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Diseases Like vitiligo - White spots on skin

Vitiligo is usually easy to diagnose and mistakes are uncommon. White spots on skin are the common symptom of vitiligo. But it does not necessarily mean that vitiligo is the only skin condition responsible for white spots on skin. For accurate vitiligo diagnose it may however need to be differentiated from other causes of white patches on skin once in a while. A brief description of the common causes of the skin diseases which result in white spots on skin is given below.

Nevus depigmentosus

These are localized white spots on skin which may effect any area of the body, but they are quite stable lesions. Size of these skin spots may however grow in proportion to growth of the body. The distribution is also fairly stable.

Causes: They result from abnormalities in the function of melanocytes which produce little pigment thereby resulting in characteristic white spots in skin. Nevus depigmentosus is usually not difficult to differentiate from vitiligo.

Pityriasis Alba

The white spots on skin of pityriasis alba are a common skin problem of the children. The lighter spots of hypo and depigmentation are dry with fine scales and mostly affect the face, and may easily be mistaken for vitiligo. They may occasionally appear on other parts of the body as well. These white spot on skin are more frequently seen in winter because of the dry weather, and boys are more commonly affected than the girls. The lesions usually pass through three stages.

  • 1. Red and raised - although the redness is often mild and not noticed by parents
  • 2. Pale an raised
  • 3. Pale, flat and smooth

It is a self limiting problem but moisturizer creams can facilitate the healing process. In very severe cases, local psoralen therapy with or without laser may be tried.

Causes: No specific cause has been identified, but the activity of melanocytes has been found to be sub-normal with fewer and tiny melanosomes The child usually presents with small to 2 cm lesions on the face, but they can be as large as 20 cm, and may affect other parts of the body as well.

White scars and hypopigmentation

Scars from any injury may leave a white spot on skin after healing, and look like vitiligo at times. Whether an injury will leave a white or a colored scar depends on the type of injury and the extent of damage to the pigment producing cells of the skin, the melanocytes. If the melanocytes are lost, or functionally impaired, a scar is likely to have a faulty pigmentation on healing.

Causes: Hypopigmented or white scars can result from any injury, physical, chemical or inflammatory e.g. acne. White scars can usually be identified easily because the history of an injury or insult can be traced to and linked with their appearance. White scars can usually improve with local psoralen therapy. Laser resurfacing of skin may also be attempted if psoralen and PUVA fail.

Idiopathic guttate hypomelanosis

These are tiny (2-5 mm), rounded and flat spots of lighter color in the skin which are sometimes referred to as white spots on skin. Such skin spots usually appear on the skin which is exposed more to the sun like shins and the forearms, but other parts of the body may also be affected like the chest, shoulders and the face. These white spots on skin are generally smooth but mildly scaly lesions may also be seen in some cases. It is important to note that guttate hypomelanosis is a harmless depigmentation and not considered to be a precancerous disease. Biopsies of the affected skin have demonstrated skin cells with no melanin, and the melanin producing cells are reduced in number. Overall thickness of the skin is also reduced. The depigmentation of guttate hypomelanosis is also important because it may be mistaken for other cause of abnormal pigmentation like vitiligo. Biopsies of the affected skin have demonstrated skin cells with no melanin, and the melanin producing cells are reduced in number. Overall thickness of the skin is also reduced. Treatment is usually difficult and may sometimes leave a residue, which is worse than the original problem. It is however a benign condition and treatment may only be required for cosmetic and emotional reasons. Protection from the sun is however important because exposure to sun light has been incriminated as a causative factor. It is generally enough to cover up the lesions with a camouflage make-up, the following may also be tried.

  • Surgical and semi-surgical correction
  • Topical Steroids

Causes: The word idiopathic implies that the cause is obscure. It has however been associated with the aging process. This so-called aging of skin is assumed to be hastened by inheritance, sun exposure and seborrhoeic keratoses. It is more common in men than in women, and it generally affects those who have already celebrated their 40th birthday. People with a fair skin are more common victims but those with a darker skin are not immune.

Pigmentation

Pigment means a color and pigmentation is the phenomenon of coloring. In biological terms, pigment is defined as "A substance that gives color to tissue" (Dictionary of popular medical terms). Variations in the color of human skin are because of a pigment called melanin, which is produced by special types of cells known as melanocytes. The intensity of pigmentation may vary in human skin because of numerous reasons like race, environmental condition and disease. Any change in the pigmentation level of skin always generates concern, because it can have serious health as well as cosmetic implications. An increase in the pigmentation level known as hyperpigmentation can result from excessive tanning, pregnancy, Addison's disease and hyperpigmentation of scars. A lack or loss of pigment known as hypopigmentation can result from albinism, Vitiligo, leprosy, hypo-pigmented scars and many others. Of all the acquired hypopigmentary disorders, vitiligo is probably the most common. It causes no danger to your health, but can have tremendous impact on the psychosocial wellbeing of affected individuals.

Vitiligo depigmentation is the most comonly observed form depigmentation. Vitiligo pigmentation loss can occur in any age, any gender and in any race.

If you notice any change in your skin color which you can not account for, you must seek the opinion of an expert.