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Q: The dermatologist for both of my grandchildren (ages 1 and 4) has indicated that he has observed "very white" spots about the size of dimes.

He says that they are vitiligo. Could they be something else?

-- K.O., Oveido, Fla.
A: The chances are that the small white spots you write about will not be a major problem. But, certainly, it's important to make sure of the diagnosis.

Vitiligo is a condition in which the cells that cause coloration of the skin -- the melanocytes -- are being destroyed in a localized area of the skin. The reason this occurs is not known, but it's probably an example of the immune system mistaking normal cells for foreign invaders.

Vitiligo occurs in about one in 100 people without regard to race or sex. However, it occurs more frequently in people with thyroid problems, diabetes, pernicious anemia and Addison's disease. Depigmentation of the skin can also be secondary to atopic dermatitis, lupus, psoriasis and alopecia.

In addition, a fungal infection called tinea versicolor may mimic the appearance of vitiligo. But tinea typically occurs on the trunk, whereas vitiligo typically appears at the corners of the mouth and on the finger.

Scraping of a tinea lesion will yield fungus that can be seen under the microscope. A biopsy will show vitiligo has destroyed all the melanocytes as compared to tinea where many remain alive.

In an article recently published in the Journal of the American Medical Association, researchers reviewed much of the medical literature on the treatment of vitiligo and found two things. First, the combination of topical steroids and ultraviolet light was the most effective treatment and it had the fewest side effects.

Vitiligo poses no threat to health, other than possible associated medical problems and the emotional trauma of cosmetic abnormalities. But the trauma may be substantial, especially in people with darker skin and probably more so in children.

Unfortunately, the treatment for vitiligo is often prolonged, may not be successful, and can have side effects, including increased risk of skin cancer for treatment with ultraviolet light and skin problems resulting from prolonged topical steroids.

So it's especially important to compare the benefits with the risks. In fact, most pediatricians feel that treatment, if recommended at all, be delayed until the person is at least 12 years old.

If you and the parents are concerned about what's happening with your grandchildren, I suggest that you call the dermatologist, discuss your concerns and ask what was done to make the diagnosis.

Update on SIDS: The National Institute of Child Health and Human Development recently issued a winter alert for parents and other care-givers of infants to prevent sudden infant death syndrome.

Although the number of infants who die of this condition each year is comparatively small (about 3,000 to 4,000 in North America), the fear of SIDS is much more widespread.

In SIDS, children die during sleep for no apparent reason. SIDS occurs more often in the winter. It's thought that this is due to a higher rate of lung infections and the bundling of children in more clothing and blankets when put to sleep.

Studies have also shown that African-American and American Indian children have two to three times the risk of SIDS. Even so, all children need to be taken care of to reduce the risk of SIDS.

Experts advise placing babies on their backs to sleep on a firm mattress with no blankets or fluffy bedding under the baby and no pillows and stuffed toys. It is also important to keep the baby from becoming overheated. Keep the temperature in the baby's room so it feels comfortable for an adult and don't overbundle the baby.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is

This column is for informational and educational purposes only. It is not intended to provide medical advice or take the place of consultation with a doctor or other health-care provider.

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