White spots on the skin: causes of white skin spots

White spots on the skin can be cosmetically disturbing. White spots on the skin usually indicate a loss of skin pigmentation. A pigment disorder can manifest itself as small spots or large spots, which can appear anywhere on the body. There are different types of pigment disorders and the most common of them is vitiligo (see image). This causes parts of the skin and hair to lose their color, especially on the face, hands and pubic area. Milky white spots develop on the skin, varying in size. Other possible causes of white spots on the skin include tinea versicolor, halo birthmark, lichen sclerosus, morphea, post-inflammatory hypopigmentia, tuberous sclerosis and confetti skin.

  • Skin discoloration: white spots on the skin
  • Common complaint
  • Anyone can suffer from it
  • Causes of white skin spots
  • Vitiligo: white spots on the skin
  • Loss of skin pigment
  • Risk factors
  • Symptoms
  • Diagnosis and treatment
  • Tinea versicolor: white skin spots
  • Summer yeast
  • Risk factors
  • Therapy
  • Lichen sclerosus: small white spots on the skin
  • Morfea: discoloration and hardening of the skin
  • Post-inflammatory hypopigmentia
  • Tuberous sclerosis: light patches on the skin
  • White spots on arms and legs due to Bier spots
  • Confetti skin: spot discoloration of the skin
  • Halo birthmark: birthmark with a white ring
  • White grains on the skin due to milia
  • Pityriasis alba or white-cheeked

Skin discoloration: white spots on the skin

Common complaint

Skin discoloration is a common skin problem, and it can appear in the form of white spots, dark spots, or other changes in skin color. White spots on the skin usually indicate a loss of pigmentation of the skin, in the form of reduction of pigment (hypopigmentation) or complete absence of pigment (depigmentation). This can manifest as small spots or large spots that can appear anywhere on the body, including the neck, shoulders, upper back, shins and forearms. White spots on the skin are not usually associated with pain, itching or irritation, but they can cause psychological distress, especially in people with darker skin where the contrast in skin color is more pronounced.

Anyone can suffer from it

White spots can occur in people of all ethnic backgrounds or skin color. They occur in both men and women, adults and children. Some white spots develop into brown spots with whitish scaly skin. This type of white spots may be accompanied by itching.

Causes of white skin spots

There are many possible causes of white spots on the skin, but the most common is vitiligo. Other possible causes include:

  • Tinea versicolor;
  • Halo birthmark;
  • Lichen sclerosus;
  • Morphea;
  • Beer spots or hail skin;
  • Post-inflammatory hypopigmentation;
  • Tuberous sclerosis; and
  • Confetti skin.

Vitiligo of the hands in a dark-skinned person / Source: James Heilman, MD, Wikimedia Commons (CC BY-SA-3.0)

Vitiligo: white spots on the skin

Loss of skin pigment

White spots that develop on various areas of a person’s skin are usually caused by vitiligo. Vitiligo is a condition characterized by the loss of the skin pigment called melanin, which is normally produced by cells called melanocytes. The discoloration is caused by the destruction of the melanocytes, but the exact cause is unknown. It may be an autoimmune disease, in which the body’s immune system destroys its own cells.

Risk factors

Up to two percent of the Dutch population suffers from vitiligo. The white spots usually appear early, between the first and third decades of life. Men and women are affected equally. Risk factors include:

  • Family history of vitiligo;
  • Premature graying of the hair; and
  • Autoimmune diseases such as Hashimoto’s, a disease of the thyroid gland.

White spots on the skin due to vitiligo / Source: Charlinb001, Wikimedia Commons (CC BY-SA-3.0)

Symptoms

A rapid loss of skin pigmentation often characterizes the development of vitiligo. However, it can also be followed by a period of stability, but the course is difficult to determine and varies per individual. Preferred locations are:

  • Body folds (armpits, groin);
  • Around joints (hands, feet, knees);
  • Body openings (mouth, anus); and
  • Mucous membranes.

It can also be observed on the hair and eyelids. Once the white spots have developed, the skin cannot return to its normal color.

Diagnosis and treatment

The diagnosis of this skin condition can easily be made by a doctor after a medical history and physical examination. Healing is not possible. The aim of the treatment is to reduce the physical appearance of the skin spots by applying cosmetics to the white spots to camouflage them, inducing repigmentation using corticosteroid treatment or phototherapy, reducing the pigmentation of unaffected areas, and by skin grafting.

Pityriasis versicolor / Source: User Evanherk on en.wikipedia, Wikimedia Commons (CC BY-SA-3.0)

Tinea versicolor: white skin spots

Summer yeast

Tinea versicolor or ptyriasis versicolor, sometimes referred to as ‘summer yeast’, is another common and harmless skin condition that affects skin color. It is caused by the yeast Malassezia furfur, which is common on human skin. However, certain conditions can cause the overgrowth of this yeast, causing white and reddish-brown patches on the skin. Damp, warm and oily skin encourages yeast overgrowth, especially on the upper arms, neck, abdomen and thighs. It is not a contagious disease.

Risk factors

Conditions that lead to the appearance of white spots on the skin due to tinea versicolor include a hot and humid climate, excessive sweating, oily skin, malnutrition, pregnancy, medications such as corticosteroids, or weakening of the immune system.

Therapy

The condition can be treated with antifungal medications such as terbinafine, clotrimazole, or miconazole. Shampoo with selenium sulfide (Selsun®) is a medicinal shampoo that can be used against this condition.

Lichen sclerosus: small white spots on the skin

Lichen sclerosus is a rare condition in which the skin slowly loses its elasticity. This makes the skin feel firm and tight and becomes white in color. Lichen sclerosus can appear anywhere on your body, but most commonly it is seen on the skin of the genitals or on the skin around your anus. Anyone can get lichen sclerosus, but postmenopausal women are at high risk. Treatment focuses on relieving complaints and preventing complications.

A thickening of the skin due to morphea / Source: Leith C Jones, Wikimedia Commons (CC BY-3.0)

Morfea: discoloration and hardening of the skin

Morfea is a rare skin condition that causes painless, discolored patches on the skin. It concerns hardening and discoloration of the skin. Usually the skin on the abdomen, chest or back changes. But it can also occur on your face, arms or legs. Morfea tends to affect only the outer layers of the skin. Some forms of the condition also cause limitation of movement in the joints. Morfea usually disappears on its own over time, but recurrence is not excluded. In the meantime, medications and other treatments can help counteract skin discoloration and other effects.

Post-inflammatory hypopigmentia

Post-inflammatory hypopigmentation presents as white patches on the skin with an irregular outline. Often the loss of pigment is partial or complete. It can occur with many eczema-like conditions, where a light spot temporarily remains after the eczema has disappeared. This can occur with the following conditions:

  • Eczema;
  • Psoriasis; and
  • Fungal and yeast infections.

Tuberous sclerosis: light patches on the skin

Tuberous sclerosis, previously also known as Bourneville-Pringle disease, is characterized by the formation of accumulations of certain cells that evolve into small tumors (hamartomas). These can occur in many organs. One of the first symptoms of this congenital condition are light spots on the skin, usually located on the trunk.

Beer spots on the hand / Source: Mikael Häggström, Wikimedia Commons (CC0)

White spots on arms and legs due to Bier spots

Beer spots or hail skin are small, light spots usually found on the arms and legs of young adults, where the skin in between appears red but turns white when you press on it, so these light spots disappear. Beer spots are a benign physiological vascular abnormality, caused by the squeezing of the blood vessels in the skin. Beer stains were first described in 1898.

Confetti skin: spot discoloration of the skin

The medical name for confetti skin is hypomelanosis guttata. This condition causes small, depigmented spots to appear on the skin. Preferred areas are arms and legs, especially the shins. The cause is unknown.

Halo birthmark: birthmark with a white ring

A halo birthmark is a benign birthmark with a depigmented ring around it. Such a birthmark is relatively common in children and young adults, just as often in girls as in boys. The cause is unknown, but it is believed to be a result of an immune reaction against melanocytes (pigment cells).

Milia on an eyelid, visible as small white dots on the eyelid / Source: Silver442n, Wikimedia Commons (Public domain)

White grains on the skin due to milia

Milia are firm, raised, painless, white, small cysts in a hair shaft (hair follicle), which is filled with keratin. Primary milia arise spontaneously, especially in neonates, but sometimes also in children and adults. Secondary milia develop as a result of trauma from events such as dermabrasion, tissue damage, blistering and skin inflammation. Secondary milia can also occur as a side effect of some medications.

Pityriasis alba or white-cheeked

Pityriasis alba is a relatively common skin condition that causes red, scaly, itchy patches. After these spots have healed, they leave behind light, white spots. It is therefore also known as ‘white cheek’. Pityriasis alba tends to develop in children between the ages of 3 and 16 and is usually found on the face, but can also affect the neck, shoulders and arms. It is not certain what causes this skin condition, but it is thought that it could be a mild form of eczema.

read more

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  • Piebaldism: hereditary pigment disorder (white patches of skin)
  • Parapsoriasis: symptoms, cause, treatment and prognosis
  • Lichen sclerosus: symptoms, causes and treatment
  • Light spots on the skin: causes, treatment & prevention