White Rash on Skin: Fungus, Sun, and More

A white rash on your skin can occur as a result of many skin conditions. Causes can range from somewhat harmless sun spots and milia to more serious pityriasis alba, vitiligo, and tinea versicolor that can cause major changes in skin color. The most severe cause involves basal cell carcinoma, a form of skin cancer.

While some causes of white skin spots can resolve on their own or with home treatment, other causes require topical treatments or drugs. White spots caused by skin cancer should be diagnosed promptly to prevent severe conditions from worsening.

This article describes the causes, symptoms, and methods of diagnosis for a white rash on your skin. It also explains common treatments and ways to handle chronic white spots on your skin.

Causes of White Rash on Skin

A white rash on your skin can occur for several reasons. These health conditions and factors can include:

White Sun Spots

White sun spots, clinically known as idiopathic guttate hypomelanosis, occur in areas with less pigment. While the exact cause of sun spots is unclear, they occur as a form of hypopigmentation, which is a lack of pigment (color)-producing melanin), in the affected area. The more melanin present, the darker the color of your eyes, skin, and hair. Sun spots usually appear after age 40 and increase with age.

Sun spots occur in all skin types and races. However, their appearance is more dramatic in darker-skinned racial and ethnic groups. Among White people, sun spots occur more often in those with brown eyes and brown hair. While the exact cause of sun spots is unknown, excessive sun exposure and genetics seem to contribute to this harmless cosmetic issue.

Milia

Milia, also known as milk cysts, appear as tiny white bumps on your face. These keratin-filled cysts do not cause any pain or itching. They form when dead skin cells do not properly exfoliate (get cast off) and are trapped under your skin. This can occur for no reason. Milia can also occur as a secondary symptom after an injury, burn, or other condition.

Milia can develop in infants, children, and adults. While milia resemble whiteheads, milia should not be popped or squeezed. Attempting to remove milia in this way can cause scarring. Milia are not related to acne because they do not form within pores. They form just under your top layer of skin.

Pityriasis Alba

Pityriasis alba is a minor form of eczema (atopic dermatitis) that appears as scaly hypopigmentation. It mostly occurs in children and adolescents age 3 to 16 years. It can also occur in people of any age. The condition is more prominent and more common in people with darker skin.

While the cause of pityriasis alba is unknown, it often occurs with dry skin and atopic dermatitis. It often appears after sun exposure, likely because the affected skin looks lighter than the surrounding tanned skin.

Vitiligo

Vitiligo causes patches of skin to lose pigment. It is generally considered an autoimmune disease that attacks and destroys melanocytes (skin cells that make pigment) due to signals from a damaged immune system. The affected skin turns a milky white.

Research indicates that vitiligo may have genetic causes. It occurs more often in people who have a family history of the disorder. It is also more common in people who have certain autoimmune diseases, such as rheumatoid arthritis, systemic lupus erythematosus, or thyroid disease. Symptoms can appear before age 20 in all races, starting in early childhood. In some cases, an event such as emotional distress, sunburn, or chemical exposure can trigger the problem.

Tinea Versicolor

Tinea versicolor, clinically known as pityriasis versicolor, is a fungal skin rash caused by an overgrowth of a certain yeast that is naturally present on your skin. The condition affects all races and only occurs before midlife. It appears as patches that are lighter or darker than your natural skin color.

This condition occurs if your skin becomes oily, warm, and moist enough to allow the yeast to develop into small colonies on its surface. While the spots look reddish brown on pale skin, they appear as white spots on tanned or darker skin. You have a higher risk of tinea versicolor if you live in a hot, humid climate, have moist or oily skin, or have a weak immune system.

Basal Cell Carcinoma

Basal cell carcinoma is a common type of skin cancer that develops in the areas of your body most exposed to the sun. While most people think of skin cancer as being black, brown, or red, basal cell carcinoma can also occur as a shiny bump or nodule that is clear or pearly white. It can also look like a scar that is flat and white to yellow, often with poorly defined borders.

Basal cell carcinoma occurs when exposure to ultraviolet radiation from the sun and indoor tanning damage the basal cells in the epidermis, the outermost layer of your skin. Being chronically exposed to the sun or indoor tanning and having light skin are two risk factors,

Describing White Rash Skin Spots

White rash skin spots can vary based on the cause of the problem and the skin tone of the surrounding skin. Despite the cause, any white spots may seem more pronounced if they border skin that is naturally darker or tanned.

White rash skin spots can occur with the following symptoms:

Sun spots: These small white dots can vary in size from 1 to 10 millimeters (mm), with most sun spots having a diameter of between 1 and 3 mm. They are otherwise asymptomatic.

Milia: These asymptomatic skin spots appear as pearly bumps that do not present a health threat. However, they can cause an annoying cosmetic issue. While they grow up to 2 mm in size, they are often smaller.

Pityriasis alba: This condition starts as red or discolored, scaly patches on your face and arms. After it resolves, it leaves areas of scaling hypopigmentation. The lesions may be round, oval, or irregular in shape.

Vitiligo: Vitiligo can start as a small white patch that differs in color from your normal skin tone. As the spot becomes paler, it can turn completely white. The loss of color can be accompanied by skin inflammation, resulting in a slight red skin tone plus soreness and dryness.

Tinea versicolor: These patches are slightly reddish brown on pale skin but do not tan. As a result, they look like white spots on darker skin. A fine dry scale may coat the patches.

Basal cell carcinoma: Basal cell carcinoma can look different in different people. In addition to a shiny white bump or nodule, this type of skin cancer can also appear as the following:

• An open sore that does not heal but may ooze, crust, or bleed
• A reddish patch or irritated area that may itch, crust, or cause discomfort
• A small pink growth with a slightly raised, rolled edge and a crusted indentation in the center that may develop tiny surface blood vessels over time
• A flat white or yellow scar-like area with poorly defined borders

Location on Body

The location of white rash skin spots varies based on the cause, as follows:

• Sun spots: Sun spots occur most often on the most exposed areas of your body, which include the arms, legs, upper back, and face.
• Milia: Milia typically occur on the face, especially on your cheeks, nose, and chin. They can also develop in areas of your body that are inflamed or injured.
• Pityriasis alba: Lesions usually appear on the face, mostly on your cheeks and chin. They can also occur on your neck, shoulders, and upper arms.
• Vitiligo: The milky-white patches of vitiligo can occur anywhere but most often develop on the hands, feet, arms, and face. They often appear symmetrically on both sides of your body. Your hair can also turn white in the areas where your skin loses pigment, such as on your scalp, eyebrows, eyelashes, body hair, and beard.
• Tinea versicolor: Patches of skin that are lighter or darker than your normal skin tone typically appear on your neck, upper back, shoulders, and chest.
• Basal cell carcinoma: This type of skin cancer usually develops on your face, neck, arms, and other sun-exposed areas.

Seeing a Dermatologist to Diagnose Your Symptoms

Seeing a dermatologist is the best way to get an accurate diagnosis of your white rash skin spots. A dermatologist is a medical doctor who specializes in treating diseases that affect your skin, hair, and nails.

A dermatologist can easily diagnose many skin conditions by visually examining the affected area. This can include:

• A full skin examination, which includes examination of your scalp, nails, mucous membranes, and entire body to check the distribution of the problem
• Use of a hand-held lens or dermatoscope (a handheld visual aid that includes a built-in light and magnifying lens)
• Medical and family history of skin conditions, autoimmune disorders, and other health problems

Other tests may be used based on the types of symptoms present. These tests can include:

• Culture: A sample can be taken to check for infection. It is sent to a laboratory and placed in a culture medium, which allows microorganisms to grow and be identified.
• Skin biopsy: This test removes a small piece of skin using a knife scalpel, scissors, razor blade (shave biopsy), or round cutter (punch biopsy) for examination under a microscope. In some cases, a biopsy can be used to both diagnose and remove an entire lesion or tumor in an excisional biopsy.
• Wood’s lamp (black light): A Wood’s lamp examination can identify skin infections. The skin is illuminated with an ultraviolet light, known as black light. When viewed in a dark room, some fungi or bacteria glow brightly. The light also accentuates the skin’s pigment (melanin), making pigmentation abnormalities, such as vitiligo, more visible.
• Potassium hydroxide (KOH) preparation: A skin scraping is placed on a slide with potassium hydroxide (KOH) solution and gently heated to dissolve skin cells. If fungus is present, it can be seen under a microscope.

A visual examination can be used to diagnose the following causes of white rash skin spots:

• Sun spots
• Milia
• Pityriasis alba

While more extensive diagnostic tests can be used to confirm a diagnosis of any cause of white dots on the skin, these tests are typically used when the following conditions are suspected:

• Tinea versicolor: In addition to a physical examination and history of symptoms, a KOH preparation may be used for confirmation.
• Vitiligo: A Wood’s lamp, which makes affected areas of your skin appear chalky and bright, may be used to confirm a diagnosis of vitiligo.
• Basal cell carcinoma: A skin biopsy is the most accurate way to verify a diagnosis of basal cell carcinoma.

Treatment for White Skin Rash

Treatment for white skin rash can vary based on the cause. Some types of white spots may be harmless to your health. However, the changes in skin appearance that result, such as those that occur in vitiligo, can have a detrimental impact on your quality of life.

While treatment may not be medically necessary for some conditions, it may benefit people whose white skin rash affects their emotional well-being and psychosocial health.

Common treatments for white skin rash include:

Sun Spots

While sun spots do not require therapy, they are often treated to resolve their impact on appearance. Treatments can include the following.

Topical treatments:

Procedures:

• Cryotherapy: The use of liquid nitrogen to freeze sunspots so the abnormal tissue can peel away
• Chemical peels: Uses salicylic acid and glycolic acid applications to remove the top layer of damaged skin
• Excimer laser: A type of phototherapy that produces ultraviolet radiation at 308 nanometers, a wavelength often used for treating certain skin conditions
• Skin grafting: The removal of healthy skin tissue from your buttocks or thighs for use in grafting onto white skin patches

Milia

No treatment is advised for milia in babies. These spots typically resolve on their own.

Adults bothered by persistent milia may benefit from the following treatments that can remove milia and prevent them from returning:

• Cryotherapy
• Cautery (using extreme hot or cold to destroy abnormal tissue)
• Chemical peels
• Laser surgery
• Dermabrasion
• Topical or oral medications (retinoids and glycolic acid)

Pityriasis Alba

Pityriasis can resolve itself spontaneously without treatment. Symptoms can be managed with the following treatments:

• Moisturizer cream to maintain moisture in the skin
• A low-potency topical corticosteroid to decrease inflammation
• Topical nonsteroidal anti-inflammatory medications to reduce redness and itching, such as Elidel (pimecrolimus), Protopic (tacrolimus), and Eucrisa (crisaborole)

Vitiligo

Treatments for vitiligo aim to even out skin tone and restore lost skin color. These therapies can include:

Topical and systemic medications:

Other therapies:

• Excimer laser therapy
• Phototherapy (light therapy)
• Skin grafting
• Depigmentation (applying a cream daily to bleach pigment and even out skin tones so vitiligo patches blend in)

Tinea Versicolor

Tinea versicolor treatment aims to reduce and treat the fungus causing the spots. Therapies can include:

Anti-fungal shampoos, soaps, creams, and lotions to control yeast using one of the following active ingredients:

• Selenium sulfide
• Ketoconazole
• Pyrithione zinc

Antifungal pills for short-term treatments:

• Nizoral (ketoconazole)
• Sporanox (itraconazole)

Basal Cell Carcinoma

When possible, basal cell carcinoma is treated with surgical removal. The technique used varies based on the type of basal cell carcinoma present, its location, and how deeply it goes into the skin. Common surgical techniques used to remove this type of skin cancer include:

• Excision: The skin cancer and a section of surrounding normal skin are cut from the affected area.
• Mohs surgery: This technique involves sequential surgical removal of thin layers of lesions until no cancerous cells are seen. It aims to leave as much healthy tissue as possible, with the smallest possible scar.
• Currettage and electrodesiccation: In this procedure, the basal cell carcinoma is scraped from your skin using a technique called curetting, followed by electrodesiccation that uses heat to destroy the remaining cancer cells.
• Cryosurgery: This procedure uses extremely cold temperatures to destroy abnormal tissue.
• Photodynamic therapy: The affected skin is treated with a special light-sensitive solution and then treated with a blue or red light to kill cancer cells.
• Topical medications that destroy cancer cells: These include Aldara (imiquimod) and 5-fluorouracil (5-FU).
• Radiation therapy: This procedure uses high-energy radiation to treat basal cell carcinoma in people age 60 or older.

How to Manage Chronic White Skin Rash

Strategies for managing a chronic white skin rash vary depending on the cause of the problem. Contact a dermatologist for a treatment regimen designed to help manage the condition causing your symptoms.

General skin care to reduce the incidence of clogged pores and dryness can support healthy-looking skin. This can include the following strategies:

• Wash your face with a gentle cleanser when you wake up, at bedtime, and when you sweat.
• Do not scrub your face aggressively, but pat it with a towel.
• Apply a moisturizer daily.
• Get adequate sleep for overall health and well-being.
• Manage stress to prevent flare-ups.
• Perform a skin self-exam to identify signs of skin cancer and other problems as early as possible.

One of the best ways to manage symptoms of a chronic white skin rash is to follow recommendations to protect your skin from ultraviolet rays by doing the following:

• Wear proper clothing, such as long-sleeved shirts and pants, to cover your skin.
• Use sunglasses and a wide-brimmed hat to protect your head.
• Stay out of the sun in the peak hours of 10 a.m. to 4 p.m.
• Use extra caution near reflective surfaces such as water, snow, and sand.
• Apply a broad-spectrum, water-resistant sunscreen with a sun protection factor (SPF) of 30 or higher to protect against overexposure to ultraviolet A (UVA) and ultraviolet B (UVB) rays. Make it a habit year-round, even on cloudy days.
• Do not use tanning beds. Consider self-tanners instead.

Summary

While a white rash on your skin is likely harmless, changes in your skin color should not be ignored. Sometimes, a white rash or white spots can indicate a more severe problem, such as basal cell carcinoma, a form of skin cancer.

Specific symptoms and treatments for a white rash vary based on the cause. Some causes of a white rash, such as milia, can resolve on their own without treatment; more severe causes of white spots, such as skin cancer, typically need surgical removal as early as possible.

Contact a dermatologist or general healthcare provider if you notice changes in the color or texture of your skin.