Hypopigmentation Causes: Conditions That Lead To White Spots & Patches On The Skin

Whilst hypopigmentation simply means a lack of pigment in the skin, there can be a number of different causes. Here we briefly cover each of those different conditions.

Vitiligo

This is a very common condition affecting around 1% of the population – yes, an amazing 1 in a 100 people suffer from vitiligo!

It’s a non-infectious skin condition that causes white patches on the skin. These patches can be anywhere but are most commonly found around the mouth, eyes, hands, armpits and groin.

The cause is not really known, although it may be in some way an autoimmune disease. You can read more about the vitiligo skin disorder and treatment for hypopigmentation.

Hypopigmentation Scars

Scars can take many different forms. They happen when the skin is damaged to a certain degree due to a wound, disease or surgery. The scarring is part of the skins normal healing process.

The scar tissue created is made of exactly the same material as what it is replacing (i.e. collagen). The difference however is that the way it is put together is inferior to the original construction. It tends to align in one direction creating stiffer bundled lines of collagen for example. This can make scars raised, and very visible. It may not look as we would like it to, but it does serve the purpose of repairing the structural damage.

Just as scarring can take very different shapes (some being raised whilst others are pitted), they can also be different colors. Some scars can cause a red or darker skin color whilst others can be pure white. These white scars are the hypopigmented ones. That is, the repaired skin lacks normal pigment leaving them white. Research indicates^[1] the reason for this is related to the depth and width of the wound, which at certain levels can prevent new melanocytes (the pigment creating cells) from being able to move into the scar material.

Piebaldism

This is a rare condition that results in a lack of pigment cells in quite specific areas of the body. 90% of those affected have a white forelock – a section of the hair near their hairline lacks pigment and therefore appears white. This may also affect eyelashes and eyebrows and sometimes the skin on the forehead just below the forelock.

People with piebaldism will also tend to have other small white patches on other areas of their body too, typically fairly symmetrical on each side. This looks a lot like vitiligo, but piebaldism differs in that those with the condition are born with it and the patches do not grow or spread.

The extent of the white patches can be quite minor or fairly severe. The forelock area for example may just result in a small flick of white hair. Or it can extend down across most of the forehead. Similarly with patches on other areas of the body.

Pityriasis Alba

This is mostly experienced by children, causing initially pink/red scaly areas of skin (about 1-2cm) that then fade to white patches. Pityriasis alba most commonly occurs on the face, in particular the cheeks. With around half of the cases the lesions also occur on the body too.

The white hypopigmented areas will return to normal by themselves over time. This will typically take a month to a year^[2], but can extend into years.

The name of the condition comes from pityriasis meaning flaking/scaly skin, and the latin word for white, alba.

Albinism

This is a rare genetic condition where people can lack pigment throughout their body. It can be partial or even a total lack of pigment, but typically applies throughout the skin, hair and eyes.

Whilst it is a genetically inherited condition, most people with albinism have parents with normal hair and eye color.

There are many different variants of albinism so the condition can affect just the eye color, or can leave the body with no pigment at all. In the latter case this can mean white hair, pure white skin all over the body and blue eyes. It’s often misunderstood that albinism causes red eyes – this is not true. Light levels can make the red blood vessels at the back of the eye more visible due to the lack of dark pigment, but the eyes themselves are not red. It’s similar to the ‘red eye effect’ from flash photography.

Read more in the causes, types and symptoms of albinism.

Tinea Versicolor

Tinea versicolor is also known as pityriasis versicolor, and is caused by a fungal infection to the skin. That may sound pretty unpleasant, but it’s actually just a yeast that lives naturally on your skin that can get out of control. This is more likely to happen for those with oily skins or people who live in hot climates. The extra sweat and moisture creates more favorable conditions for the yeast to grow.

The appearance of tinea versicolor is patches or spots of skin that can actually be lighter or darker than your normal skin color. So they can be anywhere from brown to pink to white – the lighter hypopigmentation spots will not tan the same as the surrounding areas, so can become more visible with sun exposure. The patches occur mostly on the chest, back and arms.

The most commonly prescribed treatment for tinea versicoloris to just apply an anti-fungal lotion or wash to the affected area. This brings the yeast back under control and the patches typically disappear fairly quickly, sometimes within days although it can take a month or two.

Read more in Tinea Versicolor – Cause, Symptoms & Treatment

Hypopigmentation From Birth Control?

Birth control medication can potentially cause skin pigmentation problems. But it’s not common. So if you do notice light patches or posts on your skin, do talk to your doctor first before making any decisions as to what the actual cause may be.

References

[1] Chadwick, Sarah, Rebecca Heath, and Mamta Shah. "Abnormal pigmentation within cutaneous scars: a complication of wound healing." Indian journal of plastic surgery: official publication of the Association of Plastic Surgeons of India 45.2 (2012): 403.

[2] Vinod, Sujatha, et al. "Clinico epidemiological study of pityriasis alba." Indian Journal of Dermatology, Venereology, and Leprology 68.6 (2002): 338.