White Patches of Skin

White Patches of Skin
Q:
White Patches of Skin

Dr. Greene, I was giving my nephew a bath the other night and noticed white patches on his upper arms. Is this normal? Are they a sign of malnutrition? They never feed him any greens or fruits — just cereal and chicken nuggets. We are worried about these spots. He is turning 3 years old, and we fear he is not growing up healthy.
Amy W. – Maryville, Tennessee

A:

Dr. Greene’s Answer:

Every year as the final weeks of summer come to a close, I am asked by parents on the phone, in the office, and online about white patches that their children have developed. It’s almost a Labor Day tradition.

Fun in the sun often brings out these white spots — especially noticeable at the end of the summer. While a healthy, balanced diet of whole foods is very beneficial, diet is probably not responsible for your nephew’s white patches. Many different conditions can produce new white patches in children; I will highlight two of the most common.

Doctors call one of these conditions pityriasis alba, which is Latin for white, scaly patches. Children with this extremely common condition develop uneven, round or oval patches after sun exposure. The patches are dry with very fine scales. Varying from 1 to 2 inches in diameter, they are most common on the face (cheeks), neck, upper trunk, and upper arms of children 3 to 16 years old.

These are completely benign, similar to a mild form of eczema. They are most common in children with dry skin. The involved patches don’t darken with sun exposure the way the surrounding skin does. Treatment involves daily lubrication with a good moisturizer (such as Aquaphor), especially whenever the skin gets wet. Using sunscreen can decrease the appearance of the patches by inhibiting the skin around them from darkening. Sometimes topical steroid creams help. Even with no treatment at all, the spots will disappear on their own — although it may take months to years. Some people get pityriasis alba every summer during childhood. Even then, the pigmentation will eventually end up normal.

The other extremely common white-patch condition is called tinea versicolor. This is a mild, superficial fungal infection, somewhat similar to ringworm (true ringworm can also result in white patches). Since the affected skin doesn’t change color well with sun exposure, it usually becomes apparent as white patches during the summer months. In the winter it may seem to disappear, or even seem to become slightly darkened patches as the surrounding skin gets paler (this is where the name versicolor comes from).

Tinea versicolor - close-up

Tinea versicolor is most common in adolescents and young adults 15 to 30 years old (although it can certainly happen at any age). The infection is chronic and recurs easily, but it causes no other health problems. People are most susceptible to the fungus during hot months in humid areas. Taking steroids, excessive sweating, wearing tight-fitting clothing, and chronic illness can all predispose a person to tinea versicolor, but someone without any of these factors can still get this mild infection.

The patches of tinea versicolor can appear white, tan, or pink. The white patches look very similar to pityriasis alba. There are two good ways to tell them apart.

The most reliable way is to have a doctor gently scrape the white patch, dissolve the scrapings in potassium hydroxide, and look at what is left under a microscope. The classic “spaghetti-and-meatball” appearance of budding yeast confirms the diagnosis of tinea versicolor. A quicker and easier approach is to look at the patches under a black light. The patches of tinea versicolor will usually light up with a blue-white, yellow, or orange color.

Topical antifungal medicines are very effective for treating tinea versicolor, but there is a more convenient, less expensive, highly effective alternative. Selenium shampoos are great at getting rid of the fungus. Simply apply a thin layer over the affected skin before bed (with a wide surrounding margin, since it may already be beginning to spread). Wash thoroughly the next morning.

The problem is that no matter what the treatment, it comes back easily. Whatever treatment is used for tinea versicolor, all bedding and nightclothes should be changed after treatment to prevent recurrence. Also, re-treating once a week for 3-4 weeks and then once a month for 3-4 months makes it much less likely to come back.

With either pityriasis alba or tinea versicolor, even when the condition is effectively treated, the white patches will remain for a while. At least several weeks must pass for the newly healthy skin to adjust its color to the amount of ongoing sunlight exposure, so that it will match the surrounding skin.

At your nephew’s upcoming three-year-old well child exam, it would be wise for his parents to ask the doctor about the patches (just to be sure that it isn’t one of the other more unusual causes). But in the meantime, relax. Both of these mild, benign, primarily cosmetic conditions are so common, Amy, that “got some white patches” could show up on many “What I did this summer” essays.

Did you find this article helpful? Need more information? Let us know in the comments below.

January 19, 2011
Reviewed by: Rebecca Hicks
Last reviewed: June 29, 2014
Dr. Alan Greene

Article written by

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

 

Comments

  • nathalie

    hi, i am 22 and have these white patches all over my back and stomach and chest. they are spreading to my arms and i am so scared it will go to my face. ive tried teatree oil and selsum before with no results. and just started lamsil. i dont know what else to do, ive been to so many doctors and nothing. it looks like tinea versicolor and the doctor say it is a fungal infection, i just dont wanna live with this on my face! what else can i do? please helppp
    ive changed my diet to little to no sugar because so internet forums say it occurs bcause of yeast overgrowth inside the body. still no change.

    • Alan Greene

      Hi Natalie. Lamasil is usually very effective for fungal infections. If it’s not doing the trick, I’m a fan of seeing a dermatologist to be sure you know what you are dealing with.

  • jerry cole

    Hi my name is jerry im 20 years old and have white spots all over my arms and a little on my neck it looks alot like the picture….what can I take or do to make them eventually go away?

    • Alan Greene

      Jerry, tinea versicolor, described in the article above, can look like the spots in your picture. Tinea versicolor is treated with anti-fungal medications. Seeing a dermatologist can help make it clear what’s causing your spots.

  • Barbara Hewins

    I am a 61 year young female who has always had beautiful skin all my life. Fortunately, never had acne. Well, about 9 months ago I noticed that these little small dry-achy spots appeared on my eyelids, around my mouth, some on my chin, and neck. Well, I panicked because I have always looked so much younger than my age, but these spots had me thinking it was eczema (which I’ve always had in my scalp only), or even skin cancer. I went to a medical doctor that prescribed Triamcinolone Acetonide Cream. It immediately stopped the itching…but…when the white patches went away, this darkish blue discoloration appeared in it’s place. By then I was extremely depressed!!! I am a very fair-skin Black woman, and a former Model, now a Modeling Coach…I need great skin!…but now I have this discoloration on my face where ever the patches were; almost looking like I have a five o’clock shadow. And makeup does not cover it! Well, I dealt with the discoloration for 9 months because I could see it trying to fade away slightly, but within the last 2 weeks, here comes the while dry patches again!!! And it’s getting bigger and bigger (started out the size of a Tic-Tac)!! I called the pharmaceutical company about the cream, but they said they never had anyone call with my complaint. When I came on Google and researched my problem, they gave me the assumption that it may be a yeast infection! Okay…I can stop eating sugar, potatoes, dairy, etc. But I’m still so confused because I keep my face washed and moisturized daily! I have to because it’s part of my business. I’m am so lost at this moment and feeling like shutting myself in the house forever!!! I’m very serious…I need some help!…:-(((((

    • Alan Greene

      How frustrating, Barbara! Yeast infections can cause white spots. Dietary changes might make these less likely to start, but once a yeast infection is going strong an anti-yeast cream can be much quicker at making it go away. Triamcinolone is not an anti-yeast cream, btw.

      With skin problems that aren’t getting better as hoped or expected, I’m a fan of seeing a dermatologist (skin specialist).

  • Alyssa Breeding

    hello,
    this is my 2 year old son…hes had these white patches for a couple of months and they seem to be spreading…it started on a small part by his neck and now they go down his arms and in random places on his back…any ideal if it could be in the article above??

  • PENGUiiN

    i love you

  • An

    Hi – my daughter is 21 months old, and recently (last few months) Iv noticed a lighter patch on her thigh, about 6cm long (it may be more noticeable as its been summer and she is more tanned than normal) I am very concerned it is vitiligo, as there does seem to be another small patch on her opposite leg, but its also not VERY white, looks more like a faded tan. There is no history in our family of vitiligo. Any ideas would be appreciated!

  • An

    Hi – my daughter is 21 months old, and recently (last few months) Iv noticed a lighter patch on her thigh, about 6cm long (it may be more noticeable as its been summer and she is more tanned than normal) I am very concerned it is vitiligo, as there does seem to be another small patch on her opposite leg, but its also not VERY white, looks more like a faded tan. There is no history in our family of vitiligo. Any ideas would be appreciated!

  • rhys

    Hey , im 18 and i have started to notice tinea versicolor on a small area of my neck , i am always exposed to sun as i surf nearly everyday but this has never occurred before , is this just a random skin infection or will it keep on occurring ??
    Thanks

  • Generous DuBois Calliste

    has white spots directly on my pores all over my back. they are itchy and are spreading.

  • Alan Greene

    Both pityriasis alba and tinea versicolor can itch and spread. But tinea versicolor, the fungal infection, is more common on the back and more common in people over age 16.