The human skin color is due to the presence of melanin, a substance (pigment) manufactured in the outermost layer of the skin. The concentration of melanin determines the color of the skin. The melanin is manufactured by melanocytes, cells located in the basal layer of epidermis. People with dark skin have higher amount of melanin than those with fairer skin. The production of melanin on a regular basis is very important to ensure that the skin does not lose its natural color. Small white spots on skin are an indication of malfunctioning of melanocytes that causes inadequate production of melanin.
Skin discoloration that does not go away on its own is pointing towards decrease in supply of melanin. However, it can also mean a skin infection. It is discussed below:
In vitiligo, the skin does not produce melanin because the melanocytes are destroyed. In the initial stages, vitiligo appears as white spots on the skin. With the passage of time, these spots enlarge and become white patches on skin. Eventually, the skin discoloration engulfs other areas of the body. With no treatment, the abnormal skin coloration affects the entire body.
Fungal Skin Infection
Fungal skin infection can also lead to formation of white spots on the outermost layer of the skin. Studies show that presence of skin fungus and white spots are linked. Although fungi are present on the skin, they become troublesome, when their growth exceeds beyond the normal range. Too much fungus on the skin, gives rise to a condition, known as tinea versicolor. This is basically a yeast (type of fungus) infection that is more common among youngsters. It is observed that affected area of the body changes color and the discoloration manifests as small white spots on skin. These irregularly shaped light-colored spots are usually noticed on the chest, back and the shoulder area. In some cases, people with this type of fungal infection show development of brown or reddish brown spots that turn white upon exposure to sun. People with oily skin are at increased risk of developing this skin fungal infection.
As the name suggests, this condition resulting from less production of melanin, causes the formation of small (0.5-1 cm in size), stretchy white spots or patches (lesions) on the skin. In the later stages, small spots that are close to each other, combine giving rise to irregular white patches. Unlike vitiligo, these white marks remain confined to the area where they appear and do not spread to other parts of the body over time. Approximately 20 percent of nevus depigmentosus cases are diagnosed in newborn babies. This is chronic skin problem that occurs due to deficiency of melanin but produces localized white spots. Studies show that in this condition, the melanin is not absent but present in insufficient amounts as the melanocytes do not function effectively.
Small white patches on the skin that are confined to the facial, arms and the neck area can also indicate pityriasis alba, a skin problem that is prevalent in small children in the age group of 6-12. Initially, pityriasis alba manifests as reddish pink, irregular shaped lesions on the skin. Over time, the lesions heal only to form white scaly, marks on the superficial skin. In most cases, the white patches that show scales have a size of around 0.5 cm Thus, the hypopigmented areas that are left after the lesions go away is termed as pityriasis alba. The hypopigmentation that is scattered in the form of patches may last for a few months to even 10 years. During summer, the harsh UV rays can tan the skin, leaving the lighter patches distinctly visible. Dry skin that is common in winter can also make scaly appearance more prominent.
Idiopathic Guttate Hypomelanosis
In this skin problem, white marks appear on areas of the skin that are frequently exposed. No wonder these small spots that are around 2-5 mm in size occur on the forearms, neck and the face. Examination of skin tissues affected with idiopathic guttate hypomelanosis has revealed absence of melanin and a sharp decline in the number of melanocytes. It is observed that these white spots appear mostly on sun exposed area, which means that ultra violet rays of the sun may be responsible for the occurrence of this skin problem.
A treatment plan will be advised by the doctor after diagnosing the type of skin problem. Depending upon the underlying condition, following treatment options are available:
Tinea Versicolor Treatment
A skin disease like tinea versicolor is usually treated with topical antifungal medicines. Over the counter medicines like miconazole and clotrimazole applied for a fortnight can help to reduce the appearance of white spots on the skin. Lotions containing ketoconazole, selenium sulfide or pyrithione zinc are quite effective to treat this skin problems. Oral antifungal medicines that include Nizoral or Sporanox may also be prescribed for patients with tinea versicolor.
Unfortunately, vitiligo cannot be cured but one of the best ways to reduce its impact considerably is to start the treatment at the earliest. As small white spots on skin is an early symptoms of vitiligo, application of topical corticosteroid creams can help to greatly minimize the appearance of vitiligo. Vitiligo cure is also possible through herbal remedies. Use of anti-vitiligo oil have also been effective to improve this skin disorder substantially.
Pityriasis Alba Treatment
Usually, treatment is not required to repigment the affected area. The skin can return to its original color without taking any prescribed treatment. However, using certain skin care products is beneficial to restore normal skin color. Application of topical corticosteroids is the most preferred treatment by patients with pityriasis alba. Corticosteroids like hydrocortisone do help to bring back normal skin color. Use of a good moisturizer after taking a bath is also advised to minimize hypopigmentation. One can also apply pimecrolimus cream or tacrolimus ointment on the lesions that occur initially to decrease the inflammation and the itchiness. A point to note that long-term usage of topical corticosteroids is not advised, so consult a doctor to know how long corticosteroids should be continued.
Idiopathic Guttate Hypomelanosis Treatment
For idiopathic guttate hypomelanosis, other than steroid creams, the patients may be advised with other non surgical procedures such as cryotherapy that involves freezing the area using liquid nitrogen, which helps to destroy the affected skin tissue, thus helping to clear the skin. Other techniques such as dermabrasion can also benefit patients suffering from idiopathic guttate hypomelanosis. In dermabrasion, hand-held tools are also used to remove the uppermost layer of the skin. Application of sunscreen lotion may help to resolve the issue.
Application of sunscreen lotion is the best treatment for nevus depigmentosus. Keep in mind that small white marks on skin are not a cause for concern if they are non progressive. Minimizing sun exposure and use of appropriate sunscreens is the best way to prevent the appearance of these marks. On the other hand, if these marks gradually increase in size, immediate medical treatment has to be taken to prevent further damage to the skin.