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What are the white patches on this 10 year old boy's cheeks?

10 year old boy with white patches on his cheeks. Otherwise healthy. More noticeable in summer. Older brothers and sister also had similar condition at his age. Parents worried that he may be developing Vitiligo?


What is your diagnosis?

PITYRIASIS ALBA

Essentials of Diagnosis: Cream to light-colored oval patches on the upper arms and cheeks commonly seen in children of color ages 5 to 15.

Diagnosis: Clinical presentation.

Treatment: I find the most effective treatment is a gentle cleansing program and mild moisturization program for maintenance, but active treatment requires a topical moisturizer with a mild antiinflammatory.

Pearls:

  • This is extraordinarily common in children of color. In fact, when I was working at Martin Luther King Medical Center in Los Angeles in the Pediatric Dermatology Clinic, one afternoon we had 23 patients and 13 of the 23 of the patients had this condition; however, none of them actually came in for the condition, they were all coming in for other things.
  • I find that the absolutely most effective treatment is hydrocortisone 2.5% compounded into Impruv lotion. I apply this twice daily with narrow-band phototherapy and in 80 to 90% of cases, complete resolution occurs within four weeks. In my practice, this is the most effective treatment.
  • Reassure the patients that it is very common, it will resolve with treatment, and it is not vitiligo. In most of the cases I see, the parents are terrified their children are developing vitiligo. Vitiligo is porcelain white and starts off around the eyes and on the back of the hands. Pityriasis alba is cream colored and occurs on the cheeks and arms.

Charles E. Crutchfield III, MD
Clinical Adjunct Associate Professor of Dermatology
At the
University of Minnesota Medical School
Medical Director, Crutchfield Dermatology
www.CrutchfieldDermatology.com

 


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