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The Mystery of Recurring White Spots

Jul 22 2016

Last week I saw a young couple John and Debbie who came back from a vacation in Cabo. They came to see me because shortly after returning from vacation Debbie noticed white spots that seemed to appear out of nowhere all over John’s back. They reported a similar phenomena last year when they returned from a trip to Cancun. Debbie wanted to know if this was contagious and John wanted to know how to get rid of it.

I carefully examined John’s back and immediately recognized that he had one of the most common skin conditions known as Tinea Versicolor. This condition is caused by yeast growing on the skin. Many people have the yeast harmlessly growing on their skin while others will develop Tinea Versicolor. The condition is often worse in hot humid conditions. It usually appears as circular patches of skin that look as if it has lost color. There may be some fine scaling on the skin. The reason the skin looks lighter in color is that the yeast produces azelaic acid that can inhibit pigmentation. That is the reason it is more noticeable after sun exposure. The area that has the yeast does not tan while the rest of the skin does. This explains why Debbie and John noticed this after their sunny vacations. As John’s tan faded so did the appearance of the rash. I felt obligated to educate them about sunscreen and sun protective clothing. Soon we will discuss treatment.

Tinea Versicolor isn’t the only skin condition that results in loss of pigmentation. Another condition that commonly causes some loss of pigmentation is Pityriasis
Alba (a form of eczema). This condition is commonly seen in kids who spend a lot of time in the pool. This dries out the skin resulting in loss of pigmentation. It most commonly occurs on the face but can occur anywhere on the body. Treatment includes mild soap, moisturizer as well as topical prescription creams. Many parents of children with Pityriasis Alba bring their child to us fearful that they have Vitiligo. Vitiligo is a skin disease that occurs when the body’s immune system attacks the pigment producing cells. Michael Jackson made this disease well known. Pityriasis Alba is easier to treat than Vitiligo but fortunately there are now newer treatments that can help people suffering from Vitiligo.

Some people get small white patches on their arms and legs. The spots usually are not scaly. They typically represent long-term sun damage. Unfortunately there is no great treatment for this problem that carries a big fancy name, idiopathic guttate hypomelanosis. Prevention with sunscreen and protective clothing is your best bet.

Of the many treatment options, John chose to use a topical antifungal lotion. Topical treatments are available in foam, cream, lotion and shampoo preparations. Some people choose to take oral antifungal medications but these do pose greater risks than medicines applied topically. Recurrence is very common so some people choose a monthly application of a topical antifungal to prevent the condition from coming back. Return of the lightened pigment does not occur immediately but rather over the course of several weeks to months.
If you think you may have Tinea Versicolor or any other skin or pigmentation issue feel free to call us as we are accepting new patients.

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