What are white patches?
Dr Vivekananda Bhat
Lavelle road, Bengaluru Feb 9, 2017
Pigmentation on the face or facial pigmentation is a condition of the skin that concerns everybody. The pigmentation could be caused because of pimples, tanning, blemishes after being under the sun, sun spots, freckles. The face could appear pigmented because of white patches too.
What are white patches?
White patches are basically skin lesions characterized by depigmentation, which could be brought about by an allergy, infection or autoimmune disorder. In rare cases, white patches could signify precancerous or cancerous growth.
The most common cause behind white patches is a fungal infection known as tinea versicolor, non-infectious conduction that can be easily treated. Tinea versicolour may be accompanied by other symptoms such as itching, dryness, etc. on the white patch or its surrounding area.
Hypopigmentation may also occur due to a condition called vitiligo, which is an autoimmune disorder that causes the body to attack its own melanocytes, i.e. skin cells responsible for the production of melanin (skin pigment). In case of vitiligo, the patches may stay life long (permanent), or may appear for a small period and then vanish. Vitiligo can be treated using medications, different therapies, and surgical procedures. In some cases, it may not be curable, but it can be managed, and the white patches can be minimised.
White patches could also be caused because of eczema, an inflammatory skin disorder due to allergies or hypersensitivity. Eczema is often associated with asthma and is characterized by itchy, scaly skin that may peel or ooze out.
White patches are rarely dangerous, but sometimes they spread rapidly throughout the body. Even if it doesn't affect you, it is always better to contact your dermatologist and figure out the cause behind it.
Symptoms Along With White Patches
White patches rarely appear on their own. They are usually accompanied by other symptoms based on the underlying condition that is causing it in the first place.
Some of the symptoms that you may experience along with white watches include;
Dry, scaly skin that may peel out or may ooze out
The skin around the white patch feels different
Redness and swelling along with warmth
Should the white patches be accompanied by the following symptoms, then immediately visit a doctor as it may signify a serious health disorder:
Swelling in the face, lips, or throat
Causes of White Patches?
As mentioned above, white patches usually come about because of allergies, infections or autoimmune disorder. Below we discuss some conditions that cause white patches.
This is a fungal infection that causes the skin to develop white patches, which could appear anywhere over the body. This is because the fungus that infects the body affects the normal pigmentation of the skin, causing small discoloured patches to appear. Most of these patches may be found near the trunk or shoulders.
This condition is mainly found amongst teens and young adults, but it isn’t contagious. Tinea versicolour is often treated using antifungal creams, lotions or shampoos, as well as antifungal medications in general.
In spite of treatment, the discolouration may still last for weeks to a couple of months.
Vitiligo is an autoimmune disorder that causes the body's immune system to attack the melanocytes, which are skin cells responsible for producing melanin, the skin pigment that gives us our skin colour. As the melanocytes get attacked and killed, no melanin is produced, causing the skin to get discoloured. This discolouration causes patches in different parts of the body, including skin, hair and mucous.
Vitiligo is incurable, but with medications and other medical procedures, the condition can be managed and will help with the appearance of the patient.
Eczema is caused because of hypersensitivity, which leads to the skin becoming scaly, itchy or discoloured because of common allergens. In certain cases, eczemas may also cause blisters.
These rashes or discolouration are mostly found on the arms or behind the knees, but it could also appear anywhere.
Eczema can be managed and treated by avoiding soap and other irritants that cause it, taking in anti-allergy medications or creams and ointments.
Besides the above reasons, white patches may, in very rare cases, signify skin cancer or other precancerous growth. This is why it is very important to get the patches checked to figure pout the reason behind it.
Treating White Patches
There are various ways of how one can approach treating white patches. It is important to get treatment immediately, as the patches tend to spread throughout the body. Some of the treatment methods include giving the patient immunomodulators, immunosuppressives, or steroids. The treatment may be further coupled with UV therapy or excimer laser therapy.
UV Therapy or Excimer Laser Therapy
Before UV therapy, patients would take in Psoralens and expose themselves to sunlight. But with the advancement in technology, narrowband UV therapy has been developed, which completely eliminates the use of Psoralen.
Narrowband UV therapy involves stimulating the melanocytes (melanin-producing cells), therefore eliminating the need for medications. In stimulating the melanocytes, the narrowband UV light brings about pigmentation in hairy areas in our skin, thus helping even out the discoloured patches, which in turn stabilises the patches.
Treating white patches using UV therapy involves getting the treatment in multiple sittings. Since UV therapy comes with cancer risk, the doctor will supervise the skin to look for thickenings or signs of skin tumour.
UV or laser treatment may cure the patches completely or partially. It may not cure the patches at all, but it will eventually stop the spread of white patches.
Usually, doctors perform UV therapy for over a year, after which they may decide to add in surgery as a part of treatment. But, it usually starts taking effect within a few months, bringing about pigmentation in the body.
UV therapy has some side effects such as erythema, itching, burning sensation, pigmentation, blistering and ocular side effects, though it differs on a case-to-case basis.
Surgery (Skin Grafting)
As mentioned before, should UV therapy or medications prove to be ineffective against the white patches, then the medical team will consider surgery. Most popular surgical treatment for white patches is skin grafting, which basically involves removing skin from one area and transplanting it onto another part of the body.
The skin is usually grafted from the thighs or the buttocks, and this graft must be a slightly larger area when compared to the patched area. Before transplanting the graft onto the affected area, the doctor will dermabrade the white patch. Dermabrasion is basically an exfoliation technique, where the outer layer of the skin is removed. Once dermabraded, the graft will be planted on to the patchy region.
A skin graft is ideal if the white patch spreads across a small area, but if it is covering a large area, then it would be difficult to harvest a large amount of skin. Another issue with skin grafting is to make sure that the colour of the skin graft matches the area where it is being transplanted to.
Now since skin grafting had certain disadvantages, another procedure was developed; called punch grafting. Punch grafting involves circular harvesting pieces of skin tissue, also known as punches, and then transplanting it onto the patched area that now has punch shaped pits. This procedure would then be followed by Narrowband UV light therapy or Psoralen and sunlight therapy.
Now Punch grafting is mostly successful, but in certain cases the punches tend to stand out, thus giving a cobblestone appearance.
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