Caring for your child’s skin can seem like a never-ending task in the early years. Many types of skin rashes will seemingly come and go, some never having a proper name or even a specific treatment. Common skin conditions you encounter while your child is growing up include blotchy red viral rashes popping up when your child has a fever, flaky cradle cap on the scalp, crusty yellow impetigo patches on the face, itchy chicken pox blisters, and nappy rash. Many skin conditions settle and disappear quite quickly.
We all have cells in our skin called melanocytes (skin pigment cells). We all produce a pigment called melanin, but each of us pumps out differing amounts of melanin. This is why you get visual differences in skin colour and tone. Sun on your skin and hormonal changes (such as in pregnancy) can also affect the amount of melanin that your skin pigment cells produce. The more melanin produced, the darker the appearance of the skin.
What skin pigment changes might you see in your child?
These are little collections of skin pigment cells and look like dots on the skin. They tend to be dark brown, black, or dark pink in colour. You might spot some at birth, but usually they come up later. Moles may be flat when you first notice them, and then get more raised and dome-shaped over time.
As your child grows, their moles will also grow a bit. They may get darker or lighter with time. Moles to be worried about and get checked out include those on the soles of the feet or the palms of the hands, and those under the nails.
When your child goes through puberty, they may well suddenly have lots more moles appearing.
A dozen or so moles are regarded as normal, though if you are more prone to moles, up to around 40-50 may crop up between birth and young adulthood. Moles can keep coming up well into adulthood, though you wouldn’t expect any new ones beyond the age of 40. Moles should always be small (less than a few millimetres across). They should always be even coloured and a neat shape. Always look out for new moles, growing moles (getting bigger than six millimetres across), or itchy or bleeding moles.
2. Skin colour changes due to fungal causes
Parents can worry when they see darker patches or lighter patches appearing on their child’s skin, and get quite anxious if their child does not have a “perfect” appearance. In my experience, parents find skin pigment changes on their child’s face particularly upsetting.
Two reasons for pigment changes causing patches on the skin include pityriasis versicolor and pityriasis alba. These names may be rather odd, but the conditions are common and not serious.
Pityriasis versicolor is due to a fungus on the skin, and this condition happens more in teens and young adults rather than smaller children. The fungus is not something you catch – it is just something that flares up possibly due to warmth or moisture. Patches appear mainly on your child’s chest, neck, arms, and back. When you look closely, you can see a fine scaly appearance on the tops of the affected patches of skin. The patches themselves may be pale and pinkish or quite dark. In a child with darker skin, the patches could be very dark or very light-coloured. If your child has dark skin and then gets tanned in sunlight, these pityriasis versicolor patches may become even more obvious. The patches are generally more pale-brown looking in those with light-coloured skin.
If pityriasis versicolor patches are mild and not affecting your child, you can just leave them to go on their own. You can speed up the clearing of the fungus by using something called Selsun shampoo (buy from pharmacies). Although it is a shampoo, you put a thin layer on the affected skin, leave it on for 10 minutes, then wash off, and you repeat this every day for a week. The Selsun helps if your child is getting a bit itchy from the pityriasis versicolor rash. The most important thing to note is that even with treatment, it can take several weeks, if not months, for the actual skin colour to return to normal. Also, pityriasis versicolor can recur – some teens seem to get it every summer!
Pityriasis alba is another type of skin pigment change. This tends to occur in younger children. These patches are small and lightly scaly. They are pale whitish or light-coloured patches and usually only on the face (mostly on the cheeks), but you can get them on the arms too. Again, if your child tans while away on a sunny holiday the pale patches on the face appear more obvious. Pityriasis alba does not need any treatment. It goes away by itself. If your child’s skin is dry, emollients (simple moisturisers) will improve the condition of the skin, but again, it is a waiting game of several months for the skin to return to its normal colour.
3. Skin colour changes after inflammation of the skin (“post-Inflammatory” changes)
Pale patches can happen after any cause of inflammation. Different conditions can make parts of the skin flare up and get inflamed. Once the area of skin gets better and heals up, you can get something called “post-inflammatory hypopigmentation” (“hypopigmentation” means a loss or lack of pigment). You end up with light pale patches of skin. This sort of reaction can happen after a burn to the skin, or when your child gets ringworm, or if your child has lick eczema (where they have a habit of constantly licking their lips, so the skin around the mouth gets irritated by saliva). People with darker skin are particularly prone to post-inflammatory hypopigmentation. The normal skin colour gets disturbed and you get skin pigment changes.
If you ever need to use strong steroids creams or ointments on the skin, these can also cause long-lasting pigment changes. A particularly bad area of eczema on the skin often needs a strong steroid cream. This area of skin could end up a paler colour once everything is healed up – there is a dual effect causing the lighter skin patch: from the steroid cream itself and also because of post-inflammatory changes to the skin pigment cells. In general, you will find doctors advise against using strong steroids on the skin of the face.
Being left with lighter paler patches of skin is generally considered to be a “cosmetic” issue, but it can have far-reaching worrisome consequences for families. Post-inflammation colour changes may take a very long time to get back to normal or may never return to their previous colour.
Other pale or dark skin pigment marks
There are lots of other conditions that relate to skin pigment, such as:
Birthmarks – Children sometimes get area of blue-grey coloured skin on the buttocks or the lower part of the back. They can look a bit like bruising and tend to gradually fade.
Vitiligo – This is a skin pigment condition that the singer Michael Jackson was thought to have. It is not common in very small children but white skin patches start to become visible during childhood, appearing first on the face and the arms. The skin is extra sensitive to sunlight. Hair colour and eye colour are also affected.
Café au lait spots – groups of light brown (coffee-coloured) patches are something to look out for. These are called “café au lait” spots, and if your child has more than five of these, then your paediatrician will look for a genetic condition called neurofibromatosis.
In essence, pale or dark patches of skin can occur for a number of reasons and generally are very slow at returning to their normal colour. Colour changes, particularly on visibly obvious parts of the body, can affect a child’s confidence.
By Dr. Jahura Hossain
Born and brought up in London, Jahura is a U.K.-qualified doctor. She has worked in hospitals, general practice, public health, prison medicine, and the pharmaceutical industry.
Photo by Cloudia Chen
Cloudia Chen is a portrait photographer specializing in family and children’s portraits, as well as Swiss CV, business headshot and event photography. Before settling in Zurich, she lived in Mainland China, Hong Kong, London and the South of France. Her photos and articles have been published in various social media and popular travel magazines in China. To contact her please visit her website www.cloudiachen.com.
© Copyright. Jahura Hossain. 2017. All rights reserved. No part of this article may be reproduced without the express consent of the author.