ByDr. Vidushi Jain

May 21, 2022 (IANSlife) White or pale lesions of skin disorders are the most worrisome complaints from Indian and Indian subcontinent people. Pityriasis alba (PA), polymorphic light eruption (PLE), pityriasis versicolor and vitiligo are clinically look-alike conditions commonly seen in children.

Pityriasis alba is a skin condition commonly seen in kids and usually on the face. The cause of pityriasis alba is unknown, although it has been regarded as a manifestation of another skin disorder called atopic dermatitis. The lesions may be round, oval or irregular and red, pink or white colored. Several patches may be observed at once, usually on the face and arms. The duration of the rash is variable, lasting from several months to over a year. Lesions can appear several times. The lesions are obvious to those with darker skin. Patients with lighter skin will notice the rash more frequently during the summer months as their skin tans. Young children are most often affected but pityriasis alba tends to go away with time. The loss of pigment here, unlike vitiligo, is not permanent and recovers with time. 

Pityriasis alba sometimes works itself out spontaneously and does not always require treatment. A moisturizer cream or lotion may be recommended to retain moisture in the skin. A low potency topical corticosteroid may also be prescribed to decrease inflammation and reduce symptoms.

Polymorphic light eruption is a common post inflammatory condition where the skin can look a little white at spots when resolving but more commonly on photo exposed areas like nape of neck and in the forearms. The spots and structureless and have I’ll defined borders, also they show faint brown pigmentation. It’s a delayed hypersensitivity response to the UV radiations and sometimes to visible light too. They recur every summer and sometimes use or steroid creams for long to calm the redness can leave white spots on the skin. 

Pityriasis Versicolor is a fungal infection of the skin where skin lesions can be a little whitish in colour, but they are very well defined with circular borders and are scaly. Thin granny scaling is characteristic.

Vitiligo is characterized by acquired, well defined depigmented small to large patches on the skin, the wet areas like mouth, genitals and/or white hair and it is mainly differentiated from congenital skin lesions. It is frequently associated with various autoimmune diseases. Hashimoto’s thyroiditis is the most common association in children. It occurs worldwide, with an incidence rate of between 0.1% and 2%. Vitiligo is an important skin disease, having a major impact on the quality of life of the patient suffering from it. The causes of this condition are uncertain but seem to be dependent on the interaction of genetic, immunological and neurological factors. 

The management of vitiligo includes information and reassurance of young patients and their parents on the disease, thyroid investigation, avoidance of trigger factors, topical treatment and proper follow-up. Cosmetic improvement can be achieved by camouflage products and self‐tanning dyes. The course of vitiligo is unpredictable, but often progressive. Spontaneous repigmentation may occur in a few people (10–20%), mainly in children, but this tends to be only partial and on sun‐exposed areas.

(Dr. Vidushi Jain, Medical Head Dermalinks)

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