White Spots On A Child's Face: Causes And Treatment

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Most parents are concerned when they notice white patches on a kid’s face. These white patches or spots are also known as hypopigmented spotsⁱWhite spots patches on the skin . The discoloration may cause them to be more concerned about any underlying illness than about their child’s appearance. Knowing the common causes may help ease concerns and help you take suitable actions.

Hypopigmented spots on a child’s face can be caused by many different disorders, ranging from self-resolving conditions to diseases that can last a lifetime. Therefore, it is advised that you seek professional care for your child for a precise diagnosis and to determine whether there is a viable treatment option.

Read on to know more about the causes, diagnosis, treatment, and prevention of several types of white spots on children’s faces as well as some home remedies.

White Spots On A Child’s Face

Dr. Mykale Elbe

, a family nurse practitioner from Mascoutah, Illinois, says, “White patches can be caused by many different things and do not always mean a deficiency. There are viruses, bacteria, and skin conditions that can cause white spots and white bumps on children’s faces for various reasons. It is safe to start with soap and gently clean your child’s face as this can help with some causes. Then, get your child seen by a health professional to determine the cause before adding other solutions, medicated lotions, or supplements.”

There are many reasons for leucoderma dermatosis (skin conditions with white spots) on a child’s face. Sometimes, these leucoderma patches 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 are primarily tiny white bumps rather than patches and 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.

• Causes and diagnosis of milia

Milia is caused by trapping 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

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 skin discoloration, and pale marks 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.

• 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 copperⁱIndicates copper deficiency which can cause loss of pigment from the skin , ultraviolet radiation, or Malassezia yeastsⁱThe group of yeasts which can cause or worsen a variety of skin infections , are not yet proven to cause hypopigmentation (3).

• Symptoms and signs of pityriasis alba

One or more light 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

This condition can be diagnosed clinically. Physical examination under a wood lampⁱA special lamp used to identify pigmented or depigmented patches on the skin could diagnose the condition. A skin skin biopsyⁱSmall amount of skin removed and inspected under a microscope may show mild spongiotic (fluid buildup between cells) dermatitis with melanin deficiency. Scraped skin may also be collected for mycology examinationⁱTest to detect a fungal disease 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 and using good-quality sunscreen could help reduce the risk of developing the condition (3). Also, avoid using harsh soaps that can dry out and irritate the skin.

3. Vitiligo

Vitiligo in children

is characterized by depigmented areas on the skin due to the loss of melanocytes. These are the cells that produce the skin pigment called melanin.

Vitiligo can affect both sun-exposed and unexposed areas of the body. Irregular pigmentation of the lips and graying of hair are often seen in vitiligo.

The graph below shows the results of a study conducted on 4523 cases of European ancestry. According to the findings, vitiligo’s prevalence is distributed widely across different age groups. While the mean age of early-onset vitiligo was found to be 10.3 years, the mean age of late-onset vitiligo was 34 years. The study also found that the average age of onset for vitiligo is 25.9 years, with no significant gender-based differences.

The distribution of vitiligo age-of-onset

Source: Early-onset autoimmune vitiligo associated with an enhancer variant haplotype that upregulates class II HLA expression; Nature Communications

• Causes of vitiligo

Exact causes of vitiligo are unknown (7). These pigment irregularities 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 years 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 with fair blemishes may not require treatment, and some spots may disappear over time. There are few treatments that can help improve an uneven skin tone. CorticosteroidⁱMedication used to reduce inflammation and overactive immune system  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 for blotchy skin 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 a patchy complexion with 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).

• 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 spotting on 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 or fair skin patches. 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).

• 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 causing these discolored spots. 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 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. It is a must to visit a doctor if the white spots spread and 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 vitamin deficiency, can be cured effectively.

Home Remedies For White Spots On The Child’s Face

Maintaining a child’s skin health is an important aspect of their overall well-being. 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.

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