What causes those white spots on my kid’s cheeks and arms?

Fawn with spotsIt could be a common dry skin rash called pityriasis alba.

With pityriasis alba, the white patches of fine dry scale are usually located on the sides of the cheeks and the outer side of the upper arm. They’re more likely to occur when activities or weather conditions dry out the skin such as swimming in chlorinated pools or with the temperature extremes of a cold and dry winter. They also show up more when skin is tanned because the scaly patches stay white and contrast against the tanned skin. That means that towards the end of summer, they may well be in full bloom if you live in a dry climate.

What is pityriasis alba?

It’s a subtle form of eczema (also called dermatitis). It’s an unusual rash though because there really isn’t much, if any, inflammation. This means the involved skin doesn’t itch, it just looks funny. Most people mistake it for a fungus, which it isn’t. It’s just a form of dry skin eczema.

What treatments will help get rid of the white spots from pityriasis alba?

Hydrating gentle skin care – it works for both treatment and prevention. Hydrating skin care means doing things to increase the water content of the outer skin layers.

The 4 key points for hydrating gentle skin care are:

  1. Use only mild soaps (such as Vani Soap, Cetaphil Cleanser or my favorite glycerin soap which is the Whole Food’s 365 glycerin bar soap).
  2. It also means bathing in warm, not steamy hot, water and only soaping up the parts of the skin that are actually dirty (often just the armpits, groin, buttocks and feet). Remember, washing your skin is just like doing the dishes, the hotter the water and the harsher the soap, the more oils are removed. For dry skin, that’s just the opposite of what we want.
  3. Within 3 minutes after toweling the skin dry it’s essential to apply a thick and rich moisturizing cream. Good options include Vanicream, Cetephil Cream or Eucerin Cream (if there is no wool allergy).
  4. Avoid irritating ingredients like you would find in an anti-aging or acne product because the little white patches are actually more vulnerable to irritation than normal skin.

As the pityriasis alba starts to improve, you’ll first see the scale disappear and then VERY slowly the color will normalize. Often a physician will prescribe a very mild cortisone cream for a few weeks to speed things along, but cortisone creams have side effects such as permanent skin thinning and this would be a treatment that required physician supervision.

Why my kid? Who’s most likely to get pityriasis alba?

People with dry, sensitive skin are most prone to pityriasis alba. Often there’s a personal or family history of asthma, allergies, eczema, keratosis pilaris or extremely dry sensitive skin. We call this constellation of conditions an atopic diathesis and they are genetically linked; if one or some of these conditions are in the family DNA then most family members are likely to show up with some or all of them too. Pityriasis alba happens because the ‘barrier function’ of skin in people with these conditions may be just a little less able to handle drying conditions – like swimming pool chemicals and harsh weather. That’s why hydrating skin care helps, both for treatment and prevention.

Reference: James WD, Berger TG, Elston DM, Andrews’ Diseases of the Skin 11th ed., Elsevier Inc., 2011, p 65-6

Photo: Thanks and Gratitude to mock-turtle

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