White spots on the skin can occur due to a variety of reasons – autoimmune, infections, inflammatory skin conditions, sun damage, exposure to chemicals, and very rarely due to cancer.
In most cases, these white patches or spots are harmless and may resolve or fade over time. However, some conditions like infectious rashes and cancerous spots require proper diagnosis and treatment.
White spots refer to any areas of skin that are hypopigmented or lighter than the surrounding skin. These lighter spots on the skin may lack melanin pigment or have less of it.
“White spots” is a general term used for all white skin lesions, whether they are flat or raised (white bumps). On the other hand, a “white patch” refers to a flat area of discoloration that is more than 1 cm.
A very common cause of white spots on the skin is vitiligo. However, there are other conditions that can also cause white spots but are not related to vitiligo. These include pityriasis alba, white sun spots, tinea versicolor, lichen sclerosus, and birthmark (naevus depigmentosus), among others.
Below, these conditions are described in detail, along with pictures and treatment options.
Jump to
- Vitiligo
- Pityriasis alba
- Idiopathic guttate hypomelanosis
- Tinea versicolor
- Milia
- Folliculitis
- Closed comedones
- Sebaceous hyperplasia
- Molluscum contagiosum
- Allergic contact dermatitis
- Seborrheic dermatitis
- Skin cysts
- Nutritional deficiency
- Treatment side effect
- Contact leukoderma
- Lichen sclerosus
- Progressive macular hypomelanosis
- Halo nevus
- Ash leaf spots
- Naevus depigmentosus
- Piebaldism
- Leprosy
- Actinic keratosis
- Skin cancer
- When to see a doctor
- Prevention
1. Vitiligo
White patches on the skin that are smooth may be caused by a skin condition called vitiligo. It often starts as a small white spot that can gradually enlarge over time.
These patches occur due to the loss of melanocytes, which are the cells that produce the melanin pigment and give our skin its color.
There are several hypotheses as to why this happens. Genetics may play a significant role in this condition. Additionally, an autoimmune process, where our own immune cells destroy the melanocytes, may be a cause. This could be triggered by stress or injury.
There are different types of vitiligo. Nonsegmental vitiligo, the most common type, leads to symmetrical patches of pigment loss on both sides of the body. It’s usually seen on the backs of the hands, around the eyes and mouth, and on the elbows, knees, and feet.
Treatment
While there is no cure for vitiligo, certain treatments can give positive results. These include topical steroids and calcineurin inhibitors, which suppress our immune cells. Light therapy can also be beneficial. In some cases, surgery involving skin grafting may be considered
2. Pityriasis alba
Dry white spots or patches on the skin can occur due to a type of eczema known as pityriasis alba, which is predominantly seen in children. This condition often presents as oval or circular light spots, usually on the face, particularly on the cheeks and chin.
The patches might initially appear as pink lesions, which subsequently transform into lighter, hypopigmented patches with a dry, scaly surface. Pityriasis alba often coexists with another condition known as atopic dermatitis.
Treatment
Usually, pityriasis alba doesn’t require specific treatment, as the lesions usually regain their color over a few months or years. However, moisturizers and emollients can be beneficial in managing the associated dryness. Steroids may also be useful in reducing redness and itchiness.
3. Idiopathic guttate hypomelanosis
Idiopathic guttate hypomelanosis, also known as white sun spots, is a skin condition that presents with white spots on parts of the body exposed to the sun, such as the legs, arms, or face.
They may look like freckles, just white in color, and are often called white freckles.
It is most commonly seen in individuals over 40 years of age, predominantly those with lighter skin tones. Both genetics and sun exposure may play a role in its development. Usually, the lesions are 2-6 mm in size and may appear as white dots on the skin; however, larger patches can also occur.
Treatment
Idiopathic guttate hypomelanosis does not require treatment unless desired for cosmetic reasons. The effectiveness of treatments can vary. Commonly used treatments include topical steroids, retinoids, lasers, chemical peels, and cryotherapy.
Read more: White spots on skin from the sun.
4. Tinea versicolor (Pityriasis versicolor)
Tinea versicolor, also known as pityriasis versicolor, is a fungal skin rash that results in scaly oval or round white patches, typically on the trunk – including the back and chest, neck, or upper arms and shoulders.
This condition can also lead to patches that are brown or pink. It is most commonly seen in young adults.
Tinea versicolor occurs due to an overgrowth of the fungus Malassezia, which forms part of the normal skin flora. Factors that can precipitate this overgrowth include heavy sweating, hot and humid climates, stress, and immunosuppression.
Treatment
Tinea versicolor treatment usually involves the use of topical creams, lotions, or shampoos containing antifungal ingredients such as miconazole, clotrimazole, ketoconazole, and selenium sulfide. In some cases, oral antifungals may also be prescribed.
Read more: White spots on skin from fungus.
5. Milia
Small, hard white spots on the face that do not pop are usually milia. These are often found on the cheeks, nose, and under the eyes. They can occur at any age and are frequently seen in infants.
These spots occur due to the trapping of dead skin cells under the skin. The dead skin cells can harden, resulting in hard white bumps.
The following factors are associated with its development:
- Damage to the skin barrier due to a rash, injury, or harsh skincare products.
- Prolonged use of topical steroids.
- Sun exposure.
- Autoimmune conditions.
- Genetics.
- Procedures like laser skin resurfacing and microdermabrasion.
- Use of heavy cosmetics.
- Hormonal changes (especially in infants, due to the mother’s hormones).
A single lesion is called a milium, while multiple spots or a cluster are called milia.
Treatment
Milia are harmless and may go away on their own, although this may take a few weeks or months. Over-the-counter products like exfoliants (salicylic acid) and topical retinoids like retinol may help clear these tiny white skin spots by removing dead skin cells.
If over-the-counter treatments do not work, your doctor may recommend the following medications or procedures:
- Prescription retinoids like tretinoin.
- Extraction by de-roofing.
- Cryotherapy (freezing of the lesion).
- Chemical peels.
- Laser ablation.
6. Folliculitis
Itchy skin with white spots that look like acne may be due to folliculitis. Folliculitis is the inflammation and/or infection of hair follicles. It is of several types.
Bacterial folliculitis, often caused by the bacteria Staphylococcus aureus, is the most common type. If a hair follicle becomes deeply infected with the bacteria, it can become a boil.
It can present as white, red, or skin-colored bumps. Sometimes they may be filled with pus. The common areas are the face, arms, legs, and buttocks.
Some risk factors for developing folliculitis are any skin injury, hair removal like after-shaving or waxing, heavy sweating, diabetes, being overweight, tight clothing, and hot tubs that are not cleaned well.
Treatment
Mild cases of folliculitis may resolve on their own. In more severe cases, topical antibiotics like mupirocin may be used for bacterial folliculitis. Oral antibiotics may be needed for more severe cases.
7. Closed comedones
Closed comedones are a type of non-inflammatory acne lesion. They appear when the hair follicles get blocked by dead skin cells. Unlike open comedones, closed comedones do not have an opening on the surface.
Closed comedones, also known as whiteheads, can appear as either white or skin-colored bumps on the skin. The most common locations for them are the forehead and chin.
Treatment
It is recommended not to try to squeeze or pop closed comedones as that can lead to inflammation or scarring. Although they are harmless, they can be treated with exfoliants like salicylic acid and retinoids like tretinoin, retinol, or retinal.
8. Sebaceous hyperplasia
Sebaceous hyperplasia occurs due to enlarged sebaceous glands, or oil glands, which have trapped oil. It can lead to white, yellow, or skin-colored bumps on the skin, which are usually a few millimeters in size.
They are usually seen on the cheeks and forehead. Sometimes, they can be confused with basal cell carcinoma (a type of skin cancer).
Treatment
Sebaceous hyperplasia is harmless and does not require treatment. If needed, these spots may shrink with the use of retinoids, especially prescription-strength ones. Oral anti-androgen medication and isotretinoin may also help shrink them.
These spots can also be removed by several in-office procedures such as freezing, electrodesiccation, lasers, or curettage.
9. Molluscum contagiosum
Shiny or waxy white spots on the skin can be caused by Molluscum contagiosum, a common viral infection of the skin caused by a pox virus called Molluscum contagiosum virus.
These spots can also appear pink, skin-colored, or light tan. They have a central depression and this appearance is called umbilicated. They are usually 1-5 mm in size and appear on the face, trunk, or limbs. They can also appear on genitalia in adults.
Molluscum contagiosum usually occurs in children but can also occur in adults, especially those with suppressed immune systems.
One can get this infection through direct contact with the lesion or contaminated surfaces. In adults, it can occur through sexual transmission.
Molluscum contagiosum may occur more frequently in children with atopic dermatitis due to a defective skin barrier.
Treatment
These white spots usually disappear on their own however, they may take several months or a few years to clear. Several procedures can be done in a doctor’s office to remove them, like laser therapy, curettage, or cryotherapy.
10. Allergic contact dermatitis
Allergic contact dermatitis can sometimes result in a rash characterized by tiny white spots on the skin. However, it more commonly presents with red spots or sometimes fluid-filled bumps.
This rash appears when our skin comes in contact with an allergen, such as poison ivy, certain metals like nickel in jewelry, molds, pollen, dust, and so forth.
Treatment
One should avoid any further contact with the allergen. Applying a cool compress may alleviate symptoms. Antihistamines and topical steroids may help in reducing symptoms.
11. Seborrheic dermatitis
Seborrheic dermatitis is a skin condition that occurs due to overgrowth of Malassezia yeast, excessive oiliness of the skin, and skin barrier dysfunction, among other factors.
It presents as oily patches covered with thick yellow, greasy scales. In people with lighter skin tones, it can present as red areas, while in people with darker skin tones, it can present with either dark red, brown, or hypopigmented white patches on the skin.
The affected areas often involve the scalp, face, and chest and are frequently associated with itching.
Treatment
Seborrheic dermatitis is often treated with over-the-counter dandruff shampoos. When choosing a shampoo, look for ingredients like zinc pyrithione, selenium sulfide, ketoconazole, piroctone olamine, sulfur, and salicylic acid.
Your doctor may also prescribe topical steroids and immunosuppressants for flare-up episodes. Phototherapy may also benefit some people.
12. Skin cysts
Skin cysts are lumps under the skin. The overlying skin may be stretched, and the cyst may appear as a white, yellowish, or skin-colored spot. If inflamed, the cyst can appear as a pink or red spot.
There are different types of skin cysts, and epidermoid cysts are the most common. These occur due to skin injury or blockage of the hair follicle. They are lined by stratified squamous epithelium and are filled with keratin.
Treatment
Epidermoid cysts usually do not require any treatment unless they cause symptoms or for cosmetic reasons. If the cyst becomes inflamed, intralesional steroids may be helpful.
If the cyst becomes infected, antibiotics may be needed. To completely remove it, it has to be surgically excised to remove the entire cyst wall.
13. Nutritional deficiency
Vitamin deficiencies, including deficiencies in vitamin B12, vitamin D, vitamin E, and folic acid, may lead to the development of white spots on the skin. Similarly, deficiencies in proteins, copper, and iron can also cause white spots on the skin.
Treatment
Initiating treatment requires an understanding of which vitamin is deficient. Therefore, it is important to consult a doctor who can carry out a thorough workup, including blood tests, to make an accurate diagnosis. Following a healthy diet rich in green leafy vegetables and healthy oils can help address these deficiencies.
If you are a vegan, you might need to supplement with vitamin B12, as it is primarily found in animal-based foods.
14. Medication or treatment side effects
Topical medications such as hydroquinone and steroids can lead to alterations in pigmentation. This can result in either dark hyperpigmented or hypopigmented light spots on the skin.
In some cases, white discoloration of the skin can also occur following in-office treatments like chemical peels and lasers, or after surgeries.
Treatment
In most cases, simply discontinuing the treatment is all that’s needed to improve the white blotchy areas on the skin. The affected areas usually return to their normal color after some time. Any remaining scars may show improvement with the use of silicone gels or sheets, lasers, or peels.
15. Contact leukoderma
Contact leukoderma refers to the loss of melanin pigment that occurs after contact with certain chemicals. These chemicals destroy the melanocytes, the cells responsible for producing the melanin pigment in our skin, resulting in white patches.
Such chemicals can be encountered through occupational exposure or through certain skin and hair products. The main chemicals implicated in contact leukoderma are aromatic or aliphatic derivatives of phenols and catechols.
In cosmetics, hair dyes containing para-phenylenediamine are often behind the occurrence of these white patches. In addition, dyes used in lip liners, eyeliners, and lipsticks can also lead to this condition.
Treatment
Usually, complete avoidance of the product causing contact leukoderma can lead to re-pigmentation of the affected area. However, in some cases, even after stopping the use of the product, the white splotchy areas may persist or even expand. Steroids and phototherapy may help in faster recovery.
16. Lichen sclerosus
Lichen sclerosus is an uncommon skin condition that predominantly affects genital or anal areas, though it may less frequently involve the breasts, upper arms, or trunk.
This condition commonly occurs in post-menopausal women and is believed to be caused by a combination of genetic factors, hormonal changes, and immune processes.
It presents as shiny, scar-like white patches and may be associated with itching, bruising, bleeding, or blistering. Lichen sclerosus can lead to painful sex and urination.
In some individuals, lichen sclerosus may increase the risk of a type of skin cancer called squamous cell carcinoma.
Treatment
While there is no cure for lichen sclerosus, certain treatments such as topical steroids and immunosuppressants can help manage the symptoms.
17. Progressive macular hypomelanosis
Progressive macular hypomelanosis results in round, ill-defined pale to white patches on the skin, usually appearing on the trunk. Unlike the scaly white patches characteristic of tinea versicolor, the white patches associated with progressive macular hypomelanosis do not have scales.
This condition is commonly seen in young adults. The exact cause is unknown, but genetics and the acne-causing bacteria Cutibacterium acnes may play a role in its development.
Treatment
Progressive macular hypomelanosis is usually treated with topical anti-acne medication, antibiotics, or phototherapy.
18. Halo nevus
A halo nevus is characterized by a mole surrounded by a symmetrical hypopigmented or white circular area or ring. Over time, the mole may gradually fade, leaving behind a white patch that could take years to regain its color.
Halo nevi are thought to occur due to an autoimmune process. Rarely, they may be associated with melanoma elsewhere on the body, so a full skin examination by a doctor may be necessary.
Treatment
Treatment is usually not required for a halo nevus unless it presents atypical features like irregular borders.
19. Ash leaf spots
Ash leaf spots are elliptical or lance-shaped, hypopigmented, or white marks on the skin that are usually present at birth or shortly after birth. The presence of multiple ash leaf spots (more than three) may be indicative of a genetic disorder known as tuberous sclerosis.
Treatment
Ash leaf spots typically do not require treatment. Over time, the affected area may darken and become less noticeable.
20. Naevus depigmentosus
Naevus depigmentosus, also known as achromic naevus, is an uncommon birthmark that results in a light-colored patch on the skin, characterized by an irregular yet well-defined border.
This birthmark occurs due to altered melanocytes, which produce less pigment than normal. It usually appears as a single white skin lesion on the chest or back. Despite its name, the area is not devoid of pigment but rather exhibits reduced pigmentation.
Treatment
Naevus depigmentosus does not require treatment. The affected area can be concealed with cosmetics. For those seeking re-pigmentation, skin grafting or phototherapy may be beneficial.
21. Piebaldism
Piebaldism is an uncommon inherited disorder in which the migration and development of melanocytes are affected. Many mutations are associated with it, but the most common is the one in the KIT proto-oncogene.
It usually presents at birth, with an individual having a white forelock (white hair at the front of the scalp or head) and white marks or spots on the anterior aspect of the midline. Commonly affected areas are the forehead, the anterior aspect of the abdomen, and the extremities.
Treatment
The white spots do not require treatment and usually remain stable. If needed, the areas can be camouflaged. Some procedures like autologous melanocyte transplantation or skin grafting may be helpful.
Patients should be educated to protect their skin from the sun to prevent sunburn and skin cancer.
22. Leprosy
Leprosy is an uncommon bacterial infection caused by the bacterium Mycobacterium leprae. This is a slow-growing bacteria, so once you get an infection, it can take up to 3-5 years, sometimes even longer, to develop symptoms.
Leprosy can affect the skin, nerves, eyes, and mucous membranes. It can lead to red skin lesions or hypopigmented or light-colored skin lesions. These may be flat areas or raised to form bumps or lumps. Leprosy can be classified in different ways.
One way of classifying is to broadly divide it into three types: Tuberculoid, borderline, and lepromatous. Tuberculoid is on the mild spectrum of the disease and can lead to fewer, usually hypopigmented lesions, while lepromatous is the severe form with many skin lesions.
Other symptoms may include loss of sensation, enlarged nerves, and loss of eyebrows and eyelashes.
Leprosy cannot be transmitted by casual contact like shaking hands or sitting together. One needs prolonged close contact with someone with untreated leprosy to get this infection.
It is thought that one can get the infection by inhaling droplets containing the bacteria when an infectious person coughs or sneezes.
Treatment
Treatment for leprosy involves multidrug therapy, which includes the use of multiple antibiotics. These include dapsone, rifampicin, and clofazimine.
Early treatment may prevent long-term complications like paralysis, loss of vision, or permanent damage to other parts of the body.
23. Actinic keratosis
White spots with crusty or scaly surfaces may be due to actinic keratosis, a precancerous skin condition.
Actinic keratosis is typically seen on sun-exposed areas like the scalp, face, lips, ears, neck, and extremities. This condition occurs due to DNA damage in the squamous cells, which form the top layer of our skin.
Actinic keratosis can present as a white, tan, pink, red, or brown patch or bump, characterized by a rough and crusty surface. It can progress into squamous cell carcinoma, a type of skin cancer, in about 5 to 10% of cases.
Treatment
Actinic keratosis can be treated with topical medications (such as 5-fluorouracil, imiquimod, ingenol mebutate, or diclofenac), cryotherapy, curettage, laser therapy, photodynamic therapy, or local excision.
24. Skin cancer
Rarely, a white spot or patch on the skin may be a sign of skin cancer. Some cancers that can present as a white spot include the following:
- Basal cell carcinoma: This can present as a white, scar-like patch with a waxy appearance and irregular edges. Additionally, it can also appear as a skin-colored, pink, red, tan, or brown spot.
- Hypopigmented mycosis fungoides: This is an uncommon variant of skin lymphoma that can present as white patches primarily on the trunk and extremities.
- Amelanotic melanoma: This is an uncommon variant of melanoma that can present as a white, skin-colored, or pink spot on the skin. Unlike melanoma, which is usually brown in color, this variant does not produce melanin pigment.
Treatment
Treatment will depend on the type of cancer, its location, size, and depth of invasion. The treatment options may include surgical excision, radiotherapy, chemotherapy, phototherapy, or cryotherapy.
To prevent skin cancer, it’s important to protect the skin from the damaging effects of the sun by wearing sunscreen and sun-protective clothing.
You can read more about white spots and skin cancer in this article.
When to see a doctor
While most white spots on the skin are harmless, some may require treatment, so it’s important to see a doctor for a diagnosis.
You should seek medical attention immediately if:
- There’s a change in the size or appearance of the white spots.
- You’re experiencing intense pain, itching, or burning in the area of the white spots.
- You have a fever or other systemic symptoms.
- The white patches are spreading on your body.
Prevention
Preventive measures cannot completely eliminate the risk of developing white patches or spots on the skin for some people, however, they can still be helpful in certain cases:
- Be gentle with your skin: Avoid harsh scrubbing or exfoliation, and use gentle, non-irritating skincare products.
- Use sunscreen every day: This can prevent sun damage, which can contribute to the development of white patches or spots.
- Avoid known skin irritants: Certain products or substances can irritate the skin and potentially contribute to skin discoloration or blotchy skin.
- Don’t use over-the-counter steroids without a doctor’s guidance: Misuse of these products can lead to skin problems, including white discoloration.
- Practice good hygiene: Regular washing can help keep your skin healthy and free of infections that can lead to skin discoloration.
- Eat a healthy diet: This can help you avoid nutritional deficiencies that can cause white discoloration on the skin. Ensure your diet is rich in vitamins, minerals, and other nutrients essential for skin health.
Summary
White spots on the skin can occur due to idiopathic guttate hypomelanosis, vitiligo, tinea versicolor, pityriasis alba, birthmarks, milia, closed comedones, folliculitis, molluscum contagiosum, uncommon infections like leprosy, and rarely due to skin cancer.
The majority of these are harmless, but it is important to get them checked to receive a proper diagnosis and treatment.
References
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- Halo naevus. Oakley A. (1997).
- Givler DN, Basit H, Givler A. Pityriasis Alba. [Updated 2022 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
- Brown F, Crane JS. Idiopathic Guttate Hypomelanosis. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
- Dyall-Smith D. Contact leukoderma. DermNet.
- Relyveld GN, Menke HE, Westerhof W. Progressive macular hypomelanosis: an overview. Am J Clin Dermatol. 2007;8(1):13-9. doi: 10.2165/00128071-200708010-00002. PMID: 17298102.
- Furlan FC, Sanches JA. Hypopigmented mycosis fungoides: a review of its clinical features and pathophysiology. An Bras Dermatol. 2013 Nov-Dec;88(6):954-60. doi: 10.1590/abd1806-4841.20132336. PMID: 24474105; PMCID: PMC3900347.
- Basal Cell Carcinoma Warning Signs. Skin Cancer Foundation.
Disclaimer: This blog post is for information purposes only and does not replace medical advice.