White discoloration on skin - Pale skin discoloration

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White or pale discoloration on skin occurs due to hypopigmentation (diminished pigmentation). The epidermis layer of skin has melanin pigment which gives different hues ranging right from white to dark black.

The amount of melanin to be produced by the skin and the color of a person are decided by the genetic factors.

There are also conditions wherein white hypopigmentation occurs due to some other factors like lack of vitamins, congenital conditions, autoimmune diseases, injuries, infections etc.

White discoloration on skin due to albinism

Albinism (achromia) is a hypopigmentary disorder which is congenital. Albinism results from defect in production of melanin pigment due to dysfunction of melanocytes (melanin producing cells) in the skin, hair and eyes. Albinism can be complete or partial leading to degrees of absence of melanin pigment in the hair, epidermis and eyes.

Two main clinical phenotype categories of albinism are ocular albinism and oculocutaneous albinism which are further categorized into subtypes based on specific genetic mutations.

Albino deer (image: Paulo Brandao)

This genetic white color occurs due to mutations to the tyrosinase gene and several different types of mutations can occur. Certain mutations can lead to completely inactive tyrosine enzyme production resulting in total albinism.

In some mutations tyrosine enzyme may have reduced activity (leaky mutations) and partial albinism may result. Mutations to P protein gene and human gene coding for TRP-1 also produce varying degrees of albinism.

Leucism

This type of white discoloration on the skin is a result of defects in neural crest pigment cell differentiation. Unlike albinism wherein the melanocytes are very much present but they fail to produce melanin pigment only, here the discoloration is caused due to defect in the embryonic development. There is partial or complete absence of pigment cells.

In partial absence of skin pigment cells 'piebald' effect is seen with varying degree of pigment absence leading to spotted pigmentation. Another difference between albinism and leucism is that albinos lack skin pigment in both iris and the retinal pigmented epithelium (RPE) leading to red color of the internal blood vessels showing up as red eyes.

However the formation of iris and the retinal pigmented epithelium is by the outpouching of the neural tube during development and is not affected by the neural crest aberration. Hence the eye color is not affected and has normal pigmentation in leucism.

White discoloration on skin due to vitiligo

In this chronic disorder loss of pigment (depigmentation) occurs in patches leading aesthetic disfigurement of the affected individual.

Vitiligo

Though the very exact cause of this white hypopigmentation - hypomelanosis is not known, most of the researchers agree that autoimmunity, neural, oxidative stress, genetic or viral causes precipitate the death and destruction of melanocytes.

These depigmentation patches affecting the normal human skin color, occur usually on the extremities and around body orifices like umbilicus, mouth, genitalia, nostrils and eyes.There are different types of vitiligo and now various treatments are available for eradication or camouflage of the white patches.

Leprosy and white discoloration on skin

Leprosy or Hansen's disease (HD), which is now on the verge of eradication from the world population, is a chronic disease caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis. Dermal lesions are the initial external signs, characterized by one or more hypopigmented macules or patches.

These white patches are anaesthetic in nature where sensations are lost. This is due to damage caused by human immune cells on the peripheral nerves. Leprosy can be cured completely and if detected early damages to nerves, dermis, eyes and limbs can be prevented.

White discoloration on skin due to tinea versicolor

Tinea versicolor is caused by yeasts (fungi) Malassezia globosa and Malassezia furfur. Tinea versicolor, though a common microbe living on the skin, sometimes over grows in some people and the exact reason is not clear. However, tinea versicolor is found to affect people with oily epidermis and in tropical and humid climates.

The first signs of tinea versicolor infection are small hypopigmented spots, usually lighter than the surrounding area, developing on the oily areas of the body, such as back, upper arms and shoulder giving rise to itching. The white coloration caused by tinea versicolor can be effectively treated and cured with anti-fungal lotions.

Idiopathic guttate hypomelanosis

Idiopathic guttate hypomelanosis is a non-infectious common benign acquired disorder of the skin affecting women more frequently than men. Idiopathic guttate hypomelanosis white discoloration appears to affect the exposed areas of the body, more particularly forearms and legs, in late twenties.

Idiopathic guttate hypomelanosis appears as small drops-like spots of white discoloration, the exact cause of which is not clear. However, as they appear on the exposed parts of the body, exposure to sun may have some role on the melanocytes making them effete.

Nevus depigmentosus

Nevus depigmentosus are harmless non-progressive hypopigmented stable localized skin patches. Nevus depigmentosus patches result from localized abnormalities in the function of melanocytes which fail to produce pigments. Most of the nevus depigmentosus patches are usually present right from birth.

Pityriasis alba

Pityriasis alba is a common and highly prevalent facial condition occurring in children. Pityriasis alba appears as dry, fine-scaled, white patches especially on the face. Pityriasis alba is a non-contagious condition and resolves by itself after sometime. Use of moisturizers improves the scaly condition especially in winter.

Avitaminosis and white skin discoloration

The chronic lack of certain vitamins, especially vitamins of the B complex group in the diet can cause hypopigmentation.
This white skin hypopigmentation can be corrected by improving the quality of diet and taking vitamin supplements.

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Current topic: White skin discoloration.

Idiopathic guttate hypomelanosis

White bumps on skin, lips, fingernails, teeth, tonsils and genitalia > Idiopathic guttate hypomelanosis > Causes - symptoms - diagnosis > Treatment Idiopathic guttate hypomelanosis are acquired white spots of hypopigmentation on the skin usually on shins and forearms.

The name of this disorder is self-explaining about the problem.

The reason for these white spots is not clearly known (Idiopathic).

The spots (macules) are 'drops' like (guttate), small in size (2-5 mm) and hypopigmented (hypomelanosis).

In some cases lesions measuring up to 10 mm diameter have been observed.

The causes for these white spots is not completely investigated and it is believed that sun exposure causes it.

It is further believed that the UV range of the sunlight could be the culprit.

These tiny white spots are usually formed on the forearms and shin regions of the body which are usually exposed more to sunlight.

They may also form on the other exposed parts of the body like shoulders, neck and face.

These white spots have been found to affect far more women than men.

Fair skinned people are found to be affected more frequently and at a younger age.

This disorder usually begins around the age of 30 years and it is also believed to be the part of the aging process.

Idiopathic guttate hypomelanosis on forearm

Idiopathic guttate hypomelanosis, typically develops on the legs, more particularly on the shins of the fair-skinned women in their early thirties.

Later idiopathic guttate hypomelanosis slowly progresses to cover forearms, shoulders and neck.

A familial (genetic) acquirement of these idiopathic guttate hypomelanosis white spots has been noted, requiring further research in this aspect.

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Causes of vitiligo skin disease - loss of skin pigment - white patches

White spots on skin, lips, fingernails, teeth, tonsils and genitalia > Vitiligo white skin patches > Causes > Signs > Diagnosis - Treatment and cure - Recent research

Vitiligo causes loss of skin pigment giving rise to white skin patches.
Vitiligo disease causes depigmentation of the skin in patches.

There are a number of possible causes for the onset of the disease. This disorder of white patches is believed to be primarily brought about by an autoimmune disease.

Autoimmunity causes vitiligo disorder

The most strong and accepted view about the causes of loss of pigmentation is autoimmunity.
In an autoimmune disease an individual's immune system reacts and destroys his own organs and body tissues.

In vitiligo disorder, the immune system produces certain proteins known as cytokines (immunomodulating agents) which target and alter the pigment producing melanocytes and leads to their gradual death resulting in white skin patches.
There is another view that some autoimmune factor causes the self destruction of melanocytes and loss of pigment.

Persons already affected by other autoimmune disorders like psoriasis, rheumatoid arthritis and thyroid disease have the greater risk of loss of pigmentation.
The autoimmune disease of the adrenal glands (Addison's disease) has been associated with the occurrence of this disorder.
Thyroid disorder causes the disease with white patches having no pigment.
Inflammatory and autoimmune diseases of thyroid glands lead to their over expression or under expression.

Persons with this thyroid impairment have been found prone to loss of pigment.

Hereditary factors in loss of pigment

Strong evidence is pointing towards inheritance in persons whose close blood relatives already have this disorder.
There is a great possibility of children of the vitiligo affected parents developing this white patches.
It has been found that 30% of the persons affected by this disorder have at least one family member affected by the disorder of loss of skin pigment.
Individuals with vitiligo pigment disorder seem to inherit a batch of multiple genes which make them susceptible to loss of pigmentation.
Vitiligo affected hand Physiological conditions and stress like sun burn and skin injury sometimes seem to be one of the causes for white patches.
Psychological stress triggers and leads to loss of pigment.
Environmental factors can also be the reason for white vitiligo patches.

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Vitiligo - skin disease - depigmentation - white skin patches

White spots on skin, lips, fingernails, teeth, tonsils and genitalia > Vitiligo white skin patches > Causes > Signs > Diagnosis - Treatment and cure > Recent research

Vitiligo is a skin disorder or disease in which there is loss of skin pigment resulting in white depigmentation patches.

What is vitiligo (leucoderma or leukoderma)?

Our skin color is due to the melanin pigment present in it. The melanin pigment is produced by specialised cells in the epidermis called melanocytes. The melanin pigment is formed into bundles called melanosomes and deposited in the epidermis.
Due to some physiological conditions there is stoppage of pigment production or death and loss of the pigment producing cells in patches and white areas of depigmentation occur.
This condition of loss of pigmentation is called vitiligo (leucoderma or leukoderma).

Causes for vitiligo disorder

Though the basic cause of this disease is the depigmentation of the skin there are divergent views, theories and research results pointing to many possible factors like physiological conditions, hereditary disorders, genetic disorders, environmental factors, thyroid disorders, psychological stress and autoimmune diseases.
For more details about the causes read the page ' causes for vitiligo disorders'.

Who can be affected by this condition of depigmentation?

Worldwide it is estimated that this condition of loss of skin pigment is affecting 1-2% of the population.
This disease affects all races and both genders and appears prominent in dark skinned people.
Persons with autoimmune disease and thyroid disorder are prone to get vitiligo disorder.
The chances for the immediate relatives of an affected person to get this disorder are greater.

Patterns and types of vitiligo disease

Three types of this loss of skin pigmentation, namely focal, segmental and nonsegmental vitiligo are observed.
In the focal form of the disorder, the white patches are restricted to one or a few areas.
In non-segmented form the white patches appear on both sides and somewhat show symmetry.
These white patches of skin grow over a period of time to spread all over the body.
If the depigmentation is total or only a few pigment patches remain, the condition is called as vitiligo universalis.
Segmental vitiligo disease affects younger individuals. The disorder affects some parts of the body and may not appear in symmetry.

Diagnosis of white skin patches

Vitiligo disease appear as white skin patches around orifices of the body like mouth, nostrils, eyes etc. They also appear on the end of the limbs like fingers and toes.
These white patches are irregular in shape and keep growing in most of the affected persons. For more detail about diagnosis of the disorder read 'Diagnosis of vitiligo disease'.

Therapy and treatment for vitiligo skin disease

There is a difference between the approach towards this disorder between the western medicine and the oriental medicine.
In oriental medicine the claim is that it is addressing the underlying cause of the disease.
There are number of ways to alter the appearance in the vitiligo skin disease affected.
The white vitiligo disease patches can be hidden by application of camouflage creams and skin dyes.
Further treatment methods for the disease like topical application, oral medicine, phototherapy, surgical grafts, repigmentation and treatment with melanocyte cultures are possible.
For detail information on treatment of this disorder read the page "Therapy and treatment of vitiligo disease".

Psychological and aesthetic aspects of the disorder of loss of skin pigment

Though this disease has no harmful effects on the body, it devastates the mental health of the affected person leading him to mood and depression disorders.
The loss of aesthetic appearance and being stigmatised for the condition ruins the self-esteem and emotional health of the person affected by the disorder.
Those affected by this disease are tormented sub-consciously about others reactions, feel ashamed, embarrassed and dejected and may become introverts.

Support groups for the vitiligo disease affected

Considering the psychological impact of this disorder all over the world, a number of organisations have come up to help out the affected by educating them and providing them advice, counsel and course of treatment for the disease.
These efforts are to save the affected from becoming a burden on the society just because of this harmless skin condition.

Research on pigmentation, depigmentation and repigmentation of this skin disorder

Wide spread research is going on to tackle this disorder. Methods for repigmentation of these white skin patches are already known and further research is going on .
If the vitiligo disorder has affected more than 50% area, a process for depigmentation of the rest of the skin pigment is now known. Further research is being carried out in this aspect of tackling vitiligo disease.

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Idiopathic guttate hypomelanosis white spots - treatment

White spots on skin, lips, fingernails, teeth, tonsils and genitalia > Idiopathic guttate hypomelanosis > Causes - symptoms - diagnosis > Treatment - medication
Idiopathic guttate hypomelanosis treatment includes application of topical steroids or retinoids, dermabrasion or microdermabrasion, cryotherapy, cosmetic cover-up, surgery and grafting. As the white spots are completely harmless best way for this hypomelanosis is to cover them up with cosmetics and forget.

Even if treatment is carried out fresh white spots may keep appearing at new areas.
For individuals conscious about aesthetic appearance cure is available.

Idiopathic guttate hypomelanosis treatment with retinoids

Retinoids like tretinoin have been used with some success in removing guttate hypomelanosis.
Tretinoin is the acidic form of vitamin A and it should be used with caution by people with sensitive skin as it can cause redness, burning and itching.
To avoid these problems the frequency of application must be increased slowly.
Tretinoin applied hypomelanosis lesions can get severe sunburn and exposure of these areas to sunlight must be avoided.
Topical corticosteroids have been found to alleviate the white spots condition to some extent.

Dermabrasion or microdermabrasion for idiopathic guttate hypomelanosis

Dermabrasion or microdermabrasion may also be considered in the treatment of this disorder.
These procedures must be done by a trained Aesthetician or a dermatologist as improper therapy may leave greater scar marks.
Dermabrasion is a painful process to be done under general or light anesthesia. Microdermabrasion is not very painful and can be done at cosmetic spas.

Idiopathic guttate hypomelanosis treatment by cryotherapy and surgery

Cryosurgery or cryotherapy also have been tried successfully. In this method of therapy white spots are frozen resulting in the death of thin layer of skin at the affected area.
Soon the normal skin takes over and cover-up the dead skin and the white spots disappear.
Surgical removal of the affected skin and grafting of the healthy skin has been successful.
Although these procedures may remove the current hypomelanosis, there is no treatment to stop fresh lesions from appearing. Idiopathic guttate hypomelanosis on leg
Hence it is advised to tackle the root cause. Sun tanning and tanning beds may be avoided by young fair-skinned individuals, especially young women, to prevent possible idiopathic guttate hypomelanosis white spots at a later life.

Nevus depigmentosus

Home › White bumps on skin, lips, fingernails, teeth, tonsils and genitalia › Fordyce spots overview › Fordyce spots treatment and cure › Nevus depigmentosus
Nevus depigmentosus is usually a congenital benign non progressive white macule (white patch or spot) with hypopigmentation. Nevus depigmentosus is stable in size and distribution, during the lifetime of the affected individual. The investigation on the histopathology and pathogenesis of this ailment is not complete and its cause is not fully understood.

Symptoms of nevus depigmentosus

These white spots appears as stable spots affecting any part of the body. However they have been found to affect the trunk, hands and feet often.
They do not grow in size. They are usually present from birth and in rare cases they are formed at a later stages of life.
These lesions appear round or oval and grow only with proportion to the growth of the person.
In rare cases certain neurological afflictions have been associated with this ailment; delayed development, seizure disorder and mental retardation have been associated.

Causes of nevus depigmentosus

These white spots are believed to form due to functional abnormalities of the melanocytes and morphological anomalies of melanosomes.
This results in the lowered pigment production in the affected area giving the characteristic pale white spots in the skin.

Differential diagnosis of nevus depigmentosus

Differential diagnosis for this disorder is done to rule out the possibility of affliction by vitiligo (leucoderma) and leprosy.
Unlike leucoderma the white patches or spots are usually present right from birth.
Leucoderma normally show hyperpigmented border to the lesions, whereas in this disorder there is no clear cut hyperpigmented border.
Vitiligo white spots normally grow in size and spread. In rare cases they disappear altogether.

In nevus depigmentosus disorder the white spots are stable and do not spread.
Vitiligo white spots normally occur around the orifices of the body like eyes, ears, nostrils, mouth, umbilicus and genitalia.
Nevus depigmentosus white spots are usually found on the trunk, hands and legs.
The back, chest and buttocks are the most common sites of affliction.

These white spots do not show any alteration of sensitivity or texture of the affected area.
In leprosy the white pale spots occur at a later stage of life and show mild inflammation, hair loss, shine in the skin and numbness. Histological study can differentiate leprosy.
The differential diagnosis for nevus depigmentosus includes hypomelanotic macules of tuberous sclerosis, vitiligo, and anemicus. Nevus depigmentosus on the belly

Treatment for nevus depigmentosus

Treatment is not necessary for this ailment. Use of sunscreen and avoiding exposure to sun is advised as the affected area may not pigment on sun exposure; increase in the contrast between the normal skin and the lesion area will affect the aesthetic appearance. There is also the danger of severe sunburn of nevus depigmentosus area on prolonged exposure to sun.

Sep 18, 2015

Pale white spots/patches on children skin face and body

Home › Skin discoloration › White spots on the face of children

The cause of pale white spots and patches on the face and the body of children must be diagnosed and treated or else it may leave a psychological impact on the kids, apart from the physiological problems.

Various conditions and diseases can cause pale white spots/patches on the skin of children. Some are harmless and resolve by themselves. Many can cause health problems. It is very important for the parents to get the causes diagnosed and have the children treated if necessary.

Pale/white spots and patches arising out of injuries, burns and infections

These white spots are due to skin damage.
Repigmentation of these areas may take a long time or may not develop pigments fully.
These patches can be corrected by chemo or
cosmetic laser treatments.

Deficiency of vitamins (avitaminosis) causes pale white spots/patches on the skin

Vitamins are very essential components of our nutrition and the deficiency of them in children can cause many diseases and also affect their skin. Deficiency of B complex vitamins affect our skin in a number of ways.

The deficiency of Vitamin B₁₂ causes pale white spots/patches on the skin especially on the forearms of the kids.These pale patches arise out of depigmentation of the skin and may later turn pink/red causing itching and distress to the kids. Giving food rich in vitamin B₁₂ to the kids makes the pale white vitamin B₁₂ deficiency spots/patches to disappear gradually.

Pale white spots and patches on the children caused by pityriasis alba

This is an asymptomatic condition, the cause of which is not known. The lesions initially appear slightly raised pinkish or reddish in color. Later they flatten out and turn pale white. This condition affects particularly children, more often boys. It usually affects the face of the child, especially cheeks, area around mouth and chin.

Pale white patches may also appear on shoulders arms and hands of kids. By puberty in most of the kids it resolves by itself. The condition may last to a few months or to years. Pityriasis alba may also recur. No specific treatment is required. Protective and preventive measures may be taken to avoid these pale white spots and patches on your children faces.

Milia (oil seeds or milk spots) causes small raised spots on the face, mouth roof and genitalia

Milia is quite often present in newborns and infants. These white baby milk spots may also affect older children and adults. Milia are keratin filled cysts and are benign and asymptomatic. Usually in newborns they disappear after a few weeks. In adults they may persist and can be removed by opening the cyst.

Fordyce pale white spots

These Fordyce spots geanules are usually found on the lips and genitalia. These white spots are actually sebaceous glands which do not have hair follicle association (ectopic sebaceous gland). These are harmless and of cosmetic worry only.

Pale patches caused by nevus depigmentosus

Nevus depigmentosus are hypopigmentation areas in the skin and may be present right from the birth. These pale spots are stable, harmless and non- contagious.

Pale white or brown patches/spots caused by tinea (pityriasis) versicolor

Skin yeast Malassezia furfur and M.globosa cause tinea versicolor infections. This ailment usually affects teenagers and young adults. Kids are rarely affected. Malnourished children and kids with suppressed immunity are affected. The fungus can be treated with a number of anti-fungal topical and oral medications.

Pale white spots and patches caused by vitiligo (leucoderma)

Vitiligo is a skin disorder and gives rise to hypopigmentation of some areas of the skin. Autoimmunity is the main cause of vitiligo. In this ailment the immune cells kill the pigment producing cells (melanocytes) in some areas of the skin leading to white patches.

Pale white spots and patches of leprosy

Leprosy initially shows as pale white spots and patches on the skin, which are numb to touch. Though this skin disease is eradicated from most parts of the world, it is still persisting is some pockets of Africa and South east Asia. This is a curable bacterial disease. Areas of skin which lack sensation require immediate medical attention.

Sudden appearance of tender feeling to touch can be a hint of progressive damage to the peripheral nerves or even the spinal cord and the brain.

Pale white spots and patches arising on children must not neglected and immediate diagnosis and treatment must be given.

Causes of pityriasis alba-white/pale spots/patches on children

Pityriasis alba > Causes > Diagnosis > Treatment
A number of causes are related for the occurrence of pityriasis alba white/pale spots and patches on the face and body of children. But the knowledge of real reason is elusive.

Pityriasis alba is considered as an atopic dermatitis occurring in children, especially on their face, shoulders and arms and could be an independent eczema. The exact causes of these white spots is not known. The investigations of skin scrapings of a number of patients have indicated non involvement of bacteria and fungus.

Pityriasis alba is not contagious and has no definite etiologic agent. Studies have revealed that the hypopigmentation is due to reduction in the numbers of functional melanocytes and decrease of melanosomes in size and number. Dryness of skin, especially in winter appears to aggravate this ailment and increase the scale formation.

We can infer that cold dry condition may trigger and cause it in persons predisposed to it. In summer months, though the patches appear prominent due to tanning of the surrounding skin, there is no aggravation of the condition. Another hypothesis is that the deficiency of calcium and related vitamins precipitates this pityriasis ailment.

The explanation and reasoning is that pityriasis alba often occurs during the growing years of children. The growing children tend to get deficient in vitamins and calcium easily. Infestation with intestinal worms and parasites has been associated with pityriasis alba occurrence. In rural India deworming of the children is done by feeding them with a spoon of Castor oil with the belief that the condition will resolve.

Some theories have associated public swimming pools as one of the reasons of occurrence of pityriasis alba. Though the condition is asymptomatic for the affected child, it is of a big worry for the parents. Schools and daycare facilities will be very apprehensive about pityriasis alba and its causes and may insist on evaluation of the infective status of the condition.