White Patches on Cheeks - Neither 'Worms' Nor 'Calcium Deficiency'

 "Doctor, please do something for these white patches that appear on his cheeks I have started giving him oral calcium supplements but it didn't help. Do you think it is because of worms?" a mother was asking me anxiously. She was worried about the light-colored circular patches that had appeared on the cheeks of her son.

 This is a very common complaint encountered in pediatric patients. Mostly parents connect it with either a deficiency of calcium or due to worm infestation; while some go to the extent of considering it a pre-vitiligo stage. The worried mothers empirically start treating the child with some OTC drugs, without knowing what is it actually?

Pityriasis alba, is a common skin disease, predominantly affecting children of 3-16 years of age [boys affected more than girls] and affects almost 8-10% of children at least once in their lifetime. 

The word 'pityriasis' denotes the finely scaled appearance while the word 'alba' is Latin for white, the color of the patches.

The patches are definitely not permanent and the condition is known to be self-limiting, resolving on its own after a certain period.

  There is no evidence that it progresses to vitiligo in future, since pathophysiologically, both are completely different entities.

Pityriasis alba falls under idiopathic dematosis, which means the cause is yet unknown.

It is considered as a superficial dermatitis, that is usually seen in atopic [prone to allergy] children and presents with dry-scaled, light colored patches on the face - especially around the mouth. 

Due to its color it seems accentuated during the summer. It might itch during the early stage of appearance.

It is most likely to be mistaken with vitiligo or leucoderma, where there is a complete absence of the dark pigmentation. The pityriasis alba lesions do not usually have a well-defined borders [like in vitiligo] and they do not coalesce [as in tinea versicolor].

Ideally treatment is not necessary for pityriasis alba, but one should consult a physician to rule out the other causes of hypopigmentation, which might need treatment. Anti-fungal ointments have shown improvement in some patients.

Homeopathy can help these patients with its constitutional treatment approach as per the assessment of individual psycho-somatic disposition.