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What Causes White Spots

Each week at the Clinic it’s dynamic, and takes a course of its own. Last Tuesday was particularly enlightening, as we were graced with the presence of Virginia Moore, a Podiatry student, who is about to enter her final year at the University of East London, England. Her knowledge base and guidance were greatly appreciated both by us at the Clinic, and clients alike.

It underscored the fact that in Trinidad, as I would imagine in most other Caribbean islands, (Virginia is of Jamaican parentage and visited there before coming here); foot care/health, proper shoes, the utilisation of sun protection creams, are not things many of us seriously acknowledge, or have access to. There are many odds against us, but our laidback West Indian way is a key contributor.

A number of feet were examined and a number of problems identified. Firstly, she was surprised about the shape of the shoes or sandals most wore.  While some were soft, and from one of the few shoe stores that cater to soft ladies shoes, generally, she was dissatisfied that there wasn’t much or any support for the arches, mid foot, and heels. Many of the shoes did not accommodate foot type, which could aggravate existing foot problems.  She was concerned as well that many women wore the “ballerina type shoes” or flat hard slippers or sandals, including diabetics. She couldn’t wrap her head around the fact that there aren’t stores geared specifically towards large feet, wide width, diabetics, and orthopaedic footwear.

Another major concern Virginia had was that those persons over the age of 50 whom she saw, had “white spots” on their feet. Some were undisturbed, most were unaware of the cause, and some, including myself, were laughing at Virginia’s suggestion to apply sunscreen to the hands and feet daily once going into the sun. As Caribbean people, we live in the sun all year round; it’s a part of our existence. Most of us Trinis only apply sun block on Carnival Monday and Tuesday; others, if going to the beach. On a regular day our face would get it through a facial product with SPF within it. Our hands and feet though, not really!

What really are“White Spots”?

 Idiopathic Guttate Hypomelanosis on Shins“White spots” – medically known as “idiopathic guttate hypomelanosis” – is the name given to the 2 to 5mm flat white spots found on the shin, thigh and forearms. The lesions are flat and are discrete, circular, oval or angular in shape. ‘Idiopathic’ means the cause is unknown; ‘guttate’ means resembling tear-drops; and ‘hypomelanosis’ refers to the lighter colour of the affected areas. It is not the same as vitiligo. Virginia noticed a lot of this and hence the topic for this week.

Who’s affected?

Idiopathic guttate hypomelanosis is most commonly a complaint of middle aged, light skinned women. However, it is increasingly being seen in both sexes, and older dark skinned people with a history of long term sun exposure. It may also arise on other sun exposed areas including the face, neck and shoulders. The white marks are usually smooth with a reduction in the normal skin markings, but they could also be slightly scaly. They are becoming quite widespread in those over 40 or 50 years of age.  However, the spots are very rare in young children and adolescents.

Cause

A skin biopsy would usually demonstrate that there is no pigment (melanin) in the skin cells (keratinocytes). There would also be a reduction in the number of pigment-producing cells (melanocytes). The skin would appear as well to be slightly thinner than normal and flattened out.

The cause of this condition is speculative. It is thought to be an inevitable part of the ageing process, with a gradual reduction in melanocytes, a similar process to the greying of hair. Other theories include:

  • Sun damage – the lesions are a kind of white freckle
  • Non-sun related seborrhoeic keratoses – degenerative scaly spots.

Idiopathic guttate hypomelanosis does not appear to be due to trauma or viral infection. No research has shown that the white areas predispose persons to skin cancer.

Treatment

In most cases, treatment is not required as the marks are completely harmless. Attempts to destroy the lesions may leave brown marks or larger white marks, which may look worse than the original condition. Sun protection therefore is extremely important.

Once again we would like to acknowledge the services rendered and advice given by Virginia Moore. She plans to visit Trinidad next year and partner with Almawi to do some charity Health Clinics in various areas of the country, especially the rural ones. One such venture was conducted on Father’s Day when the Karate Association of Trinidad hosted a Health Fair. Virginia, Almawi’s Managing Director, and I, volunteered our time and consulted with attendees on problems and gave proper foot care tips. The Management of Almawi looks forward to future ventures with this beautiful Londoner, whose passion is to become a Podiatrist to help persons, including those in the Caribbean, who need foot care.

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