So many patients come in asking about uneven pigment, including whiter spots, that this is a great question.

Whiter (or darker for that matter) spots sit on that line between medical and cosmetic.   Let’s talk about the medical first. You will almost always needs a good derm to help you find the cause for these.

White spots on the face:

  • Medical diseases like new onset vitiligo (autoimmune attack on pigment making cells) need to be considered.  The best way to make this diagnosis is with a small biopsy.  Since even small (think 3-4 mm) biopsies on the face can leave a tiny scar, patients and dermatologists are loath to do these.  But sometimes…’s the only way to really know, and then be able to treat effectively.  It may be worthwhile to get a second opinion.
  • Also, yeast forms can sometimes cause temporary loss of pigment.  Those need a culture or biopsy to confirm usually.
  • Certain medications can cause uneven skin pigment.
  • Sun damage is one of the most common causes.  Look for uneven whiter and darker areas distributed mostly over the cheeks and “crow’s foot” area.  Usually it’s fairly symmetric, but the “driver’s side” may be worse, because car window glass does not block UVA.
  • Scars from trauma, skin cancer or liquid nitrogen treatments.

White spots on the body:

  • Sun damage is the most common cause.  See your dermatologist because you may be at risk for precancerous lesions (actinic keratoses) and skin cancers. Often distributed over the chest, shoulders, upper back, arms, hands, front of the thighs and shins.  But these may be everywhere if a lot of tanning booth use, or sun bathing.  Makes sense right?  Just think about where you get tan and old sunburns.
  • Vitiligo (see above) can also affect the body.  A full body exam is key because many people have spots of it where they didn’t notice it.
  • Certain medications can cause uneven skin pigment.
  • Scars from trauma, skin cancer or liquid nitrogen treatments.
  • Birthmarks.  Yes… some birthmarks have no pigment at all.  These areas are more prone to skin cancer because there is no pigment.
  • A yeast form called Tinea Versicolor.   Usually on the trunk area.  These can be irregular, sometimes scaly spots that can be white, brown, or pink.
  • Certain rare ‘tropical disease’ like Hanson’s Disease.  These are more common in warmer, more humid climates in India, southeast Asia, or Mexico for example.

Hope this helps, and please see a good derm if you’re having problems!!



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