Yeast Can Be Cause of White Spots
Published by Contra Costa Times
Posted on Fri, Aug. 04, 2006
By John Lee M.D. and Stephen Daniels M.D.
"Doc, what are these spots on my chest and back? I'm embarrassed to take my shirt off. And it's summer."
A common complaint among teenagers and young adults, usually in the summer. Easy to control, but hard to cure. It often recurs for years before the person comes for treatment, perhaps because it tends to go away in the winter, and the person hopes it's gone for good.
As summer approaches, the patient looks in the mirror and the spots are gone. Yes! Then after a day or two in the sun, they are back. Yuck!
The white spots are caused by a yeast called tinea versicolor. It has similarities to and differences from the molds that cause athlete's foot, jock itch, and ringworm.
The versicolor yeasts are always in the environment, and usually cause no problems. Some people are more susceptible to the factors that can convert the yeast into the forms that cause the rash: oily skin, heat, humidity, birth control pills, pregnancy and corticosteroids.
Versicolor yeasts are not contagious. By contrast, the tinea molds that cause athlete's foot, jock itch and ringworm are contagious.
The yeast doesn't directly cause the skin to become lighter. It keeps the underlying skin from tanning, so it looks lighter relative to the surrounding skin.
In the winter, when the patient is untanned, the spots may actually look tan or slightly red. Often, though, they only become noticeable when the surrounding skin turns tan, leaving clusters of whitish circular spots.
The simplest treatment is to buy an inexpensive cream for athlete's foot or jock itch, such as Tinactin or Lotrimin. These are usually applied twice a day to the affected spots.
Some patients find that adding a mild (1 percent) hydrocortisone cream to the anti-fungal cream is more effective than the anti-fungal cream alone. Stronger cortisone creams are available by prescription.
If the tinea spots cover a large area, a selenium shampoo (Selsun Blue, Head and Shoulders) might be a better treatment choice. Selsun Orange 2.5 percent or Ketoconazole 2 percent shampoos are available by prescription.
If creams or shampoos don't work, pills such as Nisoril, Diflucan and Sporanox, taken for a week or two, are effective and available by prescription. They work via sweat, so the patient should build up a sweat by exercising two hours after taking them, and not wipe or wash the sweat off for 8-12 hours.
Lamisil and griseofulvin are only effective against molds, such as athlete's foot, jock itch and ringworm, not against yeasts. They do not work for tinea versicolor.
Because those with oily skin are especially susceptible to versicolor, it frequently recurs within a year or two after treatment, especially among teenagers and young adults.
So, to prevent the rash, many doctors recommend applying an antifungal cream or shampoo monthly or weekly to previously affected areas during the months leading up to summer. Monthly or weekly pills may be necessary.
Remember that in summer the spots act as a sunscreen. You need to first treat the yeast, let the surrounding tan fade, then retan the whole area, to attain a smooth, unspotted complexion.
Always use sunscreen when you tan. Don't overdo it. And if in doubt, call your doctor.
Lee practices family medicine at the Martinez Health Center. Daniels practices family medicine at the Concord and Pittsburg Health Centers. Healthy Outlook is written by the professional staff of Contra Costa Health Services, the county health department. Send questions to series coordinator Dr. David Pepper at email@example.com. For more health information, go to www.cchealth.org.