Small White Patches on Hands

The appearance of small patches on your hands may be caused by a number of things including physical trauma like burn and calluses or the action of chemical agents on the skin or skin diseases. If these white patches break out on your hands without prior injury, the most likely candidates are skin diseases.

Skin diseases that cause hypopigmentation include infections such as warts and fungal discoloration or skin pigmentation disorders such as vitiligo.

Unlike infections, vitiligo produces no symptoms and hands are one of the first body parts it affects.

Fungal Infections

There are a number of fungal infections that may cause white spots to appear on the skin. However, if there are white patches on your hands, there is a high chance that they are also found in other parts of the body especially on your face.

Eczema is one such fungal infection but it can be dramatic and is easily identified.

A better fit for small white patches on your hands is a mild fungal infection called tinea versicolor. This fungal infection is caused by Malassezia globosa and Malassezia furfur.

What is Tinea Versicolor?

The two fungi that cause tinea versicolor are normally found on the skin.

However, given the right conditions, these fungi can cause small white patches on the skin. Because hot, humid environments promote the appearance of tinea versicolor, it is most commonly seen during the summer months and in those who frequent tanning beds.

Tinea versicolor usually affects adolescents and young adults. This is because it thrives in the increased sebum and dead skin cells produced during this stage of human development.

However, tinea versicolor may occur at any age especially in the company of other skin diseases such as seborrheic dermatitis and dandruff.

Tinea versicolor affects about 2 – 8% of the population and although it is easily treated with antifungal agents the discoloration of the skin may take a while to clear.

How Does Tinea Versicolor Presents?

The white patches of tinea versicolor usually appear on the trunk and limbs.

These patches are usually small and come in oval shapes. They may grow and merge into bigger patches. Tinea versicolor patches may appear white or tan in dark-skinned people but dark colors in light-skinned people.

A good way of determining whether those small white patches on your hands are due to tinea versicolor is observing it after a hot bath and exercise. If it turns dark and itches when the temperature of the skin is raised, then it is most likely tinea versicolor. The itching usually subsides after sweat reaches the skin surface.

In addition, if on a close observation of those white patches on your hands you see fine scales then they are caused by fungal infections.

How Tinea Versicolor is Treated

Topical and oral antifungal agents are used to treat tinea versicolor. These can be over-the-counter or prescription antifungal medications.

The most commonly used topical antifungal agent used is selenium sulfide. It is available in two strengths: 1% (OTC) and 2.5% (prescription). Other topical antifungal agents used are ketoconazole, clotrimazole, ciclopirox, and tolnaftate.

The oral antifungal agents used for treating tinea versicolor are ketoconazole, fluconazole, and itraconazole.

There are 2 ways of taking oral antifungal agents: the usual short course of oral doses or an oral dose followed by sweating out the drug. In this latter method, the drug is eliminated with sweat but when the sweat evaporates it leaves the antifungal agents on the skin where they can act against the fungi causing tinea versicolor.

It will take a while before the white patches of tinea versicolor revert back to the normal skin color.

What is Vitiligo?

Vitiligo is a skin pigmentation disorder. It is due to the progressive destruction of the melanocytes of the skin. Therefore, unless it is addressed in time, the white patches on your hands may well become permanent if it is caused by vitiligo.

Vitiligo affects 1 – 2% of the population. It affects both sexes and all races equally although the white patches it causes are more evident in dark-skinned people.

As more melanocytes are destroyed, the production of melanin falls. Since melanin is the skin pigment responsible for the color of the skin, the area of the skin affected slowly turns white.

Causes of Vitiligo

If the small white patches on your hands are due to vitiligo, there are a number of possible causes that could have triggered it. The causes of vitiligo are discussed below.

Autoimmune Attack: Cells of the immune system may recognize melanocytes as foreign bodies and attack them. This is usually the cause of the small white patches on your hands are growing rapidly.

This autoimmune theory is further confirmed by the high levels of antibodies and CD8+ T cells in vitiligo patients. It is also supported by the cases of vitiligo which accompany other autoimmune diseases such as thyroid dysfunction and alopecia areata.

Intrinsic Defect of Melanocytes: The rapid rate of melanocyte destruction can also be due to some defect in the melanocytes themselves. If some melanocytes are improperly formed and cannot fully their functions, they may have shorter life spans and die out faster than normal melanocytes.

Oxidative Stress: Oxidative stress refers to the increased production and activity of harmful free radicals and oxidizing byproducts of cellular metabolism. Usually, these harmful compounds are removed by antioxidants. However, the level of catalase, an antioxidant enzyme, is very low in vitiligo patients.

Therefore, the increased burden of these oxidizing compounds increases the breakdown and destruction of melanocytes.

Chemical Bleaching: Certain chemicals can also reduce melanin production. Phenolic compounds which are usually included in both household and industrial solvents are particularly associated with the appearance of vitiligo patches.

Since the hands are the parts of the body most in contact with these chemicals, it is possible those white patches on your hand were caused by dyes, bleaches and other phenol-containing solutions you regularly use.

Nerve Damage: In some vitiligo patients, the first appearance of white patches happens after they sustained some forms of nerve damage. It is believed that the changes in the neurochemicals released at the nerve endings may cause the destruction of melanocytes.

Genetics: Genetic defects can also play a role in the appearance of vitiligo. 1 in 3 vitiligo patients has other members of their families with the same skin condition. This means that vitiligo is also an inheritable disease.

Therefore, if there are other members of your family with white patches on their skin then you should suspect vitiligo.

Although vitiligo can be hereditary, most vitiligo patients have no history of such skin condition in their families. In fact, only a small percentage (5 – 7%) of children born to parents with vitiligo develops the disease at all.

How Vitiligo Patches Spread

At first vitiligo patches appear as small, round spots. These are mostly found on the face, neck, and hands. Soon, these spots grow in size and shape by expanding outwards from the center.

Each of these small, white patches is made up of 3 color zones.

The central zone is usually white. It is the widest and its lack of color is due to the lack of melanin and the destruction of all melanocytes in that area of the skin. This zone is surrounded by another zone of hypopigmentation.

The hypopigmentation zone usually appears tan which shows that melanin production is falling off. There is a thin layer found between the hypopigmentation zone and normally pigmented skin. This is a brown area that marks the border of the vitiligo spots.

If on close examination, the skin of the small white patches on your hands does not show any other changes besides the change in color, then it is most likely due to vitiligo.

When vitiligo patches affect the hands, they are usually found at the distal fingers and they expand from the tip of the hand up to the wrist.

In some instances, these small white patches may appear in about the same areas on both hands. This symmetrical appearance of white patches is another characteristic of vitiligo.

Lastly, if the hairs growing out of those white patches on your hands have lost their color, then you are definitely suffering from vitiligo.

How to Remove the White Patches on Your Hands

If the small white patches on your hands remain that way, you may only have to camouflage those patches. This can be done with cover creams and self-tanning lotions.

To repigment those white patches, you need to see a dermatologist and see which of the following treatment options is best for you.

Topical Agents: Steroid creams are usually the first line treatment for vitiligo patches as long as those patches are still confined to a small area of the skin. Steroids act as immunomodulatory agents and help reduce the autoimmune attack on melanocytes.

However, steroids do cause stretch marks and thin the skin. Alternatively, topical products to use in place of steroids include tacrolimus and pimecrolimus. These produce fewer side effects and are just as effective.

Light Therapies: There are generally 3 kinds of light therapies used to slow down the spread of white vitiligo patches on the skin and repigment those patches. These include PUVA, narrow band UVB and excimer laser.

These therapies are expensive and time-consuming but more effective than topical agents.

PUVA, which is also known as psoralen ultraviolet treatment, is a photosensitizing drug. It can be taken orally or applied topically to the skin. A few hours after taking this medication, the skin is exposed to UVA radiation from special lamps. The UVA light activates psoralen and in turn, darkens the skin.

Narrowband UVB is a newer technique. It uses a narrower and safer spectrum of ultraviolet light and it does not require psoralen. Narrowband UVB is not only safer, it takes lesser time and it can be used at home.

Excimer laser used focused light to stimulate the melanocytes to increase melanin production.

Surgery: There are different surgical options for repigmenting the skin. The 2 most important ones are autologous skin grafting and autologous melanocyte grafting. In both cases, the donor and recipient are the same people.

In skin grafting, skin with normal pigmentation is transplanted over the white vitiligo patches. However, this leaves the skin rough especially in the places where the grafts are taken.

Melanocyte transplant involves growing melanocytes in the skin graft taken from the donor site. The multiplied melanocytes are then transplanted in the white patches to stimulate the repigmentation of the skin.

Complementary Treatment: To increase the success of the above treatments and prevent relapse, supplements are recommended. These supplements usually pack vitamins, minerals and herbal extracts which also have antioxidant and immunomodulatory properties.

A good example of such natural vitiligo supplement is Callumae. By taking Callumae along with your vitiligo treatment, you can quickly and safely repigment the small white patches on your hands.