White Spots on Your Back?

The sudden breakout of white spots on your back may be disconcerting and it can be one of a number of things. White spots are especially visible against dark skin whether in dark-skinned people or on tanned skins.

These white spots can either be caused by infections or depigmentation of the skin.

Unless these spots itch and fester, they are most likely either a skin fungal infection or vitiligo. These 2 skin conditions are the most common causes of white spots on the skin. They often appear on the back and shoulders and sometimes, they are found on the face and the limbs.

Tinea Versicolor

What is Tinea Versicolor?

Tinea versicolor is a yeast infection. It is also known as tinea flava, pityriasis versicolor and dermatomycosis furfuracea.

It is caused by the fungus, Malassezia globosa. However, in a few cases, it can also be caused by a related fungus, Malassezia furfur. These fungi are normally found on the skin but under the right conditions, they may cause white spots to appear on the body.

Tinea versicolor presents as white rashes mostly on the trunk but also on the face and limbs. It is believed that warm and humid conditions promote the appearance of this spots. Therefore, it is most common during the summer months.

However, there are reports of people developing this form of white rash after repeated sessions on tanning beds. Even then the exact initiation and progression of the fungal growth and the appearance of the white spots are still unknown.

Tinea versicolor is a common skin condition. It affects 2 – 8% of the population and it is especially found on adolescents and young adults.

This preference is believed to be because of the increased sebum production during the teenage years.

The causative fungi of tinea versicolor thrive on the lipids found in sebum and the dead skin cells produced in high amounts in adolescents. Therefore, they are usually associated with other skin conditions such as dandruff and seborrheic dermatitis.

Symptoms of Tinea Versicolor

Tinea versicolor starts out as oval spots measuring less than 1 inch in diameter. These spots can appear whitish, dark tan or pink in color and they soon grow bigger and merge to form patches.

These spots have sharp borders and when closely examined, they may produce faint, flaking scales on the skin. When the skin temperature is raised, the white spots of tinea versicolor become darker and may itch severely.

However, once the skin starts sweating from the high temperature, the itching stops.

Under the microscope, the yeasts causing tinea versicolor appear as round structures with filaments. This has given them the popular connotation, “spaghetti and meat balls”

Tinea versicolor causes hypopigmentation in dark-skinned people but hyperpigmentation is its more common presentation in light-skinned people.

Therefore, if you are dark-skinned or have a tan, the white spots on your back can either be tinea versicolor or hypopigmentation skin disorders such as vitiligo. However, if you are light-skinned, any white spots would most likely be vitiligo.

Treatment for Tinea Versicolor

There are different medications for treating tinea versicolor depending on its severity.

Topical Antifungal Agents: These are the most common drugs for treating tinea versicolor.

Tinaderm is a topical solution containing tolnaftate. It can be mixed with bathing water and its effect lasts a long time. Therefore, it is recommended to be used at night.

Of topical antifungal agents, selenium sulfide is the most commonly used agent for treating the white spots of this skin condition.

It is available in 2 strengths: 1% selenium sulfide in non-prescription topical products such as ZunSpot medicated cream and Selsun Blue shampoo; and 2.5% selenium sulfide in prescription products such as Selsun Extra Strength shampoo.

Other common topical antifungal agents prescribed include ketoconazole, clotrimazole and ciclopirox.

Oral Antifungal Agents: These are prescription drugs. They include ketoconazole, fluconazole and itraconazole. These drugs can be taken normally but to increase their efficacies, patients are asked to work out and sweat 1 – 2 hours after taking the drug.

This is because these drugs are eliminated from the body through sweat. Therefore, when sweat evaporates, the residual drugs are left on the skin where they can produce their topical effect by working directly on the skin.

To make this work, patients are asked to delay taking their baths for a day after the dose.

Natural Remedies: A few herbal extracts have demonstrated clinical effectiveness in different studies.  The two most important natural remedies for treating tinea versicolor are tea tree oil and Senna alata.

Vitiligo

What is Vitiligo?

Vitiligo is a skin pigment disorder caused by the progressive destruction of melanocytes.

Melanocytes are the skin cells responsible for producing melanin, the skin pigment. When these cells are killed off, the area of the skin affected loses its colors and appear white. Therefore, the white spots on your back may well be the first signs of vitiligo.

Vitiligo affects 1 – 2% of the population. It usually appears between the ages of 20 and 40 but in some cases in may appear a lot earlier and sometimes later.  Vitiligo affects men and women equally and people of all races.

The first white spots of vitiligo do come in regular, round shapes. When they expand, they grow out from the center and the central white zone fills out to the edges.

Vitiligo spots change size and shape as they grow. When they join together, they form white patches.

There are ways to differentiate white spots caused by vitiligo. Besides the laboratory tests and visual examination done by your dermatologist, most cases of vitiligo presents with leukotrichia.

Leukotrichia means that the body hair growing in the part of the skin experiencing depigmentation loss also turns white. However, leukotrichia may be less noticeable when vitiligo spots appear on your back.

Apart from the change in skin color, there is very little else damage caused by the white spots of vitiligo.

They do not usually itch; they are not contagious and they are not caused by infections. However, vitiligo leaves the skin open to sunburn. Since melanin production is reduced, the natural protection of the skin is lost in depigmented areas on the skin.

Causes of Vitiligo

Although vitiligo is definitely caused by the destruction of melanocytes, there are different theories provided for the reason melanocytes self-destruct.

The major theories regarding the cause of vitiligo are discussed below.

Autoimmune Disorder: The rapid rate at which melanocytes are destroyed and white spots appear on the skin suggests an autoimmune attack on those skin cells. This theory is the most popular among clinicians because some vitiligo patients also have other autoimmune disorders especially thyroid dysfunction.

Specific antibodies and CD8 T-cells have been found in vitiligo lesions. Together with other evidence of increased immune reaction, it is believed that vitiligo involves by both humoral and cellular immunity.

Defective Melanocytes: It has also been suggested that the melanocytes found in areas of the skin where vitiligo white spots are found are malformed. This makes them weaker than normal melanocytes and, therefore, more susceptible to damage.

The defective melanocytes may have improperly formed cellular structures or lack surface molecules that makes them open to attack from free radicals and/or cells of the immune system.

Oxidative Stress: Oxidative stress refers to the harmful free radicals and other such oxidizing compounds produced as byproducts of normal cellular metabolism.

These harmful compounds are normally moped up by antioxidants in the body. In the skin, the enzyme called catalase is a known antioxidant that protects melanocytes. However, it is found only in low levels in vitiligo patients. This suggests that increased oxidative stress may be responsible for the destruction of melanocytes.

Nerve Damage: In some patients, vitiligo white spots first appear only after they suffered nerve damage. This suggests that the changes in neurochemicals released at nerve endings may cause the reduction in the production of melanin.

Genetic Disorder: This is an all-encompassing theory that ties in with the other four theories.

Since genes are responsible for all processes in the body, defects in gene may make melanocytes more susceptible to autoimmune attack, cause intrinsic defects in melanocytes or promote any other factor that can trigger the depigmentation of the skin.

Treatment for Vitiligo

Since the white spots on your back and shoulders will be covered by cloths for most of the time, you may decide not to seek vitiligo treatment for them. However, these white spots may spread further if left untreated.

Camouflaging is one way of hiding these spots as long as they remain on a small area of your skin. Cover creams and self-tanning lotions are effective for covering up these white spots but finding the perfect color to match your skin can be difficult.

To repigment the white spots, you should first consider steroid creams. They are simple to use and effective for early-stage vitiligo. However, long-term use of steroid is discouraged. On the skin, steroids can cause stretch marks and even thin the skin.

Therefore, alternative topical products such as tacrolimus and pimecrolimus serve as effective substitutes for steroid creams especially for children.

You may also consider light therapies if drugs fail. There are 3 such vitiligo treatments: PUVA (psoralen and ultraviolet A), narrow band UVB and excimer laser.

These focused light treatments stimulate increased production of melanin and can help darken the white spots on your back.

None of these vitiligo treatments work for everyone. To increase the chance of treatment success and prevent relapse, you should consider using natural remedies to supplement your vitiligo treatment.  These natural remedies include vitamins, minerals and herbal supplements. Consider a product that combines the best of natural vitiligo remedies. One such product is callumae.

In advanced stages, vitiligo may require surgery. To repigment the white patches of vitiligo, normal skin can be transplanted to vitiligo lesions or melanocytes surgically implanted in the white patches.