What are Those White Spots on Your Skin?

Although there are a number of skin pigmentation disorders, white spots or patches on the skin is most likely vitiligo.

Vitiligo is a skin pigmentation disorder that causes the appearance of small white patches on the skin. These patches may then grow in size or shape or they may lay dormant.

Vitiligo affects about 1% of the population and it occurs between the ages of 20 and 40. This skin disorder affects people of all races and both sexes equally. However, it is most evident in dark-skinned people.

The first wave of vitiligo spots usually appears on the face, hands, wrists, neck and scalp. It can also expand to the trunk and lower limbs. Vitiligo spots can also be found around the orifices of the body. These sites include the lips, nostrils, navel, genitals and rectum.

It is impossible to predict whether vitiligo spots will spread farther or lay dormant. If there are only a few spots, these can be well hidden by cosmetic camouflages. However, more extensive vitiligo spots may require consultation with a dermatologist and then treatment.

The white spots on the skin mark areas of skin depigmentation. These are parts of the skin where melanin production has ceased.

Melanin is the natural skin pigment. It is produced by melanocytes which are specialized cells found at the bottom of the epidermis.

Will These White Spots Spread on Your Skin?

There is no way to know if vitiligo spots will spread to other areas but when they do spread, they can grow very rapidly.

Vitiligo spots expand from the center. Each white spot on your skin is actually made up of at least 3 concentric color zones: white, at the center; tan, surrounding the center; and dark brown, fringing the spot and marking the beginning of normal, pigmented skin.

There are also vitiligo spots with four or five color zones. In some cases, a thin red zone may form a border around these white spots especially if the vitiligo is triggered by some injury to the skin.

The hair growing in the patches of the skin where vitiligo spots are found usually also turn brown or white. In some cases, the hair may also fall off in these areas.

Vitiligo can either be localized or generalized.

Localized vitiligo only produces white spots in one part of the body. The most common sites for this restricted form of vitiligo are the face and mucosal membrane.

Generalized vitiligo causes white spots to appear in different parts of the body. An example is acrofacial vitiligo where the white spots affect both the ends of the fingers and the orifices of the body.

Generalized vitiligo can also produce the random appearance of white spots all over the skin and it can involve any combination of other sub-types of vitiligo.

Vitiligo Spots Beyond Your Skin

Melanocytes, the cells that produced melanin and which are destroyed in the white spots of vitiligo, are also found in other places beyond the skin. Melanocytes can be found in mucosal membranes, the choroid section of the eyes and in the inner ear.

Therefore, the white spots on your skin may appear on mucosal surfaces such as the gums of the teeth.

Melanin is also essential for the transmission of auditory signals. Therefore, when vitiligo spreads to the inner ear, it may affect your hearing.

The effect of vitiligo on the eyes is much rarer. But when it occurs it can change eye color and affect the ability of the eyes to filter light.

What Causes The White Spots on Your Skin?

Since vitiligo spots are caused by reduced production of melanin in the skin, it means that there are fewer melanocytes in the skin. Therefore, the vitiligo is caused by the progressive destruction of melanocytes.

The exact cause of vitiligo is still unknown. However, different clinical studies and patient examinations have identified a number of factors that may cause or contribute to the appearance of white spots on the skin.

The most popular theories about what causes these white spots are discussed below.

Autoimmune Attack

There are a number of clinical evidences suggesting that vitiligo is caused by the body turning against itself.

Autoimmune attacks such as this are known to cause other disorders. For example, autoimmune reactions can also cause baldness (alopecia areata) and psoriasis on the skin; these autoimmune disorders sometimes also presents with vitiligo.

The autoimmune destruction of melanocytes involves both humoral and cellular immunity.

Malformed Melanocytes

The white spots on your skin can also be caused by intrinsic defects in melanocytes. When melanocytes are improperly made, they may have a shorter lifespan than normal melanocytes.

This theory suggests that the intrinsic defects in melanocytes reduce their chances of survival. These defects may cause inefficient metabolism of melanocytes or reduce the functioning of these cells.

Oxidative Stress

Oxidative stress refers to the harmful byproducts of cellular metabolism. The free radicals released from the different biochemical reactions can destroy cells. When this happens in the skin, melanocytes are destroyed.

Besides harmful free radicals, hydrogen peroxide is a common source of the oxidative stress that reduces the population of melanocytes in the skin.

Nerve Damage

This theory stems from the clinical observation that some patients develop vitiligo soon after experience nerve damage. It is believed that the changes in chemical mediators released at nerve endings affect melanin production in the skin.

Genetic Defects

The genetic basis for vitiligo is wide and it involves most of the above mentioned factors. Because genes are responsible the production of cells such as melanocytes as well as its functioning, genetic defects can cause malformed melanocytes or reducing the production of melanin.

Gene expressions also contribute to the production and action of autoimmune factors.

Therefore, the autoimmune destruction of melanocytes may stem from underlying genetic defects. For example, a gene sequence, identified in vitiligo patients, is now known to increase the susceptibility of melanocytes to autoimmune attack.

This means that the melanocytes in these patients cannot withstand autoimmune attack as much as normal cells.

How to Treat the White Spots on Your Skin

If the white spots on your skin are few and small in size, you can cover them up with cosmetic make-up.

For men, water-proof cover creams and self-tanning lotions can temporarily change the color of the vitiligo patches and match it with that of your skin. Granted that selecting the perfect match is difficult, but you can prepare your own cover cream at home with rubbing alcohol and food colorings.

However, if the white spots on your skin are spreading, you may need a steroid cream to stop their progress.

Steroids are immunomodulatory agents that can stop the autoimmune damage to the melanocytes. However, steroid creams do cause stretch marks and thin the skin.

In place of steroid creams, you may use newer topical agents such as tacrolimus and pimecrolimus.

If topical creams fail to repigment the white spots on the skin, then you should consider light treatments. Generally, there are 3 such therapies available. These include PUVA, narrow band UVB and excimer laser.

PUVA or psoralen ultraviolet A treatment uses both a medication (psoralen) and light (UVA). Psoralen is a photosensitizing agent and it is used before the light treatment session. Therefore, when the white spots are exposed to UVA radiations from special lamps, the vitiligo spots slowly repigments.

Narrow band UVB is a newer light treatment. It is safer, does not require medications such as psoralen and each treatment session takes lesser time than with PUVA.

Narrow band UVB also involves exposing the skin to ultraviolet irradiation from special lamps but, unlike PUVA, it can be done at home.

Excimer laser uses focused light to repigment the skin. It is even more expensive.

Light therapies are usually effective but they are time-consuming.

To complement your treatment, you should take supplements to improve the results and speed on the repigmentation of the skin. There are natural supplements should be combinations of vitamins, minerals and herbal extracts with antioxidant and immunomodulatory properties. A good example of such vitiligo supplements is callumae.

Where drugs fail, surgery may be an option to repigment the skin. Such surgical intervention may involve the grafting of normal, pigmented skin to white vitiligo patches or the grafting of melanocytes to the white spots. In both cases, the donor of the skin and melanocytes are the same as the recipient.

In extreme cases especially when those white spots cover more than 50% of the skin, repigmentation may no longer work. In such cases, depigmentation is usually advised.

Depigmentation turns the skin all over the body white. It is permanent and should only be done when all other treatment options have been exhausted.

To depigment the body, topical monobenzone is the drug of choice. It is applied on the skin at least twice daily and contact with other people must be avoided at least 2 hours after applying the cream.

Beyond treating the appearance of the skin, those white spots on your skin may also cause psychological distress. As the appearance of the skin changes, vitiligo patients may experience stigmatization and social withdrawal. These may cause depression and other psychological symptoms.

Therefore, you should see a therapist to cope with the emotional side of vitiligo.