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

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.

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. More about pityriasis versicolor

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

Post-inflammatory hypopigmentation is a white spot with an erratic shape that arises where a skin disorder, such as eczema, psoriasis, acne or local skin damage, used to be. The inflammation under the skin can cause the pigment cells to become temporarily stressed and stop producing pigment. Fortunately, this is temporary in nature and will disappear on its own after a few weeks to months.

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. De prognose van halo naevus is goed en hoeft geen behandeling.

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 origin of this phenomenon is unknown, but it often occurs in children who are predisposed to hay fever, asthma or eczema, also known as atopy. Some experts consider it a mild form of eczema. It is important to know that this is not contagious and is not caused by parasites, fungi or bacteria. The treatment consists of applying a greasy cream and possibly an anti-eczema agent twice a day. The good news is that it will go away on its own.

Naevus anemicus

It is a rare birthmark shape, present from birth, which is sometimes barely visible. All you see is a spot that is lighter than the surrounding skin. The cause is blood flow, because the capillaries in the mole are insensitive to substances that cause vasodilation such as histamine (or bradykinin, acetylcholine, serotonin, 5-hydroxytryptamine). Therefore, it is also called a pharmacological nevus.

Other white spots

1. Lichen sclerosus – A chronic inflammatory skin condition that usually affects women in the genital region and causes white, itchy patches on the skin.
2. Albinism – A genetic condition in which the pigment cells in the skin, hair and eyes do not function properly, resulting in white patches on the skin and lack of pigment in the hair and eyes.
3. Piebaldism – a congenital condition that causes white spots on the skin and white hair.
4. Tuberous Sclerosis – a genetic condition that can cause white spots in combination with other symptoms such as seizures and skin nodules.
5. Lichen planus – an inflammatory skin condition that can cause white, itchy bumps on the skin.
6. Morphea is a skin condition that can cause white patches on the skin. Morfea, also known as localized scleroderma, is a condition that causes hardening and thickening of the skin. The affected skin can have different colors, including white spots, red spots, purple spots or brown spots. Morphea is common on the trunk, but can also appear on other parts of the body. The condition can be accompanied by itching, pain and stiffness of the skin. The causes of morphea are not entirely clear, but it is believed to be an autoimmune disease.

and finally Vitiligo

Vitiligo is a condition in which there is loss of pigment in the skin and hair. It can occur in 70-80% of people before the age of 30 and appears as milky white spots of various sizes. These spots can appear on the face, in body folds, the genital region, hands and feet, and even on the hairy head in the form of white hair strands.

Vitiligo can be roughly divided into two groups: the generalized non-segmental form and the segmental form. In the generalized form, the spots are symmetrical and thus present on both sides of the body, while the segmental form is in one spot. In the beginning it is sometimes difficult to distinguish a generalized vitiligo from a segmental form.

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.

New alternative, off label is Latanoprost!

Latanoprost, is a derivative of prostaglandin F 2alpha (PGF2a), which is normally prescribed for glaucoma, has recently attracted attention for its potential to stimulate skin pigmentation. Here is an example where Latanoprost was used. It involved daily application of 1-2 drops to a vitiligo spot for a period of 28 days. The person who tried this treatment did not experience any side effects or skin irritations.

It is worth noting that during these 28 days the person mainly stayed indoors and went out little. It is worth noting that during these 28 days the person mainly stayed indoors and went out little. Before using Latanoprost, this person had tried a daily hormone ointment for several months, but with little result. It is important to note that the use of Latanoprost for the treatment of vitiligo is an off-label application and is not standard practice for this condition. Consult with a dermatologist before use.

The outlook is less favorable if vitiligo occurs on the mucous membranes (such as in the mouth or on the lips), on the hands, or if it develops later in life.

White spots – how to care for your skin?

To prevent or limit skin discoloration, it is important to avoid damage to the skin, such as cuts, wounds and scratches. Any damage can lead to skin discolorations, such as dark or white spots (post-inflammatory hypopigmentation).

In addition, it is essential to ensure an optimal skin barrier. This can be achieved, among other things, by not taking too long and hot showers and limiting the use of soap. The warm water in combination with soap can disrupt the acidity of the skin. The ideal acidity of the skin is around pH 5. An increased acidity of the skin can lead to dryness of the skin and an increased risk of yeast infections, such as pityriasis versicolor.

More about skin acidity.

Avoid overstimulating your skin due to excessive use of exfoliants (scrub). Instead, use a gentle skin cleanser and condition and hydrate your skin with a moisturizer.

How can Iconic Elements help you

Below are our highlighted products to take care of your white spots.

Sensitive cream, enriched with Avena Sativa and other natural ingredients, is ideal for daily use.

Calming cream, with ingredients such as Avena Sativa and Marshmallow Root, it not only helps soothe your skin, but also improves overall skin texture. Moreover, this cream is rich in Ectoin, which is known for its protective properties.

Natural Moisturizer cream, is specially formulated to moisturize your entire body. This cream with triple action to protect the natural skin barrier.

Want to know more about white spot care and general grooming, visit our blog: Take care of white spots with Iconic Elements skin care from your dermatologist

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.