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What Causes White Patches On Kid's Face And How To Treat Them?

What Causes White Patches On Kid's Face And How To Treat Them

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White spots or patches on a child’s faces can be worrisome for most parents. You may be more concerned about any underlying disease than appearance when you notice discoloration on your child’s face.

There are various causes for hypopigmented spots on a child’s face, ranging from conditions that self-resolve within weeks to diseases that can stay lifelong. Always seek medical help for exact diagnosis and to know if there is an effective treatment.

Read this post to know more about the causes, diagnosis, treatment, and prevention of various types of white spots on children’s faces.

White Spots On A Child’s Face

There are many reasons for leukodermic dermatosis (skin conditions with white spots) on a child’s face. Sometimes, it can be due to certain mineral or vitamin deficiencies. You may consult a pediatrician or a certified dermatologist to know the exact cause before attempting treatments with vitamin or mineral supplements.

Over-the-counter or commercial creams or lotions that promise a cure for white spots on the face may not be useful in most cases and may have side effects.

The following skin conditions may cause white spots on a child’s face.

1. Milia

Milia are also called milk spots. These tiny white bumps usually appear on the face, and you may rarely notice milia on the upper trunk or the limbs. Although milia can be seen at any age, it is common in newborns.

Milia

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  • Causes and diagnosis of milia

Milia is caused by trapping of keratin (skin flakes) under the skin surface. You may consult a doctor if milia are not disappearing after a few weeks. The diagnosis of milia is made by visual examination, and no tests are required (1).

  • Prevention and treatment of milia

There is no way to prevent milia, and it often disappears within a few weeks or months. There is no requirement of medical treatments for milia in kids (2).

Home remedies to reduce milia may include (1):

  • Wash your kids face daily with mild soap and water
  • Pat dry the face after wash
  • Do not pinch or scrub milia, since it may cause skin damage and infection
  • Avoid applying lotions or oils on the kid’s face

Note: Some parents may confuse baby acne or Epstein pearls with milia. However, acne can cause red bumps and pustules on the face. Epstein pearls are small white-yellow cysts, often look like milia, but these appear on the roof of the mouth and gums (2).

2. Pityriasis alba

Pityriasis alba is a self-limiting, skin condition that causes dry, fine, scaly, and pale patches on the face. It is common in children and young adults and considered as a type of eczema or dermatitis. This condition’s name is derived from the characteristic appearance of the skin. Pityriasis refers to fine scaly appearance and alba for the hypopigmentation or pale skin color.

Pityriasis alba

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  • Causes of pityriasis alba

Causes of pityriasis alba are not yet discovered. However, atopic dermatitis and dry skin often coexist with it. Sun exposure may make it more visible due to the tanning of the surrounding skin (3).

The purported causes, such as inadequate or excess bathing, low serum copper, ultraviolet radiation, or Malassezia yeasts, are not yet proven to cause hypopigmentation (3).

  • Symptoms and signs of pityriasis alba

One or more white patches, varying from 0.5 to 5cm in diameter, are a characteristic finding in pityriasis alba (4). Pityriasis alba may cause a slight itch in some children and is not known to cause any other complications.

  • Diagnosis of pityriasis alba

Physical examination under a wood lamp could diagnose the condition. A skin biopsy may show mild spongiotic (fluid buildup between cells) dermatitis with decreased melanin pigment. Scraped skin may also be collected for mycology examination to exclude the diagnosis of yeast infection (5).

  • Treatment for pityriasis alba

Treatment is not recommended for asymptomatic cases. Moisturizing creams are useful for dry skin appearance, and mild hydrocortisone (topical steroid) creams can reduce itch and redness on the spot (5).

Tacrolimus ointment, pimecrolimus cream, and calcineurin inhibitors are shown to be effective in some people. However, seek expert advice before using any medicines or creams on a kid’s skin. Skin appearance may gradually return to normal within months or two to three years (6).

  • Prevention of pityriasis alba

Avoiding sun exposure could help reduce the risk of developing the condition (3).

3. Vitiligo

Vitiligo is depigmentation of the skin due to the loss of melanocytes, which are the cells that produce the skin pigment called melanin. Vitiligo can affect both sun-exposed and unexposed areas of the body. Depigmentation of the lips and graying of hair are often seen in vitiligo.

Vitiligo

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  • Causes of vitiligo

Exact causes of vitiligo are unknown (7). It can be due to dysfunction or loss of melanocytes (melanin pigment-producing cells) that give skin color. Genetic factors or an autoimmune condition where the immune system attacks melanocytes could be a reason for it (8). It can affect any race, at any age. However, onset in childhood and teenage is typical.

  • Diagnosis of vitiligo

Vitiligo can be diagnosed on physical examination, and the doctor may examine the skin under a wood lamp. Rarely, a skin biopsy is performed, which helps confirm the diagnosis by the absence of melanocytes (pigment cells) on the skin. Thyroid diseases and diabetes are tested since it may increase the risk of vitiligo in many people (9).

  • Treatment for vitiligo

Mild vitiligo may not require treatment, and some spots may disappear over time. There are few treatments to make the skin tone uniform. Corticosteroid creams, photochemotherapy (PUVA), narrow-band ultraviolet B therapy (UVB), and depigmentation are a few medical treatments (10). These treatments may have side effects, and, thus, may not be suggested for children since vitiligo spots are harmless.

The following remedies may help children with vitiligo.

  • Using sunscreen could reduce the tanning of skin around the vitiligo spots that could highlight the spot.
  • Cosmetics such as concealers can help hide the white spots on the skin.

Although vitiligo can be upsetting for many people due to appearance, it is not a medically dangerous condition. Vitiligo is not an infection, skin cancer, or a contagious disease. Children with vitiligo are as normal and healthy as others.

Do not overly bother about covering the vitiligo spots; let your child take it as a part of their skin color. Explain about vitiligo to family, friends, and peer groups to avoid bullying or negative behaviors.

4. Tinea versicolor

Tinea versicolor, also called pityriasis versicolor, is a fungal skin infection that causes lighter or darker patches on the skin. Tinea versicolor can occur at any age, but it is most commonly seen in adolescents and young adults (11).

Tinea versicolor

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  • Causes of tinea versicolor 

Tinea versicolor is caused by yeasts that are generally present on the skin. Overgrowth of Malassezia yeasts due to environmental factors, such as warmness and moisture, could result in patches on the skin. Malnutrition and excessive sweating (hyperhidrosis) may also result in overgrowth of yeasts (12).

Note: Pityriasis versicolor cannot be spread from one person to another (not contagious) since most individuals have Malassezia yeasts on the skin. This condition is not caused by poor hygiene.

  • Risks for tinea versicolor

Weak immune systems, oily and moist skin, or hot and humid climatic conditions may increase the risk of tinea versicolor infection. Children on corticosteroid medication may also be susceptible to this condition.

  • Signs and symptoms of tinea versicolor

Although the white spots may appear on the face, it is common on the chest, back, and upper arms. Patches can be pink or light brown in some people and may have scale-like flakes. Skin change is usually limited to the skin’s outer layer and often does not cause any pain or itching. 

  • Diagnosis of tinea versicolor

Physical examination is enough to diagnose tinea versicolor in most children. Rarely, doctors may collect skin scraping to confirm the diagnosis.

  • Treatment for tinea versicolor

Shampoo containing selenium sulfide is the primary method of treatment. If the condition does not resolve, then antifungal or anti-dandruff shampoos can be used. The skin may get better in a short duration in many children. However, it may take several months to get a uniform skin tone. The monthly use of shampoo is recommended to prevent a recurrence (12).

Note: If you do not notice any changes or if there is a recurrence, consult the healthcare provider for more help. They may prescribe oral antifungal medicines or antifungal creams to treat this condition.

5. Idiopathic guttate hypomelanosis

Idiopathic guttate hypomelanosis (IGH) is a skin condition that causes small, white oval spots. People may often call it white sunspots. IGH is more common in the elderly fair-skinned people than in children and often goes unnoticed (13).

Idiopathic guttate hypomelanosis

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  • Causes of IGH

The exact cause of guttate hypomelanosis is not known. Although not yet proven, it is suggested that it may be due to sun exposure (14). 

  • Diagnosis of IGH

Physical examination is enough to determine the condition. Rarely, biopsy samples are taken. There is usually a decrease in the melanocytes in the affected areas, although melanocytes are not completely absent, like in vitiligo (13).

  • Treatment for IGH

IGH spots are benign and do not require medical treatment (14). There is no approved cure for this skin condition, and most treatments aim to improve the skin’s cosmetic appearance.

Home remedies may include regular use of sunscreen and physical barriers to prevent sun exposure since it may contribute to or precipitate the hypomelanosis.

When To See A Doctor

You may not be able to differentiate between various causes of white spots since they may look alike. Therefore, consult a pediatrician or a pediatric dermatologist if your child has white spots on the face. You must also see a doctor if the white spots are itchy or cause discomfort to the child.

Although most skin conditions do not require specific medical treatments, some causes, such as a yeast infection or a vitamin deficiency, can be cured effectively.

Home Remedies For White Spots On The Child’s Face

Always try remedies that are recommended by certified dermatologists for children. Do not bother your child by trying multiple remedies for a chronic condition. Many conditions that cause white spots on the face cannot be cured, and you may only work on ways to cover it, such as using cosmetic products. The use of sunscreen to avoid skin tanning may also prevent the exacerbated appearance of the white spots.

White spots on kids’ faces have nothing to do with their intellectual abilities and talents. Do not be overly bothered about it, and let your child choose cosmetic treatments later in life. Support and encourage your child to be confident in their abilities instead of being emotional or depressed about their skin appearance.

References:

1. Milia; Healthychildren; The American Academy of Pediatrics
2. Milia; MedlinePlus; The United States National Library of Medicine
3. Pityriasis alba; DermNet NZ;  The New Zealand Dermatological Society
4. Donald N. Givler, et al.; Pityriasis Alba; The United States National Library of Medicine
5. Pityriasis alba; C.S. Mott Children’s Hospital; The University of Michigan
6. Pityriasis alba; The Australasian College of Dermatologists (ACD)
7. Vitiligo; The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases
8. Vitiligo; National Health Service
9. Diagnosing Vitiligo; NYU Langone Medical Center
10. Vitiligo: Diagnosis and Treatment; The American Academy of Pediatrics
11. Tinea Versicolor; Harvard Medical School
12. Pityriasis Versicolor; National Health Service
13. Falon Brown and Jonathan S. Crane; Idiopathic guttate hypomelanosis; The United States National Library of Medicine
14. Idiopathic guttate hypomelanosis; DermNet NZ;  The New Zealand Dermatological Society

 

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