What Are These White Spots on My Skin?
What Causes White Spots?
It is believed that the same accumulated sun damage that causes brown spots also causes white spots. Brown spots occur when the cells in your skin that produce color (melanin) have been bombarded by sun damage to the point where they start reproducing and growing abnormally, causing spotty, dark discolorations.
In the case of white spots, instead of making more melanin, areas affected by sun damage stop making any melanin at all, causing these areas to completely lose pigment. Although these spots can be unsightly, they are benign.
NOTE: Do not confuse the white spots from sun damage with the skin disorder known as vitiligo. This disorder is believed to be an autoimmune issue where the body's immune system attacks the skin's pigment-producing cells (known as melanocytes). With vitiligo, you'll see large patches of pigment loss rather than smaller spots, and these patches tend to expand over time as more pigment cells are destroyed. There are no skin-care products that can stop or treat vitiligo, but there are various ways to manage this condition, which you should discuss with your physician.
How Do I Get Rid of These Spots?
First, the brown spots. Getting rid of brown spots isn't easy, but can be accomplished with a well-formulated skin-lightening product and consistent application of sunscreen rated SPF 25 or greater (and greater is definitely better). For best results, look for a sunscreen that contains titanium dioxide and/or zinc oxide as the active ingredients. These mineral actives tend to provide the best coverage and, at least anecdotally, seem to be a better line of defense against brown discolorations.
It also helps to use a moisturizer appropriate for your skin type, and make sure it's loaded with antioxidants. Overall, the combination of skin lightener, sunscreen, and antioxidants makes the most significant difference. There are other treatments you can consider as well, such as laser or intense-pulsed-light procedures that a dermatologist can provide.
Unfortunately, when it comes to the white spots, the news isn't as encouraging. Simply put, it isn't possible to get the pigment back. Skin-care products such as exfoliants won't help and skin-lightening products don't make sense, so treatment options involve making the spots less noticeable by preventing them from expanding.
Of course, steadfast daily use of sunscreen will give you the same benefits as it does for brown spots, so don't forget this critical step, even on cloudy days. Also, avoid getting any amount of tan, because this will increase the contrast between the white areas and your skin color (not getting any amount of tan also reduces the growth of brown spots). As you may have noticed, the white spots do not tan; they can't turn color because there's no pigment in that area to darken.
You can try to make the white spots blend into the surrounding skin by routinely applying a self-tanning product, but you need to apply it only to the white spots, which requires a delicate touch. Using a Q-tip® or makeup brush, apply a tiny amount of self-tanner directly to the white spots; then wait a few hours, or a day, and see how the color looks. If you need to apply more, go ahead. To maintain the color, reapply the self-tanner as it fades over time.
There are two other options. One is to see a dermatologist for light-emitting treatments (such as Fraxel) that target the brown spots surrounding the white spots. Lightening the brown spots reduces the contrast, making the white spots less apparent. Another option is topical application of a drug known as tacrolimus (brand name Protopic). This drug, which normally is prescribed to treat eczema, is believed to help re-pigment the white spots, although the research hasn't been that positive. At best, you'll see an 11% improvement in the spots, which is barely noticeable, but it may be worth a go for those who are not satisfied with the results from light-emitting treatments.
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Sources for the information above: Journal of the European Academy of Dermatology and Venereology, May 31, 2012; ePublication; February 10, 2012, and September 2010, pages 1026–1030; International Journal of Dermatology, July 2011, pages 798–805, and February 2010, pages 162–166; Journal of Drugs in Dermatology, March 2010, pages 238–239; and http://dermatologyforyou.com/conditions/guttate_hypomelanosis.asp.