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Idiopathic guttate hypomelanosis

Idiopathic guttate hypomelanosis is the name given to 2 to 5mm flat white spots found on the shins and forearms. ‘Idiopathic’ means the cause is unknown, ‘guttate’ means resembling tear-drops, and ‘hypomelanosis’ refers to the lighter colour of the affected areas.

Who does it affect?

Idiopathic guttate hypomelanosis predominantly affects fair-skinned individuals, but it may occasionally arise in darker skin. Although most often found on the shins and sun-exposed parts of the forearms, guttate hypomelanosis 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 may be slightly scaly.

They appear as part of the aging process, becoming quite common in those over 40 years of age. They are more common in women than in men. Inherited factors may be relevant as the lesions appear to be more common in family members.

Guttate hypomelanosis on the chest	Guttate hypomelanosis on the leg	Guttate hypomelanosis on the forearm

What is the cause of guttate hypomelanosis?

A skin biopsy demonstrates that there is no pigment (melanin) in the skin cells (keratinocytes). There is also a reduction in the number of pigment-producing cells (melanocytes). The skin is slightly thinner than normal and flattened out.

The cause of guttate hypomelanosis is speculative. It is thought to be an inevitable part of the ageing process, with a gradual reduction in melanocytes – a similar process to 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. The white areas do not predispose to skin cancer.

Is there any 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 is very important.

The following measures may improve the appearance.

• Light cryotherapy
• Localised superficial dermabrasion or microdermabrasion
• Pinch grafts of normally pigmented skin
• Tretinoin cream
• Topical steroids
• Cosmetic cover-up