When a patient tells me that they have “sunspots”, I am not always sure what they mean. People use the term “sunspots” to describe several distinct conditions. Some people mean “age spots” (see our previous newsletter for how to treat age spots). But usually people mean the white spots that you get on your shoulders that seem to show up after you have been in the sun, in other words tinea versicolor.
Tinea versicolor is caused by a yeast that lives on everyone’s skin, but only some people get the rash. Tinea versicolor gets its name “versicolor” because it comes in many colors. It is most often white, but can also be tan, brown, or orange. It is usually first noticed by a patient after a trip to the beach, because their normal skin tans in the sun, while the infected skin stays white giving the characteristic white spots (usually on the shoulders).
Why are the spots white?
The yeast of tinea versicolor cause white spots because they excrete azeleic acid. Azeleic acid works by turning off your melanocytes (the pigment-producing cells of the skin). Interestingly, we use azeleic acid cream in dermatology as a “bleaching cream” to treat hyperpigmentation!
Many people with tinea versicolor are told by a friend to treat their “sun spots” with Selsun Blue. But if they are consulting their dermatologist, then it obviously didn’t work. We make the diagnosis instantly in the office by looking at a little bit of scale under the microscope. Then we treat with a prescription anti-fungal cream (like ketoconazole). Some patients will require pills (one pill a day for two days is all that is needed).
The Staff and Doctors at Minars Dermatology
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