Like vesicular lichen, white lichen belongs to the category of simple vitiligo; it does not have an aggressive effect on the skin and the patient’s body as a whole. The rash is characterized by the formation of light spots that can be localized not only on the face, but also on the sides of the arms and legs. The disease is not accompanied by itching or fever; the only thing the patient suffers from is a cosmetic defect.
Important! Most often, vitiligo is diagnosed in children 3 years of age and adolescents, in adults in rare cases due to a decrease in the body’s protective functions for various reasons - pregnancy, diseases of internal organs, the postoperative period.
What is pityriasis alba (varicolored)
Pityriasis alba is the common name for pityriasis versicolor, which is a fungal disease caused by the yeast Pityrosporum ovale (a subspecies of the fungus Malassezia furfur). This fungus is a natural inhabitant of the stratum corneum of human skin.
The yeast fungus Malassezia furfur is a representative of the normal microflora of the skin
Tinea versicolor is a common fungal skin infection in teenagers and young adults that results in discolored patches of skin, usually pale (hypopigmented) on the upper back and shoulders. This effect is caused by a fungus of the genus Malassezia furfur, which lives and multiplies in the skin. During its life, it produces a substance (azelaic acid) that suppresses the function of melanocytes, cells that produce the coloring pigment of the skin melanin, which leads to the appearance of pale spots. At the initial stages of infection, the spots may have a pink or light brown color, since the pigment does not disappear immediately, but gradually. Hence the medical name for the fungus, “lichen versicolor.”
Pityriasis (scaly) dermatosis is an alternative name for the disease that some experts prefer because the lesion does not actually refer to dermatophyte infections caused by pathogens such as ringworm, athlete's foot, or tinea groin. Because pityriasis alba is caused by a yeast fungus rather than a true pathogenic fungus, the term "dermatosis" is technically more accurate. Although “lichen” is used much more often.
White spots on the skin: video
Why does lichen occur?
Many experts believe that the main cause of white spots on the surface of the skin is caused by malassezia fungi.
They produce a special substance that blocks the access of ultraviolet rays to skin cells. In addition, they can slow down the process of melanin transfer, which is responsible for skin color.
Doctors also do not rule out that the cause of the disease may be infectious pathologies. In some cases, if there is white lichen in the patient’s body, a hormonal imbalance is established.
It was found that people whose close relatives also suffered from various types of lichen or one form of dermatosis are susceptible to the disease. Provoking factors include:
- Presence of eczema or allergic dermatitis.
- Fever that occurs in autumn.
- Mycosis of the skin in the progressing stage.
- Bronchial asthma.
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Patients with weakened immune systems after a long illness are susceptible to the occurrence of white lichen and its spread. In certain cases, after diagnostic measures it is discovered that there are no melanocytes in the body.
These are pigment cells that give a special shade to the upper layer of the epidermis. The concentration of tyrosinase, which is also responsible for skin color, decreases several times. Constant stressful situations can also provoke an imbalance of pigment cells.
Causes and risk factors for developing the disease
As mentioned above, lesions in the form of discolored spots are caused by yeast-like lipophilic fungi that normally live on human skin. While most people are never bothered by these microorganisms, for some they can cause a ringworm-like condition, spots and flaking.
According to statistics, the disease is more common in men than in women. It affects people regardless of their skin color. It is most common in adolescence and young adulthood from 12 to 30 years. The increased risk is likely due to age-related hormonal changes that affect the skin's natural oil production. Pityrosporum ovale is a lipid-dependent fungal species. During puberty, quantitative and qualitative changes occur in the body associated with the intense secretion of natural sebum, which gradually subside with age. Noticed: The condition worsens in hot and humid climates, which is observed with most fungal infections. Throughout the world, such diseases are quite common in hot, humid countries and rarely in dry northern countries.
Increased activity of the sebaceous glands during puberty is one of the reasons for the increase in colonization of lipid-dependent fungus
Although everyone's bacterial flora contains yeast, not everyone exhibits signs and symptoms that indicate the development of shingles. An increase in pathogen colonization can be triggered by any of the following reasons:
- oily skin type;
- living in a hot climate;
- tendency to hyperhidrosis (excessive sweating);
- specific composition of sweat (hereditary factor);
- elevated blood sugar levels;
- weakened immune system;
- endocrine disorders.
Since the pathogen is a natural part of the skin microflora, which is formed in every person’s infancy, it is impossible to become infected with the disease.
Symptoms
For a dermatologist, a photo of lichen alba will be of little information, since its manifestations are nonspecific, and without a personal examination they can easily be confused with birthmarks, vitiligo, pityriasis versicolor, leukoderma and other skin diseases.
Most often, adolescent children become patients; in adults, the disease goes away on its own, and often they are not even aware of it.
Symptoms of pityriasis alba are the appearance of white patches of skin, up to four centimeters in diameter, on the face and the inside of the limbs. There the skin is most delicate and less susceptible to sun exposure. The spots may flake off in the warm season, and in winter they will again even out in color with the rest of the skin. Of course, the symptoms are more noticeable in dark-skinned or tanned people. In rare cases, peeling is accompanied by itching.
How does the infection manifest?
Discolored patches of skin are the hallmark of pityriasis alba. Typically, the spots may appear brownish or pinkish on light skin and light on dark skin. The same patient's appearance may vary throughout the year depending on whether the skin is pale in winter or tanned in summer. Visually, the spots may differ depending on their location on the body: pink-brown on the middle of the back and pale on the tanned neck.
Lichen versicolor is most often localized on the upper back and chest
The spots are usually small in size and clearly defined, but with a significant number of them they can merge into large-scale lesions. Elements of the rash do not show signs of inflammation, but may peel slightly due to loosening of the surface layers of the skin by the pathogen. The rash is usually limited to the shoulders, mid-back and chest, but sometimes it spreads further down the arms. It is seen only occasionally in the front, usually in African-Americans and other darker-skinned patients.
Other skin symptoms, such as severe itching, swelling, ulceration of the skin, hair loss, and enlarged lymph nodes, are not manifestations of lichen versicolor and should prompt a search for another diagnosis.
Symptomatic manifestations in humans
There are several types of lichen alba, which differ in the nature and location of the rash. Each of them is accompanied by corresponding symptoms. White spots appear on the skin of the face, less often on the forearms, arms, legs or other parts of the body. The rashes have clearly defined boundaries and are localized either singly or multiple times. The surface of the spot is covered with small scales, which begin to peel off over time.
Segmented
The lesions are localized in one segment of the skin. When pressed, the stain does not change its color and does not cause discomfort.
Focal
Several spots merge into a large lesion. If it is in an “inconvenient” place, then when rubbing with clothing, the patient experiences mild itching.
Universal
Foci of lichen spread throughout the body. During the cold season, such spots change their color (turn a little red), and the chances of their inflammation increase. In patients with the chronic form, during the acute stage, body temperature rises slightly.
Complications and possible consequences
The main complication is skin discoloration, which persists for weeks after treatment because melanocytes take time to resume producing skin pigment. There is no danger of developing permanent complications after suffering from lichen alba. Because the infection is superficial, there is no risk of a deeper infection in patients with a healthy immune system. The causative agent of pityriasis versicolor is a risk factor for the development of folliculitis (infection of the hair follicle) and seborrheic dermatitis, and in patients after stem cell transplantation it can cause lung problems.
Recovery time and possibility of relapse
If a person is diagnosed with pityriasis alba, treatment will significantly improve the skin condition. However, even after the infection is cleared, the skin may remain discolored for several weeks or months after treatment. The infection often returns when the weather becomes warmer and more humid. If relapses occur frequently, your doctor will prescribe a prophylactic course of medication to prevent symptoms.
Reasons for education
The factors that provoke the appearance of white spots on the skin are still being studied by scientists. There are suggestions that people who overindulge in hot baths or showers suffer from pityriasis alba. The same applies to non-compliance with personal hygiene rules (people with asocial status are more susceptible to this disease). Very often, pityriasis alba gradually develops into atopic dermatitis.
The main reasons for the development of the disease include:
- lack of copper in the body (this microelement is responsible for the production of melanin pigment, which colors the skin);
- stagnation of bile due to liver pathologies;
- parasitic infections;
- diseases of internal organs and systems (atherosclerosis, gastrointestinal pathologies, etc.);
- imbalance of hormones in the body.
As a rule, after eliminating the root cause of the disease, all unpleasant symptoms disappear.
Diagnostic methods
Any primary care provider, including family practitioners, pediatricians, and internists, can competently treat lichen versicolor. Atypical cases and those that do not respond to conventional therapy should be diagnosed and treated by a dermatologist, a specialist in skin diseases.
Most often, the diagnosis of lichen versicolor is made clinically (by appearance), but the best way to diagnose is microscopic examination using potassium hydroxide to scrape skin cells. During examination, you can observe the characteristic tubular threads (hyphae) and spores of the fungus, reminiscent of “spaghetti and meatballs.” Other diagnostic methods include:
- iodine test: the skin is wiped with tincture of iodine and the lichen spots stand out in contrast, coloring more intensely due to the somewhat loosened surface;
An iodine test (Balzer test) helps to detect the presence of multi-colored lichen on light skin. - Wood's fluorescent lamp examination: under ultraviolet light, the affected areas appear fluorescent yellow-green.
Wood's lamp reveals glowing, ringworm-affected areas of skin
Bacterial inoculation requires the addition of fatty acids to the culture medium, such as olive oil, and is rarely used in practice. To diagnose the disease in children, the doctor takes a sample of skin cells by tightly attaching clear tape to the affected area and then removing it. The sample can then be mounted directly onto the slide so that it can be examined using a microscope.
Treatment of versicolor
Despite the fact that lichen versicolor is considered a relatively harmless disease, it is necessary to treat it, especially since the disease is highly treatable. A wait-and-see approach will not bring improvement; the spots will not disappear on their own, but will only increase in size and the patient’s skin will vaguely resemble a geographical map.
The main treatment for yeast infection caused by the pathogen Pityrosporum ovale includes the use of medications with antimycotic effects for external application (gels, creams, lotions, shampoos). In case of large-scale lesions, the use of systemic antifungal drugs in tablet form is prescribed.
Medications for white spots on the skin
External remedies are effective in the treatment of lichen versicolor until the rash becomes complicated by itching, redness and does not scale. The following antifungal gels and ointments are used:
- Econazole;
- Ciclopirox (Batrafen);
- Ketoconazole (Nizoral);
- Clotrimazole (Lotrimin);
- Miconazole.
Terbinafine (Lamisil) products may be effective, but will not necessarily work as well for yeast infections as they do for fungal infections caused by pathogenic microbes. Products that combine an antifungal effect with an exfoliating agent (Kerasal) or an absorbent powder (Zeasorb) are more difficult to use on a large area of the back and shoulders than a cream or spray.
Minimal areas of lesions can be treated with topical treatments, but larger areas and frequent recurrences are best treated with oral medications. The course of therapy depends on the drug chosen, but is often short. It will take much longer for your skin to return to its normal color, and there is no reason to extend treatment until the spots clear up. Effective oral agents include:
- Ketoconazole (Nizoral);
- Itraconazole (Sporanox);
- Fluconazole (Diflucan).
Griseofulvin is not effective against yeast and should not be used.
Medicines for pityriasis versicolor - gallery
Nizoral shampoo is used to prevent seborrheic dermatitis caused by the causative agent of lichen versicolor
Clotrimazole ointment is a local broad-spectrum antifungal drug
Fluconazole is rapidly absorbed when taken orally.
Batrafen cream has antibacterial and antifungal activity
Caring for affected skin
Washing your body with an all-purpose anti-dandruff shampoo containing selenium disulfide (Selsun Blue), zinc pyrithione (Head & Shoulders, Soothe) and ketoconazole (Nizoral) can help get rid of dandruff faster and prevent re-infection. Some manufacturers recommend applying shampoos at night. They can be effective, but are often very irritating to the skin. Soap containing zinc pyrithione may also be effective.
Features of therapy in children and pregnant women
Although the topical and oral medications listed above are most often safe during pregnancy, many pregnant women will choose to try a body wash with one of the antifungal ingredients first. Pregnant women should talk to their doctor about treatment options.
If the disease is detected in a child, which is extremely rare, the pediatrician may recommend a shampoo containing selenium sulfide, which is available in pharmacies without a prescription. If this treatment does not work, your doctor may prescribe an antifungal shampoo for the affected skin. In advanced cases, the disease in children is treated with antifungal creams for external use or oral antimycotic drugs.
The feasibility of using folk remedies
Many folk remedies are recommended for the treatment of white lichen. Generally, these recipes may be helpful for other skin conditions such as eczema or acne. Home remedies have mild antiseptic and antifungal properties that can help, but more often they themselves cause additional problems.
Tea tree oil, aloe vera and garlic are all potential skin allergens and their use can cause itching and sensitivity reactions. When used intensively, garlic irritates the skin in the same way as turmeric and apple cider vinegar.
Pityriasis alba is a common fungal skin infection that is easily treated with medication. The effect of folk or non-medicinal remedies on lichen versicolor is considered ineffective.
Some home remedies, such as coconut oil, oregano oil, and Indian lilac, can stimulate the growth of yeast microorganisms, especially when made with olive oil.
Although most home remedies are harmless, there is no research to prove their effectiveness against tinea versicolor. There is also no effective diet against this disease. The only thing that both doctors and traditional healers recommend is the consumption of yoghurts and other fermented milk products for a probiotic effect.
When is medical intervention required?
Treatment of pityriasis alba is required only if the uncolored spots occupy a large surface of the skin or there are a lot of them. The second necessary condition is the localization of the affected areas on those parts of the body that are most exposed to the sun's best, that is, ultraviolet radiation.
Of course, you should go to the doctor if, due to the appearance of white spots, your health has worsened, there is fever, itching, pain, and weakness. This indicates an incorrect course of the disease; perhaps the primary diagnosis was incorrect.
As soon as hyperemia, swelling, pain and weeping appear near the white areas of the skin, this indicates the addition of a secondary infection. Such symptoms should never be ignored. Often it is opportunistic pathologies that cause the greatest number of problems. Therefore, at the slightest suspicion of such, go to the doctor.
Prevention
Using antifungal shower products from time to time can help prevent or reduce the incidence of the disease. Below are some tips to help reduce the recurrence rate of lichen versicolor:
- Avoid using oily skin care products (oils and oil-based creams and lotions).
- Reduce your time in the sun. Exposure to ultraviolet light can trigger or worsen an episode of the disease, and tanning will make the rash more noticeable.
- If you must be in the sun, start using a daily antifungal shampoo several days before you plan to be in a hot climate.
- Apply sunscreen daily. Use a non-greasy formula with a minimum sun protection factor (SPF) of 30.
- Do not wear thick clothing made from synthetic fabrics.
- Choose underwear and clothing made from breathable fabrics such as cotton or linen to reduce sweating.
