Corticosteroids
Corticosteroids that are applied on the skin are used to treat vitiligo since they have anti-inflammatory properties. Examples include mometasone furoate (Elocon) and betamethasone dipropionate (Diprosone).
- Topical Immunomodulators
Immunomodulators are substances which alter the response of the immune system. These medications, which are also known as calcineurin inhibitors are also used to treat vitiligo since they reduce inflammation. Examples include tacrolimus (Protopic).
- Avoiding trauma
You may need to change to other types of bras which do not cause a lot of friction on the shoulders.
Post Inflammatory Hypopigmentation
Post inflammatory hypopigmentation is a condition in which the affected skin becomes lighter than the surrounding skin due to conditions that cause inflammation.
Causes of Post Inflammatory Hypopigmentation
Causes of post inflammatory hypopigmentation include infections like chickenpox, burns and photofacials. Skin conditions with inflammation like seborrheic dermatitis, atopic dermatitis and psoriasis can also cause post inflammatory hypopigmentation.
Treatment of Post Inflammatory Hypopigmentation
The treatment of post inflammatory hypopigmentation is similar to that of vitiligo and includes the use of:
- Sunscreens
Broad spectrum sunscreens should be applied since tanning of the normal skin can make the post inflammatory hypopigmentation patches more obvious.
- Topical Corticosteroids
Mild corticosteroid creams like 1% Hydrocortisone can be applied on the affected skin.
- Topical Immunomodulators
Immunomodulators like tacrolimus (Protopic) are used to treat post inflammatory hypopigmentation.
- Avoiding trauma
You may need to change to other types of bras which do not cause a lot of friction on the shoulders since the hypopigmentation will continue spreading if it is caused by friction.
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