Treating White Patches on Your Skin

White spots on the skin can indicate a number of skin conditions that cause depigmentation. These spots may well be temporary, cosmetic changes, or signs of a growing underlying disorder.

Injury both physical and chemical may cause color changes on the skin. For example, the use of bleaching agents or other strong chemicals may turn the areas of the skin most exposed white. However, spots like these usually darken again once the injury has healed or the source of aggravation removed.

However, white spots can appear on the skin for no apparent reason.

The 2 most common causes of white spots on the skin are tinea versicolor and vitiligo. While vitiligo is a skin pigmentation disorder, tinea versicolor is a yeast infection that happens to sometimes cause the hypopigmentation of the skin.

These skin disorders are treated differently according to their causes.

What is Tinea Versicolor?

Tinea versicolor goes by other names including tinea flava and pityriasis versicolor. It affects 2 – 8% of the population and it is most common during humid summers.

The fungi responsible for tinea versicolor belong to the Malassezia family. They are M. globosa and M. furfur. These fungi normally live as harmless pathogens on the skin. However, they can cause skin rashes, white spots and scaly skin under the right conditions.

The causative fungi feed on dead skin cells and sebum. Therefore, they mostly affect adolescents and young adults as the skin changes during this stage increase sebum production.

The white spots of tinea versicolor are usually found on the limbs and trunks although they can also affect the face.

Such white spots are usually small and oval in shape. They are usually milky white in color but they may also appear tan and pink. Even dark color shades have been observed especially in light-skinned people.

A quick visual examination of the white spots on the skin can differentiate tinea versicolor from vitiligo spots. There are usually fine scales found on the areas of the skin affected by these white spots. Such scales are absent in vitiligo spots.

Tinea versicolor spots darken when the skin temperature is raised. They may also itch but the itching subsides as sweat gets to the skin surface.

How the White Spots of Tinea Versicolor are Treated

Tinea versicolor is treated with topical and oral antifungal agents.

However, it should be noted that although these drugs remove the fungi causing the underlying disease, the color change on the skin may take a while before it is reversed. In most cases, the white spots disappear after the skin loses its tan and acquires the same pale tone as the tinea versicolor spots.

The most common topical antifungal agent used in the treatment of tinea versicolor is selenium sulfide.

It is available in 2 strengths: an over-the-counter 1% solution and a prescription 2.5% solution. It is readily available in shampoos and other topical preparations.

Other topical antifungal agents used to treat the white spots of tinea versicolor include tolnaftate, ketoconazole, clotrimazole, and ciclopirox.

The oral antifungal agents used are ketoconazole, itraconazole, and fluconazole. Although these drugs are taken orally, they have to act on the skin to treat tinea versicolor. Since they are excreted in sweat in appreciable amounts, physicians recommend moderate exercise 1 – 2 hours after taking these oral antifungal agents.

By doing this, the drugs are brought to the skin surface along with sweat. When sweat evaporates, it leaves these antifungal agents behind to kill off the causative fungi of tinea versicolor.

Besides conventional drugs, natural herbal extracts with antifungal agents are also used to treat tinea versicolor. The 2 well-studied herbal extracts used for this purpose are tea tree oil and extracts of Senna alata or Candle bush.

What is Vitiligo?

Vitiligo is a skin pigmentation disorder. It is not infectious and in most cases, the change in skin color is the only presentation of the disease.

Vitiligo affects 1 – 2% of the population. It usually first appears between the ages of 20 and 40 although vitiligo can also affect children especially when the genetic predisposition is strong.

The root cause of vitiligo is the progressive destruction of melanocytes. Since melanocytes are the special skin cells responsible for producing melanin, their destruction means that melanin production falls and the skin loses its pigment.

The white spots of vitiligo first appear as small and round. They may stay localized or spread to other parts of the body.

There is no way to predict whether they will spread or lay dormant.

These spots have sharp, contrasting borders with the normal, pigmented skin surrounding them. The hair growing out of the white spots may lose color too. However, besides the color change, vitiligo spots look the same as the surrounding pigmented skin.

Each vitiligo spot is made of at least 3 color zones which denote the extent of depigmentation. The central zone is usually white and the melanocytes there are lost or melanin production has stopped.

In the other 2 zones, some degree of melanin production is still ongoing as melanocytes die out.

When these spots grow, they expand from the center, changing size, and shape along the way. Multiple spots can merge and form large, white patches all over the skin.

Causes of Vitiligo

There are different theories regarding the cause of vitiligo. It is most likely that different combinations of these factors are responsible for the depigmentation of the skin and the progression of vitiligo.

The Autoimmune Theory

This is the most popular theory regarding the cause of vitiligo and it is supported by multiple clinical pieces of evidence. For example, some vitiligo patients also have other autoimmune disorders.

This theory regards the autoimmune attack on melanocytes as the reason behind the fall in melanin production and the appearance of white spots on the skin. Support for this line of thought comes from the relatively high levels of melanocyte-specific antibodies and CD8+ T cells found in vitiligo patients.

When the cells of the immune system recognize melanocytes as foreign, they mount multiple attacks on them and quickly reduce their population.

An autoimmune attack usually causes rapidly spreading vitiligo patches.

The Defective Melanocyte Theory

Intrinsic defect in melanocytes is another proposed cause of vitiligo.

If melanocytes are structurally or functionally defective, they may not be able to fulfill their chief role of melanogenesis (production of melanin). Alternatively, the defect may reduce the lifespan of the melanocytes and increase the rate at which these cells die.

The Oxidative Stress Theory

Oxidative stress comes from the harmful free radicals and reactive oxygen species produced from cellular metabolism or introduced to the skin. Hydrogen peroxide is an especially common reactive oxidizing species produced in the skin and known to destroy melanocytes.

The extent of oxidative stress on the skin can be measured from the levels of oxidized compounds in the skin. When the white spots on the skin are illuminated with special lamps, they may glow with blue or yellow-green fluorescence which indicates the presence of oxidized pteridines.

Ideally, free radicals and reactive oxygen species are removed by antioxidants.

However, when the oxidative stress overwhelms the antioxidant system or when the levels of these antioxidants fall, the oxidative destruction of melanocytes can proceed very quickly.

The Neural Theory

Nerve damage has been known to cause vitiligo. This is attributed to the changes in the neurochemical factors released from the endings of damaged nerves.

Such neurochemicals can damage the melanocytes around the site of nerve damage.

The Role of Genetics

Genes play an important role in vitiligo too. It is estimated that about 30% of vitiligo patients have other members of their families living with the same conditions.

There are already subtypes of certain genes (Apa-I, for example) known to increase the risk of developing vitiligo.

However, there are different ways in which genetic differences may cause vitiligo and these will contribute to the factors discussed above.

For example, a genetic mutation may cause the production of defective melanocytes. When the defect in the melanocyte is a dysfunctional surface protein that does not properly identify the melanocytes, the immune system may identify such melanocytes as foreign and attack them.

Similarly, the genetic defect may come from the antioxidant enzymes produced in the skin (catalase, for example). A structurally defective antioxidant enzyme cannot protect melanocytes from reactive oxygen species.

How the White Spots of Vitiligo are Treated

There are different ways of treating white spots on the skin if they are caused by vitiligo. The appropriate treatment will be determined by the extent of depigmentation and the distribution of those white spots.

Camouflaging

If the white spots are small and restricted to a small area of the skin, they can be hidden by camouflaging them. The aim is to cover those spots with a color that most closely estimates the rest of normal, pigmented skin.

Common camouflaging agents including make-up, cover creams, and self-tanning lotions.

If you cannot find a commercial product that provides the perfect blend for your skin, you can make a camouflage cream at home by combining food coloring, rubbing alcohol, and waxes. 

Topical Products

Topical steroids are commonly prescribed for treating vitiligo spots (oral steroids are to be avoided due to serious side effects).

Steroids work by suppressing the immune system and preventing the autoimmune destruction of melanocytes. However, even topical steroid produces some serious side effects on the skin including thinning the skin, stretch marks, and open sores.

Therefore, long-term use of steroid use is not recommended.

Alternative topical products used for treating vitiligo spots include tacrolimus (Protopic) and pimecrolimus ointments. Vitamin D analogs such as calcipotriol and tacalcitol are also recommended over topical steroids.

Light Therapies

There are 3 kinds of light therapies used to treat vitiligo.

PUVA: PUVA refers to psoralen and ultraviolet A therapy. It is the combination of a photosensitive medication (available as an oral or topical product) and UVA radiation.

The drug is taken a few hours before the radiation. When UVA light penetrates the skin, psoralen causes the darkening of the skin.

PUVA is time-consuming and increasingly overlooked in favor of newer light therapies

Narrowband UVB: Narrowband UVB uses a small fraction of the UVB range of the ultraviolet spectrum. It is newer than PUVA and it is currently the light therapy of choice.

There are obvious advantages to treating vitiligo with PUVA. For example, it produces far fewer side effects than PUVA since it uses a narrow band of UV radiation and it does not need a photosensitive drug like psoralen.

Narrowband UVB can also be done at home and even combined with other vitiligo treatment.

Excimer laser: Excimer laser uses concentrated light to treat vitiligo. It is the preferred light therapy for segmental vitiligo where the white spots spread very fast.

Surgery

Autologous transplants can be used to repigment the white spots of vitiligo. Here, the donor is the recipient.

There are generally 2 types of such surgical treatment: skin grafts and melanocyte transplants.

In skin grafts, some normal, pigmented skin is taken and transplanted over the white spots of vitiligo. However, the results of this kind of transplant are not often tidy. Therefore, an alternative is to incubate and grow the melanocytes in the removed portion of normally pigmented skin and then transplant the new melanocytes into the area of the skin affected by white spots.

Depigmentation

When white spots cover more than 50% of the skin and are not responding to repigmentation therapies, full-body depigmentation may be recommended.

This is not really a vitiligo treatment but a way to even out the skin color. Depigmentation turns the normal, pigmented skin left white. Therefore, the skin attains a uniform white color.

It is achieved by twice daily application of monobenzone cream for 1 – 2 years.

Depigmentation is irreversible and the use of sunscreen is required every day thereafter.

Herbs and Nutritional Supplements

Besides conventional medications, natural herbal extracts, homeopathic remedies, and nutritional supplements can also be used to treat vitiligo.

Some of the herbs used in the treatment of vitiligo are ginkgo biloba, picrorhiza, and Khella. Nutritional supplements used include the B vitamins especially vitamins B6, B12, and folic acid. Alum, sulfur, silica, and natrum carbonicum are some of the homeopathic remedies commonly used to treat vitiligo.

These natural remedies can serve as complementary or main vitiligo medications. They are usually safer than conventional medications and well-tolerated too.

The best way to use these natural remedies is to get a vitiligo supplement that combines different classes of such remedies.

Callumae is a good example of such vitiligo supplements. It includes herbal extracts, vitamins, and an amino acid known for their potent anti-vitiligo properties.