White spots on your skin are not always vitiligo

In the spring and summer months, white spots on your skin are more noticeable. This is because the unaffected skin part darkens and white spots color much more slowly or not at all. A white spot self-diagnosis is often labeled as vitiligo. But there are other skin conditions that can cause white spots. Unlike dark pigment spots, where pigment cells (melanocytes) produce more pigment, white spots contain less or no pigment in the skin. As with dark spots, white spots are also perceived as cosmetically disturbing.

These white spots can be:

  • Hypomelanosis guttata idiopathica – white circles with no known cause
  • Pityriasis Versicolor – multi-colored fine scales

Hypomelanosis guttata idiopathica

Literally this means ‘white circles of unknown cause’. In de volksmond wordt het ook wel confettihuid genoemd. It is also popularly referred to as confetti skin. In people older than 50 years, it is present in 70% of cases. It is rare in dark-skinned people and most common in white people.

Vitiligo White Spots Hypomelanosis Guttata Idiopathica Confetti Skin
White Confetti Specks – Confetti Skin

The white spots do not cause any complaints and do not degenerate. It is mainly experienced as a cosmetic nuisance and unfortunately there is no successful treatment for this.

Pityriasis Versicolor

Also a common benign skin condition and means multi-colored fine scales. It is mainly on the trunk and is caused by a non-contagious yeast, Pityrosporon Ovale. Normally these yeasts are located in places where there are many sebaceous glands such as armpits, between the breasts, eyebrows, nasolabial folds, groin and genital region. And under certain circumstances such as reduced resistance, diabetes, warm humid areas, perspiring a lot and frequent showering and soap use, these yeasts can multiply.

The white discoloration is caused by the yeasts producing a substance that TEMPORARILY inhibits pigment production. The contrast is greater if you have dark skin. It can take months for the skin color to recover, even if the yeasts have disappeared there. The most common complaints are fine flakes, itching and cosmetic skin color differences.

What can you do about it?

  1. Anti-fungal cream if only a few spots are present
  2. For more extensive fields, combine an antifungal cream with an anti-dandruff shampoo, for example Resdan shampoo. You apply the shampoo undiluted to your affected skin in the evening, not in the genital region, face or wounds. Because of the strong smell and can get into your clothes, put on an old t-shirt. This shampoo can cause skin irritation in some people. In such a situation, stop for a few days to let the skin rest. If the yeast is still present, use Resdan as a body wash by diluting it slightly with water and then applying it to your skin. Leave it on for a few minutes and rinse it off in the shower.
  3. If that doesn’t help, there are still antifungal pills, such as Trisporal or Diflucan.

When is it gone? Do the stretch test.

The yeast infection is gone when no itching and flaking are visible. One trick we use is the stretch test. When the skin is stretched (overstretched), very fine powdery flaking occurs in the white spots. If it flakes then the infection is still active and if there is only a white spot then we call it negative. This trick is a Dutch invention of a dermatologist from the AMC – Amsterdam and is used worldwide.

Post-inflammatory Hypopigmentation

A whimsically shaped white spot where there used to be a skin condition. This could be eczema, psoriasis, acne or local skin damage, for example. Due to the subcutaneous inflammation, the pigment cells are temporarily stressed, so that they do not form pigment. This is temporary in nature and will disappear on its own after weeks to months.

Pityriasis versicolor on Youtube

Halo naevus

A benign birthmark, literally meaning ‘illuminated birthmark’. There is a white court surrounding a brown mole. The cause is an immune reaction against your own pigment cells. This allows the entire birthmark to disappear, leaving a white spot behind. In some people, the white spot disappears after years. 20% of people with multiple halo nevi also have vitiligo. Another study suggested that halo nevus is a defense response against troubled moles. The prognosis of halo nevus is good and does not require treatment.

Pityriasis Alba

A common harmless skin condition, especially in children between 2-16 years old. It is equally common in boys and girls and is more visible in people with dark skin.

Pityriasis alba means white scales and mainly occurs on the face. You then see moderately sharply defined white round to oval fields in the face (cheeks, chin and forehead), but it can also occur on the body. It is often visible in the summer because the affected skin changes color less quickly.

The cause is unknown. It is often seen in children with a predisposition to hay fever, asthma or eczema, also known as atopy. Some consider it a mild eczema form. It is important to know that this is not contagious and is not caused by a parasite, fungus or bacteria. The treatment is to apply a greasy cream twice a day and possibly an anti-eczema agent. The good news is that it will go away on its own.

and finally Vitiligo

Vitiligo is a loss of pigment in the skin and hair. In 70-80% of people it can appear before the thirtieth year of life. The milky white spots can be of different sizes and are located on the face, body folds, genital region, hands and feet. It can also be present in the hairy head and is accompanied by white hair strands. Roughly speaking, vitiligo can be divided into two groups: generalized non-segmental and segmental form. The generalized variant is symmetrical – so spots are present on the left and right. The segmental, local form is located in 1 place. At first, generalized vitiligo is difficult to distinguish from a segmental form.

White Pigment Spots, Vitiligo

The cause is unknown. There are many theories about the origin of vitiligo, of which the autoimmune theory is the most likely. In autoimmune, the immune system is directed against tissues and/or individual cells of the body. In the case of vitiligo, this immune response is believed to cause the destruction of melanocytes (pigment cells). This destroys the melanocytes. This theory is supported by the presence of a T-lymphocyte infiltrate in the periphery of vitiligo patches, antibodies in the blood against pigment cell antigens, and the increased incidence of certain autoimmune diseases in vitiligo patients (autoimmune thyroid disease, type 1 diabetes, alopecia areata).

Treatment of vitiligo are:

External topical treatments are, such as with hormone ointments or corticosteroid free ointment Tacrolimus or Pimecrolimus.

Camouflage the white spots with a skin-colored make-up in combination with sun protection. A skin therapist and beautician can help you with that.

Self-tanning agents, first exfoliate the skin and then apply the self-tanning agent to the affected areas. This gives a more even color.

Light therapy (UVB-TL01) for extensive vitiligo spots that cannot be improved with local treatment. Light therapy takes place in a dermatological center and the strength and frequency is adjusted based on your skin type (Fitzpatrick) and the extent of the spots.

Skin grafting is possible if vitiligo is stable and no new spots develop. Normal skin is transplanted to the affected white skin using small apple cores (biopteur) of 1-2 mm. The experience of the performing physician determines the success of the transplant.

The prognosis is poor if it is on the mucous membranes (mouth, lips), hands and if it develops later in life.

White spots – how to care for your skin?

In general, prevent or limit skin damage such as cuts, wounds and hard scratching. Any damage can cause skin discoloration. This can be either dark or white spots (post-inflammatory hypopigmentation).

Ensure an optimal skin barrier by not showering too long, too hot and limit the use of soap. The warm water in combination with soap disturbs your skin acidity, among other things. Your ideal skin acidity is around pH5. Increased skin acidity can lead to skin dehydration, but also an increased risk of yeast infections such as pityriasis versicolor.

More about skin acidity.

Don’t overstimulate your skin due to excessive use of exfoliant (scrub), use a mild skin cleanser and soothe and hydrate your skin with a moisturizer.

Vitiligo Moisturizer Squad
To your Squad – click on picture

While you are here

Moles, freckles and liver spots are sometimes difficult to distinguish from each other and are often incorrectly referred to as birthmarks.

What are the differences? The 3 are better distinguished under the microscope (biopsy). With a freckle, the amount of pigment cells (melanocytes) are equal, only more pigment is produced.
A liver spot, also known as a sun spot, actually has nothing to do with your liver. In the medical world, a liver spot is also called lentigo. Lentigines (plural) contain both more pigment cells and more pigment. The pigment cells are evenly distributed in the lower layer of the epidermis.
In moles, there are also more pigment cells, but unevenly distributed and accumulated in the skin. More about the differences between moles, freckles and liver spots.


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