White spots on the skin from fungus can be due to tinea versicolor and seborrheic dermatitis. Both these are associated with the fungi Malassezia and are treated with anti-fungal agents.
Overview
White spots are areas of skin discoloration that can occur due to a decrease in melanin pigment or a complete absence of melanin pigment.
There are various reasons behind these white spots like destruction of melanocytes by our immune cells, pigmentary alteration due to inflammation, or side effects of treatments or medications.
There are two skin conditions that are associated with fungus and may present with white spots on the skin. Both these skin conditions are associated with Malassezia.
The fungus Malassezia is part of the normal flora of our skin, which means we all have it on our skin. (To be more precise, it is a group that has several species like Malassezia furfur, Malassezia globosa, and so on).
It can lead to various skin conditions especially when it overgrows such as pityriasis versicolor, Malassezia folliculitis, dandruff, seborrheic dermatitis, etc.
In particular, when it comes to white spots, two skin conditions can have hypopigmented areas. These are:
- Pityriasis versicolor (Tinea versicolor)
- Seborrheic dermatitis
1. Tinea versicolor (Pityriasis versicolor)
Tinea versicolor is a fungal infection of the skin that occurs due to the overgrowth of Malassezia. It is commonly seen in young adults.
Why it happens in some individuals is not known, however, the precipitating factors are:
- Immunosuppression
- Excessive sweating
- Hot and humid weather
- Oiliness of skin
- Hormonal changes
The commonly affected areas are the back and chest, upper arms, and neck.
This results in pigment alteration of the skin. It can present with pink, red, brown, pale, or white patches with surface scaliness. It is thought that the metabolites of Malassezia result in this pigment alteration.
Even after treatment, the affected area may take a while before returning to its original color. In some individuals, this condition can recur in hot and humid climates.
Diagnosis
Tinea versicolor can be diagnosed by clinical examination by a doctor. In some cases, they might do some tests to diagnose and rule out other skin conditions:
- Wood lamp examination.
- Skin scrapings – Skin cells are scraped and examined under a microscope for identifying any fungal elements.
- Skin biopsy where tissue is examined under a microscope by a pathologist.
Treatment
Tinea versicolor is usually treated with dandruff shampoos and antifungal creams or lotions like Lotrimin (clotrimazole), and Monistat (miconazole).
In some cases, one may need prescription topical antifungals – ketoconazole (2%) or ciclopirox and oral antifungals like fluconazole or itraconazole.
Read more: Tinea versicolor healing phases and treatment options.
2. Seborrheic dermatitis
Seborrheic dermatitis is an inflammatory skin condition. It can occur in infants as cradle cap and in adults as a chronic disease affecting various parts of the body – face (nose, eyebrows, behind ears), scalp, chest, and back or body folds.
What really causes seborrheic dermatitis is not completely clear. However, there are several factors that are strongly associated with seborrheic dermatitis. These are:
- Overgrowth of fungus Malassezia
- Oiliness of skin
- Skin barrier dysfunction
- Stress
- Genetics
- Immune response
- Some medications
Seborrheic dermatitis occurs due to our skin’s sensitivity to Malassezia and its by-products.
What does that mean? It’s thought that due to excessive oiliness of the skin or immunosuppression, Malassezia overgrows on our skin. Malassezia then utilizes our skin oils and produces free fatty acids like oleic acid.
These can penetrate our skin barrier especially when our skin barrier is not working well. This leads to inflammation and increased proliferation of skin cells. This results in red areas with scaliness which may be associated with itching.
However, in people with dark skin tones, it can either present as dark red areas or hypopigmented or white spots.
In particular, in individuals with dark skin tones, it may present as petaloid seborrheic dermatitis in which there is coalescing or fusing of hypopigmented areas around the hairline.
Even in children with dark skin tones, one may not have typical features of cradle cap (infantile seborrheic dermatitis). It may present with redness, hyper or hypopigmentation, and scaliness.
Diagnosis
Seborrheic dermatitis is usually diagnosed clinically by a doctor. In some cases, a doctor may take skin scrapings or a biopsy to rule out other skin conditions.
Treatment
In infants, seborrheic dermatitis usually clears on its own in a few weeks or months. Gently brushing the hair can loosen the scales.
In a few cases, a doctor may recommend topical steroids or antifungal shampoo or cream. However, one should not use over-the-counter antifungals in babies without guidance from a doctor.
In adults, seborrheic dermatitis is a chronic skin condition and there is no cure. However, with treatment, this condition can be managed.
The treatment includes the use of dandruff shampoos with antifungal ingredients. Some of these ingredients are – zinc pyrithione, selenium sulfide, ketoconazole, piroctone olamine, and sulfur.
In more severe cases, one may need a short course of steroids, prescription antifungal creams or shampoos, or calcineurin inhibitors (immunomodulators that affect our immune cells and suppress them, these include pimecrolimus and tacrolimus).
In addition, since skin barrier dysfunction is associated with this skin condition, it’s important to be gentle with the skin and use skincare products with barrier repairing and anti-inflammatory ingredients like niacinamide, panthenol, ceramides, licorice, and so on.
A simple skin care regimen with a pH-balanced cleanser, moisturizer, and sunscreen can help in aiding skin barrier repair.
Read more: Skincare routine for seborrheic dermatitis
Seborrheic dermatitis vs tinea versicolor
Although both seborrheic dermatitis and tinea versicolor can present with white spots, especially in darker skin tones, their presentations have some differences.
Seborrheic dermatitis is characterized by thick, greasy scales and may be associated with itching, whereas the white spots in tinea versicolor are covered with fine, bran-like scales and usually do not itch.
In addition, unlike tinea versicolor, seborrheic dermatitis commonly affects the scalp and face.
Summary
White spots on the skin refer to areas of discoloration that appear pale or white. While there can be many reasons for this, one of them is fungus.
Malassezia, a type of fungus, is associated with two skin conditions – tinea versicolor and seborrheic dermatitis, both of which can present as white spots.
These skin conditions are usually treated with topical antifungal medications.
Read more:
- White Bumps on Face: 8 Causes (Not only Milia) and Treatments
- White Spots on Skin from Sun
- Can Cancer Cause White Spots on Skin?
References
- Saunders CW, Scheynius A, Heitman J. Malassezia fungi are specialized to live on skin and associated with dandruff, eczema, and other skin diseases. PLoS Pathog. 2012;8(6):e1002701. doi: 10.1371/journal.ppat.1002701. Epub 2012 Jun 21. PMID: 22737067; PMCID: PMC3380954.
- Oakley A. (2004). Skin conditions associated with malassezia. DermNet.
- Elgash M, Dlova N, Ogunleye T, Taylor SC. Seborrheic Dermatitis in Skin of Color: Clinical Considerations. J Drugs Dermatol. 2019 Jan 1;18(1):24-27. PMID: 30681789.
- Berk T, Scheinfeld N. Seborrheic dermatitis. P T. 2010 Jun;35(6):348-52. PMID: 20592880; PMCID: PMC2888552.
- Tucker D, Masood S. Seborrheic Dermatitis. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
- Borda LJ, Wikramanayake TC. Seborrheic Dermatitis and Dandruff: A Comprehensive Review. J Clin Investig Dermatol. 2015 Dec;3(2):10.13188/2373-1044.1000019. doi: 10.13188/2373-1044.1000019. Epub 2015 Dec 15. PMID: 27148560; PMCID: PMC4852869.
Disclaimer: This blog post is for information purposes only and does not replace medical advice.