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

I often see parents bring their kids into the office for other reasons and ask what causes those white spots on my kid's cheeks and arms? Often, it is a common dry skin rash called pityriasis alba as described in this medical review.

What does Pityriasis Alba look like?

• The white patches of skin have fine dry scale.
• They are usually located on the sides of the cheeks and the outer side of the upper arm.
• The white patches are 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.

This all means that towards the end of summer, pityriasis alba's white patches 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 the white patches of pityriasis alba it for a fungus, which it isn’t.

It’s not a fungus. Pityriasis alba is 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 of pityriasis alba. 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 to heal the white spots of pityriasis alba on your kid's cheeks and arms:

1. 
   Use only mild soaps such as Vani Soap, Cetaphil Cleanser or my fragrance-free Naturally Best Bar Soap. made with organic ingredients.
2. Bathe in warm - not steamy hot - water and only soap 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 my Natural Body and Face Lotion  which is fragrance-free and made from organic botanical ingredients. This is a great overall skin cream for the entire family.
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.

How can you tell that pityriasis alba is healing?

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 does my kid 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