PM Pediatrics
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Dr. Christina Johns
Senior Medical Advisor, PM Pediatrics

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3 common skin conditions that dont get a lot of press but you should know about

3 Common Skin Conditions That Don’t Get a Lot of Press But You Should Know About

In the warm weather months those of us in healthcare spend a fair amount of time managing medical problems related to the skin, and many of those get a lot of press:

-sunburn (how to prevent and treat it),

-bites and stings (Lyme disease, mosquitoes and Zika virus),

-cuts and lacerations (glue or stitch?)

Lately in my practice I’ve seen plenty of the latter two but not much sunburn due to the HORRENDOUS rainy weather that we’ve had in my area this Spring. In its place, I’ve had a good bit of a few other common skin problems in children that no one has seemed to be familiar with, and I want to direct some attention to those today so that if your child gets a rash and you hear these words they won’t sound like they are either: 1. Made up; 2. A foreign language; or 3. So esoteric that they go in one ear and out the other.

The three skin conditions are:

  1. Pityriasis Rosea
  2. Pityriasis Alba
  3. Tinea Versicolor

Don’t they sound like they are made up, nonsense words? I promise they are not. They’re worth knowing, and I’m going to describe a few kids I’ve seen recently (with names changed) to illustrate the clinical picture.

Story #1.

Kelsey is 13. Her mother brought her in because she was covered in red, itchy almond-shaped raised bumps over her trunk and arms that itched like crazy. She had one big oval shaped bump on her side, and her mother was certain it was bedbug bites. She had thrown out all her pillows and bleached and washed all of the sheets, quilts and mattress pads without any change. And this had been going on for about 3 weeks. Kelsey wasn’t sick otherwise and was mostly mortified that the rash was spread out over such a large part of her body and was tired of the itching. Her rash looked like this:

example of pityriasis rosea

courtesy of dermnetnz.org

I knew when I saw the large, oval red bump on her side that had some scaly skin overtop of it that she had Pityriasis Rosea, a common, likely viral induced skin rash that tends to affect kids older than 10 all the way through young adulthood. The actual cause is unknown, but there’s often a history of a viral illness in the recent past. That large oval area on her side is called the “herald patch” and often appears first as the rash emerges, but it doesn’t occur in everyone.

Pityriasis rosea tends to be annoying because it can hang on for several months. Yes, months. And there’s no real treatment for it per se to get rid of it faster. It’s harmless so I don’t worry about it when I see it, but it’s important to make sure that any discomfort from itching or inflammation of the skin is managed with lotions or creams, so it’s worth a medical evaluation if you see this rash on your child, as your clinician can help guide you through dealing with it. Pityriasis rosea doesn’t leave any permanent scarring, so even though the pink/red rash can be dramatic appearing, keep in mind that it will disappear without a trace in most instances. You just have to wait it out. I did not charm Kelsey and her mom by giving them this news but they were relieved that at least they weren’t dealing with a bedbug situation.

Story #2.

Ryan, an 8 year old soccer player, came into Urgent Care one weekday evening after his bath before bedtime and his mother noticed that he had what looked like lighter areas of dry skin patches on his face, by his cheeks and jawline. They hadn’t changed soaps or laundry detergents and his bathtime routine and been unchanged. He wasn’t sick or ill appearing. Here’s an example of these patches:

example of pityriasis alba

courtesy of dermnetnz.org

Ryan had areas of hypopigmented (lighter) skin that looked like a condition called Pityriasis Alba, a disorder that causes small amounts of skin to lose their normal color. Again, the exact cause is unknown but it’s thought to be related to eczema and dry skin, and tends to be more noticeable in darker skinned people, especially those with Asian, Hispanic, or African-American heritage. School aged kids are the most often affected. I know I won’t make any more friends here by saying that there’s no cure, but that’s the truth. It will go away on its own eventually. The best way to deal with it is by preventing it in the first place: sunscreen and additive-free moisturizer (like petrolatum jelly)!

Story #3.

Christina (name not changed), a “middle aged but fighting it all the way” mom of 2, whose favorite hobby is eating and is frequently described as “thinks her own jokes are awfully funny,” reported that she has been dealing with dark brown patches on her back, chest, and stomach on and off for many years. The rash seems to worsen in the hot, summer months and doesn’t hurt or itch. She notices that when she gets sun exposure her skin in those areas looks uneven.

illustration of tinea versicolor

I know (because I went to a dermatologist) that I have Tinea Versicolor, a common yeast/fungal infection of the top layer of the skin. The yeast lives on everyone’s skin, and teenagers and young adults are generally more susceptible because they have more oily skin. People who sweat a lot (I’m trying to be good about exercise) get it more often. It usually does not affect the face (I never get it there), and an anti-fungal cream or lotion is the treatment…with time. If you think you or your child has tinea versicolor it’s important to get checked out because prescription medicine may be needed not just to treat the acute case but to get some ongoing medicated cleanser to help it from coming back. In many cases even after the rash starts to fade the skin takes several months to return to an even pigment.

Summing up, I see some common threads between these 3 skin conditions:

  1. Weird names
  2. Mostly harmless but can mimic other rashes so should be checked out by a doctor or other healthcare provider for accurate diagnosis.
  3. Take a looooong time to go away.

Keep an eye out for these this summer. They’re out there; I’ve been seeing them firsthand (!).

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