Common Skin Discorders in Young Children
White Patches In Children
The common causes of white patches on the skin of children are:
What is Pityriasis alba?
1) Pityriasis alba
Treatment and Course of Pityriasis alba
Pityriasis alba is a mild dermatitis (skin inflammation). This is
characterized by multiple oval, mildly scaly, flat hypopigmented (white)
patches on the face, arms and upper trunk. The borders of these patches
are indistinct. It occurs in children between the ages of 3 and
16 years and up to 30% of children may be affected during their childhood.
The patches are not itchy. It is often mistaken for a fungal infection.
The condition tends to become more prominent by sun exposure.
This is a harmless condition. It can last for months to years with slow
spontaneous recovery. Sometimes, steroid creams may help. Avoid self
medication. Avoid antifungal creams. Avoid excessive washing of the skin
What is Vitiligo?
Vitiligo is a patchy loss of skin pigment. The patches are flat,
completely white and have distinct borders. Hair within the patches of
vitiligo is often white as well.
Two types of vitiligo are recognized:
In type A, the vitiligo present as multiple white patches which are
generalized and symmetrical. The limbs, face and neck are the areas most
In type B, the vitiligo presents as localized patches in a segmental
distribution. This type is common in children.
Type A vitiligo tends to continue to spread with new lesions appearing
over years whereas Type B vitiligo tends to spread rapidly then stops
after about one year. The cause of vitiligo is not entirely known. Some
people with vitiligo have a higher incidence of associated diabetes
mellitus and thyroid disease.
How do we treat vitiligo?
Your doctor will prescribe one or more treatments as follows:
- Topical steroid creams. This can induce repigmention in some
- PUVA, is a combination treatment involving the use of a drug called
Psoralen (P) and then exposing the skin to untraviolet A (UVA). Psoralen
can either be used in the lotion form to be applied on the skin or as
tablets to be taken orally to make the skin sensitive to UV light.
Patients treated with PUVA must be prepared to undergo therapy for a
year or longer for optimuni results. Such treatment is best supervised
by a dermatologist.
- Camouflage cosmetics. Some cosmetics can provide very good colour
match to normal skin. Camouflage cosmetics are particularly useful for
white patches on the face and back of the hands.
- Sunscreens. Areas affected by vitiligo are prone to sunburn. It is
advisable to use sunscreens on affected areas which are exposed to
The response to treatment varies with each person and siteaffected.
What is alopecia
areata? Alopecia areata is a common skin disorder seen in children and
young adults. It is characterized by hair loss in localized round areas on
the scalp and occasionally on the eyebrows. A positive family
history for alopecia areata is found in 10% to 20% of patients.
What is the chance of hair regrowing?
The prognosis for most children is excellent. Complete regrowth of the
hair occurs within a year in 95% of children with alopecia areata. About
30% will have a future episode of alopecia areata. Rarely, all the scalp
hair or all the scalp and body hair are lost in the disease.
What is the cause of alopecia areata?
The cause of alopecia areata remains unknown. An immune mechanism is
postulated in which auto- antibodies are produced against the hair
follicles and this results in premature shedding of the hair.
Consult your doctor.
There is no reliable treatment for alopecia areata since spontaneous
regrowth occurs in most patients. Many forms of therapy including
intralesional or topical steroids, anthralin or contact sensitisation have
demonstrated short term hair regrowth, but they do not alter the long term
course of alopecia areata. In complete hair loss, wearing a wig may be
What is discoid eczema?
This is another type of eczema that is common
in children and young adults. They present as round, red patches of eczema
or skin inflammation located mainly on the arms and legs. The lesions are
coin-like, hence the term discoid eczema.
There are 2 forms of discoid eczema:
a) Wet form: with oozing and crusting lesions. Both forms are persistent,
lasting for months if untreated.
form: with redness and scaly lesions.
Why is it important to recognize discoid
Discoid eczema is frequently mistaken for
ringworm. It does not respond to antifungal creams.
Treatment is with moderate strength steroid creams.
Lesions are slow to
resolve and treatment takes
considerable time before improvement
What is Diaper Dermatitis?
This is a childhood skin disorder. It affects young children under the
age of 2 years. It is an inflammation of the skin resulting from skin
irritation of chemicals in urine and faeces.
There are 4 presentations:
- The most common presentation is "chafing dermatitis". This is most
frequently observed at 7 to 12 months of age, when the baby's urine
volume exceeds the absorbing capacity of the diaper. There is
involvement of the convex surface of the thighs, buttocks and waist area.
- The second is "perianal dermatitis" where the dermatitis is limited
to the area around the anus. This is seen in newborns who have
- The third presentation is characterized by shallow ulcers scattered
throughout the diaper area.
What is the cause of diaper dermatitis?
- The fourth presentation consists of confluent redness with satellite
lesions involving the inguinal areas and the genitalia. This is due to a
secondary yeast (a fungal) infection.
Diaper dermatitis is the result of prolonged skin contact with urine
and faeces. Tight occlusion of faeces and urine by diaper covers increase
the penetration of these alkaline substances through the skin.
What is the treatment?
Consult your doctor for advice. Avoid self-medication.
The basis for treatment in diaper dermatitis is to remove the urine and
faeces from the skin surface and prevent skin maceration by keeping the
diaper area dry.
- Lubrication of diapered skin with a greasy ointment decreases the
severity of diaper dermatitis and protects the skin from urine and
- Very frequent diaper changes followed by application of ointment
limits maceration and prevent recurrences.
- Diaper change a few hours after the baby goes to sleep and reducing
fluids just before bedtime may help.
- Avoid plastic and rubber pants.
- Yeast infection in the diaper area requires antifungal creams. Your
doctor will prescribe the appropriate medication.
- In severe dermatitis, your doctor may prescribe hydrocortisone 1 %
cream twice daily to help decrease the infant's discomfort.