Pale patches on a child's face (pityriasis alba)

What it is

Pityriasis alba causes faint, pale, slightly dry or scaly ovals, usually on the face, upper arms and neck of children. It is a mild form of eczema.

How it works

Pale, slightly dry patches on a child's face caused by mild eczema disturbing pigment transfer.

Why it matters on darker skin

Patches are more noticeable on darker skin and in the sunny season, when surrounding skin darkens. It is not a fungal infection, vitiligo or a sign of worms or poor nutrition.

Causes and triggers

Dry skin, sun contrast, eczema.

What helps — and why it works

Gentle soap-free washing, fragrance-free moisturiser twice daily and sunscreen on the face. Colour returns over months. Moisturise twice daily: restores barrier and pigment. Expected timeline: weeks to months. Sunscreen: reduces contrast. Expected timeline: daily.

What to avoid and why

Avoid scrubbing, antifungal-steroid mix creams and bleaching or "toning" creams to blend patches.

Common mistakes

• Antifungal creams for months.
• Bleaching creams.

Caring for children's skin

Children's skin is thinner, loses water faster and absorbs more of what is applied to it relative to body size, so simpler is safer. For most children a short lukewarm bath, a fragrance-free soap substitute and a plain emollient are all that is needed, plus shade, clothing and sunscreen from six months of age. Avoid adult products, essential oils, antiseptics in bath water, bleaching or 'toning' creams, and cosmetic treatments such as relaxers and gel nails. Medicines and medicated creams should be used only as a doctor, nurse or pharmacist advises, and in children Melanin & Me does not offer photo checks: a clinician should see the child. Trust your instincts as a parent: a child who is unusually sleepy, floppy, not feeding, breathing fast or has a rash that does not fade when pressed with a glass needs urgent care. Keep a simple record — photos and dates — of rashes that come and go, as this helps the doctor.

Products, medicines and when to worry

When choosing products for children, look for fragrance-free formulas with short ingredient lists, and avoid adult acne, anti-ageing or lightening products, essential oils and talc. Medicated creams — including steroid creams, antifungals and antibiotics — are safe and helpful when prescribed for the right condition and used for the right length of time, but mixed creams sold over the counter can contain strong steroids that are unsafe for children. Sunscreen is suitable from six months of age; younger babies should be kept in the shade and covered. Do not give medicines intended for adults, and ask a pharmacist about the right medicine for a child's age and weight. Seek urgent care for any rash with fever and a very unwell child, a rash that does not fade under a glass, swelling of the face or lips, or blistering of the mouth or eyes.

Questions to ask your doctor or pharmacist

Useful questions include: What do you think is causing this? Is it likely to come back, and how can I prevent it? Which products should I stop? How long before I should expect improvement, and when should I come back if it isn't better? Are there side effects to watch for? Is this treatment safe if I am pregnant, breastfeeding or for my child? Writing your questions down, bringing your products (or photos of their labels) and taking dated photos of the problem make an appointment much more useful.