White spots on the skin become more noticeable with a tan. This often prompts people to search for the cause. Most white spots are not due to a serious medical condition.
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Vitiligo, tinea versicolor and post-inflammatory hypopigmentation are among the most common causes of white spots on the skin. Consultation with a dermatologist can help determine the cause and begin appropriate treatment.
In vitiligo, the skin's pigment-producing cells, called melanocytes, are destroyed. Without these cells, the skin loses its color. White spots appear, ranging from one or a few spots in a small area to large patches that affect almost the entire body.
Vitiligo most often occurs on the face, fingers, hands, elbows, knees, shins and feet. The cause is unknown, although it is suspected to be an autoimmune disorder. There is no cure for vitiligo but avoidance of tanning will make the white areas less obvious.
Possible treatments include topical medications, various types of light therapy, depigmentation of surrounding skin, tattooing to add color to the affected areas and, occasionally, surgery.
Tinea versicolor is a fungal infection of the skin that can interfere with melanocytes. Spots appear, which may be scaly and mildly itchy. The spots are often white, although they can also be pink, tan or brown. Tinea versicolor is usually found on the back, chest and neck.
Teenagers and young adults are most frequently affected. Although the fungus is naturally present on healthy skin, factors such as humidity, excessive sweating or a weakened immune system can cause it to overgrow and produce tinea versicolor.
Over-the-counter antifungal creams or shampoos are usually effective treatment, but prescription-strength topical or oral medications are sometimes needed. The spots may persist for weeks or months after the fungus is successfully eradicated. Although it is caused by a fungus, tinea versicolor is not contagious.
Post-inflammatory hypopigmentation refers to white spots that develop after any condition causing skin inflammation. The spots appear when inflammation interferes with the ability of melanocytes to function as pigment producers.
Eczema, psoriasis and allergic dermatitis are common skin conditions that may produce hypopigmentation. Skin infections, such as chickenpox and impetigo, and skin injuries, such as burns, are among the other possible causes.
The tendency for a person to develop post-inflammatory hypopigmentation often runs in families. Over time, the white spots may improve or even disappear on their own. Treatments are similar to those used for vitiligo.
Poikiloderma of Civatte
Poikiloderma of Civatte is a chronic skin condition caused by sun damage, especially in fair-skinned adults. White patches with a lacy appearance form on the neck and chest, intermixed with darker areas and redness.
These skin changes usually produce no symptoms, but some people notice mild burning or itching. Poikiloderma of Civatte is not cancerous. There is no cure, but protective clothing and sunscreens are important to prevent further sun damage and worsening of the condition. Topical medications and laser therapy may be helpful.
Lichen sclerosus is a disorder that begins as small, smooth white spots on the skin. It most commonly affects the genital and anal areas but may also occur in other locations, including the back, chest, shoulders and upper arms.
Over time, the white spots grow larger and become fragile, leading to cracks, pain, bleeding and blisters. Itching is common. The cause of lichen sclerosus is unknown.
Treatment generally includes corticosteroid creams. When found in the genital region, lichen sclerosus may increase the risk of developing vulvar cancer in women and cancer of the penis in men.
Reviewed by Mary D. Daley, MD.