When board-certified New York City dermatologist Dr. Amy Wechsler wants to instill fear in young patients about the cosmetic ravages of sun exposure, she pushes up the sleeves of her lab coat and shows them the constellations of white sun spots dotting her forearms. “I use them as an example to kids about why they should wear sunscreen,” Wechsler admits. “They’re all over my arms and legs.”
Idiopathic Guttate Hypomelanosis (IGH) — which, translated into human-speak is roughly “pale blotches of unknown origin” — is a specific subset of UV damage that results in a complete loss of pigment. For some members of the dermatological community, the term IGH is a bit of a misnomer. “It’s not ‘idiopathic,’” says Wechsler. “We know what causes them.” Though these white spots can measure anywhere from 1 to 10 mm, the average size is 3mm. They tend to be sprinkled in sun-magnet areas like shoulders, chest, arms and legs. And while most are flat, others can be slightly raised and scaly in texture.
Like most forms of sun damage, IGH tends to favor the fair-skinned. “People with fair skin are more likely to develop IGH while those with darker skin are more susceptible to dark spots,” says board-certified dermatologist Dr. Dennis Gross, also based in New York City. “That’s because people with darker skin are already naturally producing more melanin. For fairer skin, the cells are already producing less melanin. So if melanin production stops or slows down with age, they will be more susceptible to loss of pigment or white spots forming.”
Some unlucky sun-worshippers are blessed with hypo- and hyperpigmentation, i.e., white and brown spots. “People [can] get both,” says West Islip, New York dermatologist Dr. Kavita Mariwalla. “I find that IGH happens when you [are exposed] excessive sun, whereas hyperpigmentation can be multifactorial and is very dependent on your baseline skin tone, pregnancy status, oral contraceptive use, history of melasma, et cetera.”
As for timing, IGH typically surfaces early on in those who are predisposed to the condition. As the years pile up, so do the spots. “I see it a lot in patients in their twenties,” says Dr. Mariwalla. “Sometimes they’re athletes, like runners or lacrosse players, who are on the field a lot and don’t use sunscreen. Other times, they are young girls who fry on the beach.”
While you’ll see the word “benign” crop up in many Google® search on IGH, derms are divided about just how innocuous white sun spots actually are. Though Dr. Wechsler adamantly recommends an annual skin check to monitor any changes and taking preventative measures to keep new ones from forming, she doesn’t consider white sun spots to be “dangerous” or a sure path to skin cancer. However, Dr. Gross is in complete disagreement. “While I definitely receive a lot more patients coming in with concerns about dark spots, I consider IGH to be much worse,” he says. “While both are a cry for help, IGH leaves skin completely unpigmented and susceptible to the sun. It is basically an island of completely unprotected skin.” He notes that they should be closely monitored, as they are areas where he says skin cancer could more easily develop.
Message received: white sun spots could be bad news. Furthermore, once they’ve cropped up on various body parts, your options are limited regarding treatment. It makes sense, just for the simple reason that it’s currently impossible to “re-pigment” fairly large chunks of skin. (Like, say, your shoulders, forearms, or calves.) Although there have been sizeable leaps forward in treating hyperpigmentation in recent years, the same doesn’t hold true for hypopigmentation.
The most common options for IGH include topical steroids, prescription tretinoin, and dermabrasion. Unfortunately, they are considered mildly effective at best. And cryotherapy, a treatment gaining popularity, may even exacerbate the condition. “Definitely not cryotherapy,” says Wechsler. “Cryotherapy can sometimes remove pigmentation.”
[Editor's note: As always, talk to your doctor before starting or stopping any new treatment. Retinol shouldn't be used by those who are pregnant, considering getting pregnant, or nursing. Please consult with your doctor before use.]
There is one still-on-the-fringes procedure, however, that derms believe can be helpful for relatively small, irksome patches of IGH. “If you have a few spots that are really bothersome, there are medical tattoo artists that are able to match the skin tone to permanently conceal them,” says Gross. “It works great,” agrees Wechsler. “We’ve sent a few patients for that.”
For IGH sufferers with either too many white spots to consider pursuing medical tattooing, or a desire to just do a quick-ish DIY cover-up, foundation and either liquid or powder bronzers are a good bet, says Los Angeles-based celebrity makeup artist Jillian Dempsey. She recommends lighter, more natural coverage for milder cases of IGH. “I always find that anything that has a little bit of iridescence — like a tiny bit of mica — balances light so it’s almost like a built-in reflector, “ she says. “I would go with a liquid bronzer or a cream highlighter that would bounce light.”
Among Dempsey’s favorites in the liquid bronzer and cream highlighter category: Josie Maran® Argan Enlightenment Illuminizer ($26), Glossier® Haloscope® Dew Effect Highlighter in Quartz ($22), Milk MakeupTM Highlighter in Lit ($24) and Charlotte Tilbury® Supermodel BodyTM ($65). “The beauty of these products is that they can be mixed with an SPF or lotion and you can control how much you’re applying,” she explains. “You have to be in control of how much you use so it looks natural.”
Excessive amounts of IGH call for Dempsey’s “concealer” method. This entails layering a thick, matte foundation — in a shade that matches your skin and “has a warmth to it” — under a matte powder bronzer. Since preventing product-transfer is key, Dempsey deploys a special trick. “I like to take a dry powder puff and gently buff out areas that may touch clothing, such as under your arms. Then wait three to five minutes before you dress.”
To both cover and protect your skin from further sun damage, Dempsey swears by the surfer-inspired Vertra® Face Sticks ($23), which come in a variety of tints. “They are a go-to for covering white sun spots, and as long as you blend, there is nothing superior,” she says. “They have a reef-safe formula which makes it even better.”
There’s also an easy, no-cost — and wildly healthy — IGH camouflage fix you might want to consider: if your skin is typically fair without the help of the sun, let your skin return to its natural hue so the white spots blend in. “If someone is tan — and of course, I don’t ever want them to be — white sun spots will stand out even more,” says Dr. Wechsler. In other words, the paler your skin, the less noticeable your IGH will be. Or, you can just wait it out: Dr. Gross believes the treatment future for white sun spots is bright. “Looking at how far skincare has come even in the last 10 years,” he says, “I am confident that technology will be able to create a real fix for IGH.” In the meantime, don’t forget to slather up with SPF.
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