White Spots on Legs

If white spots start appearing on your legs, then it is time to start considering what might be causing them. These spots can either be harmless or signs of an oncoming disease.

Unless those white spots on your legs become painful, there are only a few skin conditions that might have caused it.

You may have to see a dermatologist for a precise diagnosis. However, before you do, you can also do a little investigation on your own to find out what the likely causes of those white spots are.

White spots on the skin are essentially areas of depigmentation.

This means that the melanin production in those areas of the skin is falling. Reduced melanin production can be caused by increased destruction or deactivation of melanocytes in the skin.

Since melanocytes are the skin cells responsible for producing the skin pigment, melanin, they are likely involved in any white spots appearing on your skin.

Of all the options available, the sudden or progressive appearance of benign white spots on your legs can only mean one of the following: idiopathic guttate hypomelanosis, tinea versicolor, or vitiligo.

Idiopathic Guttate Hypomelanosis

What is Idiopathic Guttate Hypomelanosis?

Idiopathic guttate hypomelanosis (IGH) is also called white age spots. It is a harmless form of local leukoderma.

By its name, IGH means the appearance of teardrop-like (guttate), white macules (hypomelanosis) of unknown cause (idiopathic). The white spots of IGH resemble freckles and they are scattered on the skin like confetti. They are round in shape, of varying sizes, and are painless lesions.

IGH is mostly found in middle-aged women but it is also known to affect people of both sexes especially during their late 20s and early 30s.

The white spots of IGH are usually found on the exposed parts of the skin especially the legs, arms, face, neck, and shoulder. These are also the body parts most exposed to sunlight. IGH is most evident in dark-skinned people especially following prolonged exposure to sunlight.

The Appearance of Idiopathic Guttate Hypomelanosis

The spots of IGH are usually small in size and range between 1mm and 3mm. However, they can also grow as wide as 10mm. These spots can be circular or angular.

The exact causes of IGH are still unknown but, based on clinical evidence, prolonged exposure to sunlight is believed to be a chief cause. IGH may also be caused by other skin conditions such as seborrheic keratosis.

IGH is called age spots because the skin loses its color much like the hair does during aging.

It is the result of a gradual reduction in the population of melanocytes in the skin. IGH is benign; it is not caused by trauma nor is it a sign of skin infection. IGH does not increase the risk of skin cancer.

Treatment for Idiopathic Guttate Hypomelanosis

Since the white spots of IGH are harmless and do not spread quickly, most people prefer to leave them untreated. Available treatment options are adapted for related hypopigmentation disorders, like vitiligo.

It cannot be guaranteed that these treatments will succeed in reversing the pigment loss of IGH and in some cases they can make the hypopigmentation worse.

Tinea Versicolor

What is Tinea Versicolor?

Tinea versicolor refers to the depigmentation of the skin by the action of fungi such as Malassezia globosa and Malassezia furfur. These fungi are normally found on the skin but given the right condition, they grow in large numbers and cause white spots to appear on the skin.

Tinea versicolor affects 2 – 8% of the population. It mostly affects children, adolescents, and young adults.

Although tinea versicolor presents as white, rash-like breakouts in dark-skinned people, it can actually cause dark spots in people with light skin.

The enabling environment for tinea versicolor is a hot, humid climate. Therefore, it is mostly seen during the summer months especially when the skin is tanned and the sharp contrast between the white spots and the darker skin is most evident.

The fungi that cause tinea versicolor feed on the sebum and dead cells accumulated on the skin. Therefore, it usually presents along with other skin diseases such as dandruff and seborrheic dermatitis.

The White Spots of Tinea Versicolor

The white spots of tinea versicolor start small and oval in shape. They may grow to form larger patches.

A closer look at those spots should make the fine, scaling of the skin caused by the fungi visible. Under the microscope, these fungi look round with outgrowths of filament. For this reason, tinea versicolor fungi are commonly referred to as “spaghetti and meatballs”

Another way to see if the white spots on your legs are due to tinea versicolor is to raise your temperature. This can be done with a hot bath or exercise. When the temperature of the skin rises, tinea versicolor spots turn white.

In some cases, these spots will also itch but the itching subsides when sweat gets to the skin.

How Tinea Versicolor is Treated

Tinea versicolor is treated with antifungal agents. Although these drugs clear off the causative fungi very quickly, the skin discoloration may remain for a few months and may only disappear when the skin loses its tan.

Topical antifungal agents are effective treatments for tinea versicolor. Examples of such drugs are tolnaftate, ketoconazole, clotrimazole, and ciclopirox.

However, the most commonly used antifungal agent for tinea versicolor is selenium sulfate. This topical agent is available in 2 strengths: 2.5% and 1%.

Oral antifungal agents such as ketoconazole, fluconazole, and itraconazole are also used. Sometimes, doctors recommend working up a sweat after taking these oral drugs. This is needed to sweat out the drug so that when the sweat evaporates, the drugs are left to act on the skin.

Herbal extracts such as the ones taken from candle bush and tea tree oil are also used.

Vitiligo

What is Vitiligo?

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

Melanocytes are the specialized skin cells that produce melanin, the skin pigment. These cells are found at the bottom of the epidermis and they are activated when sunlight penetrates the skin.

Melanin is one of the skin’s defensive mechanisms for reducing the damage caused by ultraviolet irradiation from sunlight. Therefore, when it is produced in lesser quantity, the skin turns white and becomes more prone to sunburn.

Vitiligo affects 1 - 2% of the population and most of its sufferers experience it between the ages of 20 and 40. It affects both sexes and people of all races equally but, like any other depigmentation disorder, it is more evident in dark-skinned people.

Vitiligo is benign and is not contagious. It is not caused by an infection and, in most patients, it produces no other symptoms except the white spots that appear on the skin.

These spots usually start small and affect the trunks, limbs but especially the face, neck, and scalp.

However, vitiligo spots can grow and spread to other parts of the body. When they expand, they grow out of the center. They can form even larger patches on the skin.

A visual examination of the white spots on your legs can help determine if they are caused by vitiligo.

Vitiligo spots are just like normal skin except they are depigmented. They do not itch or have scales and there are no changes in skin tone. However, the hairs growing out of vitiligo spots can also turn white.

Causes of Vitiligo

There are various suggested causes of vitiligo. These are summarized below.

Autoimmune Attack: The cells of the immune system can attack melanocytes believing them to be foreign bodies. There is clinical evidence for this theory including the presence and high levels of antibodies and specialized immune cells in vitiligo patients.

Also, the autoimmune theory accounts for the reason some vitiligo patients may also have other autoimmune disorders such as thyroid dysfunction and alopecia areata.

Melanocyte Defects: If some melanocytes are malformed, they may not live as long as healthy melanocytes. The intrinsic defects in melanocytes can refer to any structural or functional defect that reduces the lifespan of these melanin-producing cells.

Oxidative Stress: Oxidative stress refers to the increased levels of harmful free radicals and other destructive byproducts of cellular metabolism. When these reactive species are not immediately removed from the skin by antioxidants, they may destroy melanocytes.

Nerve Damage: Vitiligo spots have also been reported in patients after they experienced some form of nerve damage. It is believed that the changes in neurochemical mediators released at nerve endings reduce the production of melanin.

Genetic Defects: Defects in genes can have far-ranging effects. These defects can be responsible for weakened melanocytes, increased oxidative stress, or increased susceptibility of melanocytes to autoimmune attack.

Genetics definitely play a role in vitiligo. For example, 1 in 3 vitiligo patients has another family member with this same skin disorder.

Treatment for Vitiligo

Besides camouflaging vitiligo spots with cover creams and self-tanning lotions, you can also try to repigment those white spots.

Steroid creams and other topical agents such as tacrolimus and pimecrolimus are first-line treatment options. These are simple, affordable solutions but they are not as effective as the expensive, time-consuming light therapies.

Light therapies include PUVA (psoralen ultraviolet A treatment), narrow-band UVB, and excimer laser.

Surgical transplant of normal, pigmented skin (or melanocytes) on those white spots is also an option especially when drugs fail.

To improve treatment success and prevent relapse, vitamins, minerals, and herbal supplements can also be taken. Callumae, a vitiligo supplement, contains the right active ingredients to help improve the outcome of your treatment.