Afraid of small white spots on your skin? Don’t panic: The best guide is here

You are a man with good health aged about 50. The winter is hitting so you have started applying moisturizer over your legs. For last few days you have been suddenly noticing few small white spots appearing over your legs which are persistent and not recovering with time. You just don’t need to panic. It may be IGH.

Or

You are a housewife who uses to cook regularly. Initially a few white spots on your forearm did not seem to be alarming. It is a common occurrence due to small burns from hot oil sprinkle during frying anything. But now you are worried because the spots are not healing anymore and increasing in number with time. Take a deep breath and don’t worry. It might be just IGH.

What is IGH?

IGH stands for idiopathic guttate hypomelanosis.

Idiopathic – cause is unknown

Guttate – drop like marks

Hypomelanosis – hypopigmented / lighter in color than the surrounding skin

So IGH is a disease where round or oval white spots of 2-6 mm size appear over skin. Spots are well defined and often with irregular border. Larger spots may sometimes appear. The size does not change over time. The number increases with age. Most common site of occurrence is lower leg and forearm but it may rarely affect trunk or face.

It usually starts after the age of 40 years and it is a very common disease. At least 80% people will have IGH after the age of 70 years.

It occurs almost equally in both male and female but female patients visit clinics more often maybe because they are cosmetically more conscious.

 

Why do these small white spots appear?

Actual reason is unknown. But several hypothesis suggests that it is Ultra Violet ray induced or occurs due to photo-ageing or normal aging process. Genetic factors, trauma and autoimmunity may have some role.

Do you need to see a dermatologist for this?

Yes, you do.

The diagnosis is very straight forward with clinical examination and investigations are generally not required. But still it needs to be differentiated from few other diseases which may present similarly like pityriasis versicolor, pityriasis alba, vitiligo, pityriasis lichenoides chronica, post-inflammatory hypopigmentation etc. And this differentiation can only be done by a qualified and experienced dermatologist.

 

Disease course

Number of spots increases with age. No tendency of spontaneous re-pigmentation is seen without any treatment.

Do you need to worry about this after the diagnosis?  

No.

It is a benign disorder with only cosmetic concern.

 

Treatment

Reassurance and counselling about the disease is necessary and usually no treatment is required. And there is no universally accepted efficacious treatment present.

But as sun exposure is presumed to be the main culprit physical photo protection should be advised.

Your doctor may prescribe a sunscreen if required.

For cosmetic purposes many other treatment modalities can be tried depending on you and your doctor’s preference in case to case basis.

 

Source 

1. https://www.ncbi.nlm.nih.gov/books/NBK482182/
2. https://pubmed.ncbi.nlm.nih.gov/21699514/
3. Rook’s textbook of Dermatology, 9^th edition, chapter 88.
4. https://dermnetnz.org/topics/idiopathic-guttate-hypomelanosis
5.  https://www.visualdx.com/visualdx/diagnosis/idiopathic+guttate+hypomelanosis?diagnosisId=51655&moduleId=101