What Are Those White Spots on My Arms?

The sudden breakout of white spots on your arms could indicate a number of things ranging from infections to chemical depigmentation of the skin.

What you have to do to get rid of these skin changes will depend on the other symptoms caused by the appearance of these white spots. If the breakout is mild, it may be possible to get rid of these spots at home. For severe breakouts, you may need to visit a dermatologist and get prescription medications for more aggressive treatment.

If the white spots on your arms are simply cosmetic changes to the skin instead of the symptoms of another disease, the two most likely candidates are tinea versicolor and vitiligo.

Read on to find out which of the two skin conditions most matches the description for the white spots on your arms.

Tinea Versicolor

Tinea versicolor affects 2 – 8% of the population and it goes by a number of other names including tinea flava, dermatomycosis furfuracea, and pityriasis versicolor.

Most cases of tinea versicolor are caused by a fungus called Malassezia globosa. A few cases of the yeast infection are caused by another fungus called Malassezia furfur.

Both of these fungi are commensals that normally grow on the skin. However, given the right conditions, they can cause white rashes on the skin. The rash that appears usually affects the trunk and the limbs especially.

Hot, humid climate is the usually the trigger for tinea versicolor breakout.

Therefore, cases of tinea versicolor are mostly found during the summer months or in people who spend time in hot, humid environments such as in saunas and on tanning beds.

In addition, tinea versicolor affects adolescents and young adults more than any age group. This is because the increased sebum production at this stage of immune development is an ideal growth environment for the fungi.

These fungi feed on the lipids found in sebum and live on the dead skin cells produced in large amounts at this stage of human development. Therefore, tinea versicolor sometimes presents along with other skin conditions such as seborrheic dermatitis and dandruff.

Presentation of Tinea Versicolor

Under the microscope, the fungi that cause tinea versicolor appear round but with filaments growing out of them. This often described as spaghetti and meatballs. However, to the visible eye, the areas colonized by the fungi appear white.

Tinea versicolor lesions are oval in shape and do not measure more than an inch in diameter. Sometimes, these spots appear as milky white, tan and even pink in color. They have well-defined borders within which the skin appears scaly besides having a lighter color than the surrounding area.

These white spots can grow and merge into one another to form wider patches.

However, in light-skinned people, tinea versicolor spots may actually be darker than the surrounding areas. They do also get darker when the skin temperature is raised in a hot bath, tanning bed, sauna or even exercises.

Tinea versicolor spots may also itch but that will stop as the sweat reaches the skin surface.

Therefore, white spots on your arms can only be suspected to be tinea if you are dark-skinned or if your skin is tanned. A close observation of the skin can tell you whether what you have on your skin is a fungal infection.

If you can see fine scaling on the skin, then the white spots are most likely due to tinea versicolor. However, if nothing but the skin color is changed, the likely candidate is vitiligo.

How Tinea Versicolor is Treated

If your white spot is caused by tinea versicolor, you will need to treat it with antifungal agents.

Topical antifungal agents used to remove the causative fungi include tolnaftate, selenium sulfide, ciclopirox, ketoconazole, and clotrimazole. Some of these require prescriptions while others are easily obtained as over-the-counter (OTC) topical preparations.

Selenium sulfide is the most commonly used topical antifungal agent in the treatment of tinea versicolor. It is available both as an OTC 1% solution and a 2.5% prescription product.

Although these topical antifungal agents will quickly kill off the fungi causing the discoloration, it may take a while for the depigmentation of the skin to be reversed.

Alternatively, oral antifungal drugs may be recommended.

Examples of oral antifungal agents include ketoconazole, itraconazole, and fluconazole. To make these drugs more effective, patients are sometimes advised to work up a sweat 1 – 2 hours after taking these drugs.

The reason for this is that these oral drugs are eliminated in the sweat. Therefore, as the patient sweats them out to the skin surface, the drugs are left there when sweat evaporates. This means that the antifungal agents can then directly act on the skin.

There are also herbal extracts with antifungal properties. At least two of these natural remedies have been demonstrated to be effective in the treatment of tinea versicolor. These herbal extracts are tea tree oil and extracts of Candle Bush or Senna alata.

What is Vitiligo?

Vitiligo is a skin pigmentation disorder that is caused by the destruction of the skin cells producing melanin.

Melanin is the natural skin pigment and it is released into the skin by specialized cells called melanocytes. Melanocytes are found at the bottom of the epidermis. They produce melanin when ultraviolet light reaches the skin.

Therefore, when the population of melanocytes falls the skin experiences hypopigmentation and turns white. At first, an area of the skin may be covered with a few white spots just like the ones on your arms but these can soon spread to other parts of the body.

Vitiligo affects about 1 – 2% of the population but unlike tinea versicolor, it mostly first appears between the ages of 20 and 40. It affects both men and women equally. Although the white spots appear more pronounced in dark-skinned people compared to people with light skin colors, the distribution of vitiligo is equal in all races.

There is no way to predict whether the small, round white spots of vitiligo will expand or stay localized.

When these spots grow bigger, they expand from the center while changing size and shape. Soon, the spots become bigger and merge to form white patches all over the skin.

Each vitiligo spot is made up of at least 3 color zones.

These zones correspond to a white, achromatic center with no color and total loss of melanocytes; a surrounding tan, a hypopigmented zone where there are only a few melanocytes left; and a border zone of dark brown, normal pigmented zone.

When a vitiligo spot expands, the white center fills out and the hypopigmented area becomes depigmented. A new hypopigmentation zone is then formed in the normally pigmented areas surrounding the spot.

Vitiligo can be generalized or localized. The white spots on your arms may appear symmetrically or not.

Symmetrical white spots on both arms refer to the appearance of these spots roughly in the same areas on both arms. If this occurs, then those white spots on your arms are most likely to be due to vitiligo.

A close examination of the white spots on your arms can also help you determine whether they are vitiligo spots. Vitiligo spots seldom itch, and apart from the color change, the skin remains unchanged. However, the hair growing out of those white spots may lose color too.

What Causes Vitiligo?

There are different theories regarding what causes vitiligo even though everyone agrees that the underlying problem is the destruction of melanocytes.

If the white spots on your arms are due to vitiligo, then they may be caused by any of these factors:

• Autoimmune attack: Here, the cells of the immune system attack the melanocytes believing them to be foreign bodies. There is evidence that this is indeed the case at least for some vitiligo patients. The autoimmune attack on melanocytes is believed to be caused by antibodies and specialized T cells. This theory also gains support from the fact that vitiligo accompanies other autoimmune diseases in some patients.
• Defective melanocytes: The rapid destruction of melanocytes in some areas on the skin and not in others may mean that the melanocytes found in those white spots are weaker than those found in normal skin. Intrinsic defects in melanocytes may reduce the lifespan of these cells.
• Oxidative Stress: Oxidative stress refers to the harmful free radicals and byproducts of cellular metabolism released in the skin. When these harmful compounds are not effectively removed by antioxidants, they may break down the cell structures of melanocytes and rapidly destroy them.
• Toxic Chemicals: Some oxidizing chemical may also promote the hypopigmentation of the skin. Prolonged exposure to these dangerous compounds can kill of melanocytes. Since the arms are used for handling things, it is possible that they come in contact with these chemicals. Phenolic compounds found in household and industrial solvents are especially implicated in the appearance of vitiligo spots on the skin.
• Nerve Damage: These spots can also be a byproduct of changes in the neurochemicals produced at nerve endings. There have been cases of patients who develop vitiligo only after they sustained nerve damage.

How to Treat Vitiligo?

If the white spots on your arms remain small and do not spread, you may not need to treat them but only camouflage them. Camouflaging white spots on your arms will require finding a cover cream or self-tanning lotion that matches your skin color.

There are, however, treatment options to repigment the skin.

Steroid creams are simple to use and effective if there are only a few white spots on your arms. Because of the side effects of topical steroid on the skin, alternatives such as topical tacrolimus and pimecrolimus may be used especially for children.

Besides drugs, light therapies such as PUVA (psoralen ultraviolet A treatment), narrow band UVB and excimer laser may also be used to repigment the white spots on your arms.

These light treatments are expensive and time-consuming.

For faster results, skin graft and melanocyte transplants can also help repigment the white spots on your arms. However, surgery is also expensive.

To increase the chances of treatment success and reduce the chances of relapse, natural supplements may also be used. A good example of such vitiligo supplements is Callumae.

Callumae is an oral supplement containing minerals, vitamins and herbal extracts proven to help repigment vitiligo spots by their antioxidant and immunomodulatory properties.