White freckles can be caused by mild eczema, photoaging, fungal skin infections, or vitiligo. Treatment depends on the underlying cause, with options including topical retinoids, fungal preparations, and psoralen photochemotherapy. Actinic keratosis, a precancerous condition, can also appear as white freckles.
Small spots on the surface of the skin that have no pigmentation are called white freckles. The altered skin appearance occurs with mild eczema, photoaging, and a topical fungal skin infection. Skin lightening can also occur due to a benign condition known as vitiligo. Treatment of white freckles largely depends on the underlying cause.
Pityriasis alba is a type of mild eczema that commonly produces white, freckle-like scaly lesions on the surface of the skin. The condition is associated with atopic dermatitis and usually begins with red, scaly patches of skin. As the patches heal, the skin loses pigmentation, producing white patches that vary in shape and size. Freckles often develop on the cheek and mouth regions of the face, shoulders, and trunk. The condition usually resolves without intervention, but may require moisturizers and topical steroid preparations.
Skin resists sun damage over years of exposure, and the damage tends to accelerate a process known as photoaging. Areas of accumulated damage may appear as white freckles, but skin often has a mixture of hypo- and hyperpigmented areas. The spots appear on the parts of the body that receive the most exposure, usually the arms and legs. Dermatological treatment can be the prescription of topical retinoids that even out the skin pigment. Ablative and nonablative lasers and intense pulsed light therapy can also do this.
Photoaging can cause a condition known as actinic keratosis. Individuals who have the condition have rough, scaly areas that appear as white freckles, but the lesions could also be pink, flesh-colored, or brown. Fair-skinned people are more often affected. The lesions can appear anywhere on the body, but most commonly erupt on the face, ears, forearms, and backs of the hands. Dermatologists consider the lesions to be precancerous as the condition can lead to cancer.
Malassezia furfur, often called tinea versicolor, is a fungal-type yeast that normally inhabits skin surfaces. The organism can exceed normal growth rates in high humidity, and abnormal colonization can occur in people with immune system abnormalities or hormonal imbalance. When overpopulation occurs, the skin shows white freckles or dark areas that may converge into larger patches. Treatment generally involves the use of over-the-counter topical fungal preparations.
Individuals may develop whitish freckles during the onset of a skin condition known as vitiligo. Depigmentation occurs because the cells stop producing melanin or the cells that produce melanin die. People often inherit the condition, but some develop the disorder due to underlying conditions, including hyperthyroidism and pernicious anemia. Treatment for the genetic form of the condition includes cosmetic mimetic agents, topical steroid preparations, and psoralen photochemotherapy. If caused by a medical condition, treating that condition can stop the progression of the disorder.
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