By Gary M. White, MD
Whitish areas on the cheeks and/or arms of children is typical.
Pityriasis alba is a benign condition of the cheeks that most commonly affects preteens. It is at this age that the facial oil production is still relatively low and eczema may occur. The inflammation impairs the pigment production by melanocytes and distribution to keratinocytes of the skin. A hypopigmented area results.
An ill-defined, hypo (but not de) pigmented area occurs on one or both cheeks of a child 6-10 years of age. Sometimes other areas of the face or upper arms are affected.
The parents should be reassured that the color will return to normal once the eczema is controlled. Full repigmentation may take several months however. Application of a mild topical steroid (e.g. hydrocortisone 1% cream) BID (especially after the skin is wetted, e.g. washing face, bath) is appropriate. Once the inflammation has subsided, twice daily application of a moisturizing cream (e.g. Cetaphil cream, Eucerin cream) is sufficient. On occasion, a higher strength steroid (e.g. desonide) is needed for a short period of time. Alternatively, a calcineurin inhibitor such as pimecrolimus cream or tacrolimus ointment may be used.
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