Have you noticed unexplained white spots on your skin? There are several causes of white spots developing on the skin, some are common and some are rare, some have important health implications and others don’t. They can appear on various parts of the body and have different underlying causes.
In this guide, we’ll explore three common types of white spots and discuss their potential causes and treatment options:
White spots on arms and legs (guttate hypomelanotic macules): These benign smooth spots often appear primarily due to sun damage.
Fungal infection (tinea versicolor): It can cause white patches on the skin, often accompanied by scaling.
Spots on kids’ cheeks and arms (pityriasis alba): This dry skin rash is common in children, particularly when activities or weather conditions dry out the skin.
Let’s look into each of these conditions, understanding their symptoms, causes, and effective treatment options.
What are White Dots on the Skin of Arms and Legs?
– Guttate Hypomelanotic Macules
I regularly receive questions like the one from this reader about the white spots on her arms and legs:
Dear Dr. Bailey, I love the information in your blogs. I have a question about white spots that are on my arms and legs. They don’t tan, are they a form of skin cancer? Thank you, looking forward to reading more info on your blog, Vicki
White specks, guttate hypomelanotic macules, are usually seen on the outside of the arms and the legs. They are smooth surfaced, slightly shiny and don’t itch or hurt. There is less pigment than normal in the first living skin layer called the epidermis. The top dead cell layer, called the stratum corneum, is a little thicker than normal but very compact, resulting in a slight shine if you look closely at the spots.
These tiny white spots:
are entirely benign and don’t become cancer or anything other than a decorative nuisance
don’t tan and they are still visible even when a person uses fake tanners
are especially likely to be seen in people who have had a lot of sun exposure during their lifetime, leading us to believe that they are somehow a part of sun damage
Can You Get Rid of Guttate Hypomelanotic Macules?
Doctors don’t know why people get these little spots and they are impossible to fix. They can’t be burned off, scraped off, or lasered. I recommend that people try really hard to prevent them.
The best way I have found to prevent or reduce the number of these dots is to:
Use a physical exfoliation shower cloth or sponge
Follow by applying a professional strength glycolic acid moisturizer
Both of these are included in my Ultra-Fast Triple Action Body Smoothing Kit to achieve this double exfoliation.
For years I have used this exfoliation combination in my practice. The glycolic acid loosens the dead cells and the physical exfoliation helps them slough off.
I’ve seen it slow the rate at which people collect guttate hypomelanotic macules. I watched it do the same on my own skin once I started developing them on my arms. I’ve even seen it get rid of these persistent and annoying spots!
Prevent White Spots on Arms and Legs
Protect Your Skin from Further Sun Damage
Wearing sun protective clothing when outdoors and using a broad spectrum zinc oxide sunscreen is recommended.
One of the most effective sunscreens to use on the arms and legs is Sheer Strength Pure Physical Broad Spectrum Sunscreen.
Patients in my practice have proven for years that daily use of sunscreen helps reduce both white and brown spots on the arms and legs.
Another tip is to apply self-tanning lotion to the skin of the arms and legs. Oddly, the white spots may pick up the tanner more than your surrounding skin and this can help to make them less noticeable.
What Causes These White Spots?
The most common cause of white spots on the arms and legs of an adult are guttate hypomelanotic macules [1]. This long name actually refers to a very simple condition – the flat small white skin spots that start showing up around middle age. The name sort of translates into ‘discrete flat spots that are lighter in color than the surrounding skin’. Another name is idiopathic guttate hypomelanosis. The word “idiopathic” means that we don’t know the cause!
When I see guttate hypomelanotic macules on someone’s skin, I usually also see other evidence of sun damage such as flat brown sun spots that have no scale and that are called solar lentigines. These are age spots, also referred to as liver spots, that are actually sun freckles due to years of chronic sun exposure.
Noticing Dark Spots?
If you are noticing dark spots on your skin, read my guide that takes you through the steps of getting rid of dark sunspots with effective products.
Not seeing your white spots, I can’t be certain that you have guttate hypomelanotic macules. The information I’ve just given is inspired by my reader’s question, but you need to see your doctor for an exact diagnosis.
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Skin White Spots Caused by Fungus
– Tinea Versicolor
White spots on your skin can also be caused by a fungal skin infection. The germ is actually a yeast called Malassezia (formerly called Pityrosporum) that is a normal part of the microbes that live on your skin.
How Can You Tell if the Spots are a Fungal Infection?
The white spots of tinea versicolor fungal infection are typically covered with a fine scale. If you don’t see the scale, lightly run your fingernail over them and adjacent normal colored skin to see if more scale can be ‘scruffed up’ over the white patches. You may need to use a good light and a magnification to see the difference because the scale is very fine.
The word ‘versicolor’ implies that color can vary and not all tinea versicolor is white. It may be pink, tan or sort of a combination that I think of as salmon colored. If your spots are white, they will not tan and turn darker in the sun. The fungal white specks are typically roundish or oval and may coalesce into larger patches.
Where Do These Rashes Tend to Develop?
Oily areas of skin such as the chest and back are the areas most likely to develop the rash. Yep, even though the face and scalp may be really oily, the white spots of fungal infection are more likely seen on the trunk. They can extend down the arms, up the neck and I have even seen in the groin and inguinal (groin) fold.
How Do You Treat These Spots?
I have always said that “there are as many ways to treat tinea versicolor as there are doctors”. We all have our favorite approach, and because the yeast/fungus is a normal skin germ, recurrence is likely.
Once treated, the color of the skin takes months to normalize. This frustration is why there are so many treatment options.
Top Treatments:
Ketoconazole shampoo 2% applied to the affected area on dry skin for 5 minutes before rinsing.
This can be repeated daily for 3 days.
I usually have people who use this method do it once a month for 6 months to reduce the risk of recurrence.
Selenium sulfide 2.25-2.5% shampoo or lotion applied to the affected area 10 minutes daily for 7 days then rinsed off.
Topical 1% terbinafine cream once or twice daily for 1 to 4 weeks.
Zinc pyrithione 1% daily for 5 minutes for 2 weeks.
Reduce Recurrence:
I typically recommend my Back and Chest Acne products kit to help reduce the chance of recurrence, because this is the same fungal yeast germ that causes Pityrosporum folliculitis type of acne.
There are also oral antifungals that your doctor can prescribe. Even if they are used, I always use one of the topical treatments above, or my Kit to reduce the chance of recurrence.
Remember, there are other conditions that can cause white or tan patches on your skin. Consult your dermatologist for an accurate diagnosis if you are not improving or if you have any questions.
Why Does Fungal Infection Cause Skin Spots?
The “infection” happens when the yeast transforms from its usual form (a yeast) into its mycelial form (which looks like spaghetti under the microscope) and starts to cause problems on your skin that can include white or pink/brown spots.
The rash is called tinea versicolor. It is benign but can be unsightly and it can even itch.
Malassezia yeast love oily skin and are more likely to move into their mycelial form on warm, sweaty, oily skin. This is why it is common in humid tropical climates, especially in athletic teenagers. That said, even babies and older adults can develop it.
Is Tinea Versicolor Contagious?
No, not at all. We don’t know exactly why this normal skin yeast that lives invisibly on your skin sometimes turns into the mycelial skin infecting form. What we do know is that having oily skin combined with humid temps and sweat can make it happen. Even then, if you have it once, you don’t necessarily get it every time you are sweaty and the weather is humid. There is more to the story but we haven’t figured it out.
What We Do Know
Risk factors for tinea versicolor white spots:
Teen and young adulthood
Humid climates and sweaty skin
Pregnancy and oral contraceptives
Oily skin and applying oily lotions or creams
It runs in families – genetics
Being immunocompromised
Malnutrition
Poor hygiene does not increase the risk, though I still don’t recommend it!
Related Content
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What are Those White Spots on My Kid’s Cheeks and Arms?
– Pityriasis Alba
I often see parents bring their kids into the office for other reasons and ask, “what causes those white spots on my kid’s cheeks and arms”? Often, it is a common dry skin rash called pityriasis alba [2].
What Does It Look Like?
These white patches on the skin:
Have fine dry scale.
Are usually on the sides of the cheeks and the outer side of the upper arm.
Are more likely to occur when activities or weather conditions dry out the skin such as swimming in chlorinated pools or with the temperature extremes of a cold and dry winter.
Show up more when skin is tanned because the scaly patches stay white and contrast against the tanned skin.
This all means that towards the end of summer, pityriasis alba’s white patches may well be in full bloom if you live in a dry climate.
Treatments to Get Rid of the Spots from Pityriasis Alba?
Hydrating gentle skin care – it works for both treatment and prevention of pityriasis alba. Hydrating skin care means doing things to increase the water content of the outer skin layers.
The 4 key points for hydrating gentle skin care to heal the white spots of pityriasis alba on your kid’s cheeks and arms:
Use only mild soaps such as Vani Soap, Cetaphil Cleanser or my fragrance-free Naturally Best Bar Soap made with organic ingredients.
Bathe in warm – not steamy hot – water and only soap up the parts of the skin that are actually dirty (often just the armpits, groin, buttocks and feet).Remember, washing your skin is just like doing the dishes, the hotter the water and the harsher the soap, the more oils are removed. For dry skin, that’s just the opposite of what we want.
Within 3 minutes after toweling the skin dry it’s essential to apply a thick and rich moisturizing cream. Good options include my all natural organic Face and Body Lotion which is fragrance-free and made from organic botanical ingredients.
Avoid irritating ingredients like you would find in anti-aging skin care or acne products because the little white patches are actually more vulnerable to irritation than normal skin.
How Can You Tell That It is Healing?
As the pityriasis alba starts to improve, you’ll first see the scale disappear and then VERY slowly the color will normalize. Often a physician will prescribe a very mild cortisone cream for a few weeks to speed things along, but cortisone creams have side effects such as permanent skin thinning and this would be a treatment that required physician supervision.
What is Pityriasis Alba?
It’s a subtle form of eczema (also called dermatitis). It’s an unusual rash though because there really isn’t much, if any, inflammation. This means the involved skin doesn’t itch, it just looks funny.
Most people mistake the white patches of pityriasis alba for a fungus. It’s not a fungus. Pityriasis alba is just a form of dry skin eczema.
Why Does My Kid Get It?
People with dry, sensitive skin are most prone to pityriasis alba. Often there’s a personal or family history of asthma, allergies, eczema, keratosis pilaris or extremely dry sensitive skin. We call this constellation of conditions an atopic diathesis and they are genetically linked; if one or some of these conditions are in the family DNA then most family members are likely to show up with some or all of them too.
Pityriasis alba happens because the ‘barrier function’ of skin in people with these conditions may be just a little less able to handle drying conditions – like swimming pool chemicals and harsh weather. That’s why hydrating skin care helps, both for treatment and prevention.
Conclusion
White spots on the skin can be a source of frustration and self-consciousness. While the underlying causes may vary, by understanding the specific type of white spots you have and following the recommended treatment and prevention strategies, you can improve the appearance of your skin and regain your confidence.
The carefully formulated Dr. Bailey Skin Care products can play a crucial role in addressing and preventing white spots caused by guttate hypomelanotic macules, tinea versicolor, or pityriasis alba.
Consistent use of the right products, along with sun protection and other preventive measures, can help reduce the appearance of white spots and promote overall skin health.
Here are the appropriate products and steps for each skin condition covered in this guide:
Prevention
Use a broad spectrum zinc oxide sunscreen, such as my Sheer Strength Pure Physical Broad Spectrum Sunscreen.
Wear sun protective clothing when outdoors.
White Spots on Arms and Legs
Use a physical exfoliation shower cloth or sponge
Follow by applying a professional strength glycolic acid moisturizer
Both are included in my Ultra-Fast Triple Action Body Smoothing Kit.
White Spots Caused by Fungus
White Dots on Kids’ Cheeks and Arms
Use my mild, organic Naturally Best Bar Soap.
Bathe in warm water and limit soap for parts of the skin that are actually dirty
Apply my organic Face and Body Lotion within 3 minutes after toweling the skin
Avoid irritating ingredients
Remember: Always consult with your dermatologist for a proper diagnosis of your particular condition and personalized treatment plan.
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References
Idiopathic Guttate Hypomelanosis, American Osteopathic College of Dermatology
Givler DN, Saleh HM, Givler A. Pityriasis Alba. [Updated 2024 Jan 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431061/
James WD, Berger TG, Elston DM, Andrews’ Diseases of the Skin 11th ed., Elsevier Inc., 2011, p 65-6 Photo: Thanks and Gratitude to mock-turtle
Karray M, McKinney WP. Tinea Versicolor. [Updated 2024 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482500/
Leung AK, Barankin B, Lam JM, Leong KF, Hon KL. Tinea versicolor: an updated review. Drugs Context. 2022 Nov 14;11:2022-9-2. doi: 10.7573/dic.2022-9-2. PMID: 36452877; PMCID: PMC9677953.
Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.
