What is skin pigmentation?
A substance called melanin forms the pigment in our skin. Melanin is a complex polymer derived from the amino acid tyrosine. Melanocyte cells are specialized cells distributed throughout the top layer of our skin (also known as the epidermis). Once melanin is produced, it spreads to other skin cells nearby, giving a uniform appearance of color in our skin. Sometimes melanocyte cells can cluster in groups or “nests,” forming moles, freckles, age spots and other skin marks. At other times, our skin can lose pigmentation forming white spots and patches. The loss of pigmentation is called hypopigmentation.
Hypopigmentation is often caused by trauma, including burns, blisters, scrapes or other injuries that can scar and deplete the melanin in the skin. It can also occur due to congenital conditions, such as vitiligo or albinism. In some cases, hypopigmentation can be the result of an inflammatory skin reaction or skin infection that damages the melanin production in the skin. Seborrheic dermatitis, tinea versicolor, pityriasis alba, and eczema are some examples.
Hypopigmentation is usually a harmless condition, but it is difficult to treat; however, some specialised creams, topical treatments, laser treatments or medication prescribed by a doctor can help minimize the appearance of white spots or patches.
What could be causing the white spots on the skin?
While a loss of pigmentation can be worrying, it doesn’t always cause concern. Take a look at some of the most common causes of white spots below and be sure to visit a doctor to find the exact cause of yours.
White spots on the skin caused by Tinea Versicolor
Tinea Versicolor is a condition that occurs when a natural yeast found on the skin called pityrosporum ovale grows out of control and begins to change the pigmentation of the skin. When this occurs, patches of skin may become lighter or darker. Tinea versicolor can be caused by a variety of factors including hot weather, oily skin, a weakened immune system, hormonal changes and excessive sweating. This condition is more common in adolescents and young adults, frequently occurring in adults when they visit warm and humid climates. Tinea versicolor can typically be treated with over-the-counter anti-fungal medications, which are often effective in removing the discolored patches or spots.
If these medications don’t work, it is advised to contact your doctor for further tests to confirm it is tinea versicolor. A doctor may prescribe a topical cream or prescription pills to treat the condition. Many people are able to eliminate the infection entirely, but the skin may remain discolored for some time after, ranging from weeks to months. The condition can sometimes also flare back up, especially if the patient returns to a warm environment or switches hormonal medications.
Lichen sclerosus is a rare condition that creates thin patches of white skin. It is a long-term condition that usually affects the skin of the genitals. It is common in women who have gone through menopause, but men and children can also be affected. Common symptoms include smooth white spots on the skin, white patches that join together and become cracked or sore, itchiness, fragile skin, wrinkly or thickened skin, blisters and pain when having sex or going to the bathroom.
While the cause of lichen sclerosus is unknown, hormonal imbalances are a suspected factor as well as an overactive immune system. It is not contagious and cannot be spread through intercourse. There’s currently no cure to the condition but symptoms can be managed with the use of steroid creams and ointments. When used correctly, the creams usually help ease or alleviate symptoms entirely.
Eczema causes white spots on the skin
Eczema, also known as atopic dermatitis, is a skin condition that causes red, itchy and dry skin as a result of inflammation. Sometimes white patches or spots can form within a red rash. This condition is typically found in children but can continue into adulthood. Eczema symptoms include dry, scaly, thickened skin that is almost always itchy. Especially among darker skinned people, eczema can cause skin discoloration, making the affected area lighter or darker than the surrounding skin.
The cause of eczema is unknown but it is thought to be linked to allergies and asthma and is suspected to be an overactive immune response to an irritant. While there is no cure for the condition, symptoms can be managed. For many people, eczema will even go away over time. Doctors can prescribe topical corticosteroid creams and ointments, oral medications and light therapy to help ease symptoms.
Pityriasis alba is a skin disorder commonly found in children and young adults that causes pale pink or red, scaly patches to form on the skin. When these patches clear up, the skin is left discolored, with smooth light patches taking their place. Lesions can be round, oval or irregular in shape and many patches can occur at once, especially on the face and arms. The condition is believed to be associated with eczema and, as such, an overactive immune response is a suspected cause.
Patches may clear up within a few months or, in some cases, can last for several years. No treatment is required for pityriasis alba as the patches usually go away over time, with most cases disappearing by adulthood. However, a doctor will often prescribe a steroid or non-steroid cream to ease the dryness, and/or itching. In some cases, the patches can flare-up in the future and require further treatment.
Idiopathic guttate hypomelanosis is a cause for white spots on the skin
Idiopathic guttate hypomelanosis is a disorder that causes 1 to 10 mm flat white spots to occur, typically on the shins, arms upper back and face. It is usually found in fair-skinned individuals but can also occur in dark-skin. While the exact cause is unknown, they often begin to form as a person ages, usually appearing in those 40 years or older.
The spots are benign (not harmful) and are thought to be brought on by sun exposure, which kills melanocyte cells in the skin. No treatment is usually needed but preventative measures to block against sun damage should be taken. Topical steroids, creams, and dermabrasion can be used to minimize the appearance of the spots.
Vitiligo is a disease in which the skin forms white patches. It occurs when melanocyte cells stop producing melanin, either because they die off or simply stop functioning. Causes of the condition are unclear, but it is thought to be an autoimmune disease. It can appear at any age and on any part of the body. Sometimes the white patches will spread throughout the body, while other times they will remain the same size. Vitiligo often first appears as a small, pale spot on the skin that, over time, will develop into a larger patch.
Vitiligo is generally harmless and it is not contagious, but its cosmetic appearance can cause emotional and psychological distress in people who suffer from it. There are several treatments that can help reduce the appearance of vitiligo, including corticosteroid creams, depigmentation treatments and UVA and UVB phototherapy. Some of these treatments come with their own side effects, so it’s recommended to discuss options with a doctor.