Café au lait spots - Café au lait macules

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What are café au lait spots?
Café au lait (CAL) macules or café au lait spots are flat hyperpigmented lesions. The term "café au lait" means "coffee with milk" and these macules are colored light brown to dark brown.

These lesions are common in children. They are well-circumscribed and have even increase in the melanin pigment deposit.

The café au lait spots appear in infancy and may not be discernible. They may be observed with Wood lamp as faint lesions. As the child grows, they may enlarge in size, darken and become obvious by the age of two years. These skin lesions, as such are harmless, but are more frequently observed in patients with certain genetic and systemic diseases.

The café au lait macules occur with greater frequency in populations of Hispanic and African origins. There is no gender predilection and these skin hyperpigmentation spots can be seen in all age groups. The size and number of these skin lesions vary widely among individuals. The presence of six or more café au lait spots larger than 5 mm in diameter in children should raise the suspicion of a genetic or systemic disorder.

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Café au lait macules causes

Café au lait spots are caused by an increase in melanin deposits in the epidermal cells of the lesion area. These lesions may arise from diverse and unrelated causes. In patients with neurofibromatosis type 1 (NF1), there is significant increase in the melanocyte density. The café au lait lesions associated with genetic and systemic disorders are caused by, inheritance, mutations in specific genes and spontaneous mutations.

Syndromes associated with café au lait spots

The presence of café au lait macules is one of the symptoms of genetic and systemic diseases such as neurofibromatosis type 1 (NF1), McCune-Albright syndrome, tuberous sclerosis, and Fanconi anemia.

Neurofibromatosis type 1 (NF1)

Neurofibromatosis type 1 (NF1) is the most common type of neurofibromatosis, affecting about 1 in 3,000 newborns. Café au lait spots are usually the earliest manifestations of NF1. These macules are observed in nearly 95% of patients with NF1. The presence of six or more café au lait macules larger than 5 mm in diameter and also freckling in the axillary or inguinal regions is one of the diagnostic criteria for NF1. NF1 causes tumors along the nervous system with symptoms such as multiple small cutaneous neurofibromas, optic gliomas, vision disorders, cognitive problems and epilepsy. It is an inherited disorder caused by mutation in the NF1 gene located on chromosome number 17.

Café au lait spots

Neurofibromatosis type 2 (NF2)

Neurofibromatosis type 2 (NF2) is a rare type of neurofibromatosis, affecting 1 in 33,000 individuals. Patients with NF2 have mutation in NF2 gene located on chromosome number 22. They develops tumours on the nerves responsible for hearing and balance. They will have gradual hearing loss, that usually gets worse over time. They may also have café au lait macules.

Legius syndrome

Legius syndrome (LS) is an autosomal dominant genetic disorder. Nearly all LS patients have café au lait macules. LS is often mistaken for neurofibromatosis type I. It is caused by mutations in the SPRED1 gene. Other skin manifestations are, hyperpigmentation spots in the armpits and/or groin. The patient may suffers from lipomas, macrocephaly, ADHD, delayed development and cognitive problems.

McCune-Albright syndrome

McCune–Albright syndrome is a genetic disorder of bones, skin pigmentation and hormonal problems. McCune-Albright syndrome is caused by mutations in the GNAS1 gene. The condition is characterized by bone fractures, deformity of the legs, arms and skull, gigantism, large café au lait macules, hyperpigmentation spots on the skin and early puberty.

Fanconi anemia

Fanconi anemia (FA) is primarily an autosomal recessive genetic disease. So far 17 gene mutations have been linked to Fanconi anemia. FA is characterized by hematological abnormalities, which progress into macrocytosis, megaloblastic anemia, pancytopenia, hemorrhage, bone marrow failure, myelodysplastic syndromes and acute myeloid leukemia. Skin manifestations include petechiae, hyperpigmentation macules and café au lait spots.

Tuberous sclerosis

Tuberous sclerosis is a rare genetic disorder caused by a mutation of gene TSC1 or TSC2. Benign tumors grow on various vital organ systems of the body. Skin manifestations include, café au lait spots, a rash of reddish spots on the face, periungual fibromas, hypomelanotic macules, raised, discolored areas on the forehead, shagreen patches and hyperpigmentation macules.

Bloom–Torre–Machacek syndrome

Bloom syndrome is a rare autosomal recessive disorder with several debilitating manifestations and shortened life expectancy. Bloom syndrome is also characterized by skin manifestations like skin sensitivity to light, skin rash, pigmentation changes, telangiectasias and café au lait spots. Persons with Bloom syndrome are predisposed to develop cancers due to genome instability and immunodeficiency.

Café au lait macules symptoms

These lesions have the typical color of milk added coffee. The Café au lait spots vary in size, appearing as small freckles to large macules. The CAL spots, not associated with any neurocutaneous disorders or genetic abnormalities, usually appear as large, solitary, light brown to brown macules. Freckling in the axillary or inguinal regions and the presence of six or more café au lait macules larger than 5 mm in diameter are symptoms of NF1.

Café au lait macules diagnosis

In infants, if café au lait spots are suspected, Wood lamp is a handy tool for finding the faint marks. Current guidelines support evaluation of children with multiple macules for genetic disorders, especially NF1. The macules associated with genetic syndromes require genetic testing and counseling. The CAL lesions may have to be differentiated from melanocytic nevi, Becker's nevus, nevus spilus and nevus simplex.

Café au lait macules treatment

Café au lait spots without any association to systemic disorders, need no treatment. If the lesions are of cosmetic concern, they can be removed with lasers. Laser therapy with lasers such as PDL, Er:YAG, QS Nd:YAG, has given varying degree of success. In some cases of café au lait lesions complete clearance was achieved whereas in some cases there was recurrence or postinflammatory hyperpigmentation. The size of the macule, its location and the presence of associated disorder, if any, will help in selecting the best course of treatment for cafe au Lait spots.

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References: 1.Shah KN. The diagnostic and clinical significance of café-au-lait macules. Pediatr Clin North Am. 2010 Oct;57(5):1131-53. doi: 10.1016/j.pcl.2010.07.002. 2.Ponti G, Tomasi A, Pastorino L, Ruini C, Guarneri C, Mandel VD, Seidenari S, Pellacani G. Diagnostic and pathogenetic role of café-au-lait macules in nevoid basal cell carcinoma syndrome. Hered Cancer Clin Pract. 2012 Oct 29;10(1):15. doi: 10.1186/1897-4287-10-15. 3.Tekin M, Bodurtha JN, Riccardi VM. Café au lait spots: the pediatrician's perspective. Pediatr Rev. 2001 Mar;22(3):82-90.

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Current topic in natural skin care: Café au lait spots

Aug 16, 2015

Skin care - Fordyce spots granules - disease - lips - genitalia - areolae

Fordyce spots granules → Treatment and cure of fordyce spots disease → White bumps on skin, lips, fingernails, teeth, tonsils and genitalia → Nevus pigmentosus

What are fordyce spots (granules)?

Fordyce spots are sebaceous glands without connection to hair follicles.

They are benign, painless, small, pale, white or whitish yellow, raised bumps of 1-3 mm diameter appearing on the the vermilion region of lips, inside of the mouth, aureole or genital area(not a disease).

These granules are named after John Addison Fordyce, an American dermatologist.
Fordyce spots are sebaceous glands. Sebum may be discharged from them.
Sebaceous glands are normally connected to the pore in hair follicle and lie in the skin without showing bumps.
However these fordyce granules are ectopic glands and have no connection to hair follicles and open out directly.
These granules are out of place glands (ectopic) as instead of being at level with skin, they appear as small raised bumps usually on lips, nipple, penis and labia.

Fordyce spots disease prevalence

Though this granules condition is seen in both men and women, it is very common in men and about 80% of them have it.
The incidence is found to get reduced with old age, as is the case with other sebaceous glands.
fordyce glands are found in newborns and in the children though they are present they are dormant.
These granules become active after reaching of puberty as in the case of other sebaceous glands in the body.
It is believed that there is a genetic link to this 'disease'.
It is an idiopathic disease condition arising from unknown or an obscure cause or arising spontaneously.
Fordyce granules is not a contagious disease or caused by pathogens.
However if the lesions are squeezed and skin gets damaged, infection and disease of skin may result.
They can appear as single lesion or as a cluster on the affected area.

Though no particular treatment is necessary, the fordyce bumps are of cosmetic concern.
Men and women are known to go into depression fearing that, it may be some form of sexually transmitted disease (STD), genital warts or cancer.
Sometimes fordyce spots are mistaken for pearly penile papules (Hirsuties papillaris genitalis). However pearly penile papules have nothing to do with sebaceous glands and are just skin overgrowth and are benign.
They spoil the aesthetic appearance of the affected persons if they occur on lips or genitalia.
Fordyce spots granules disease have been successfully treated with topical application, laser therapy and electro-desiccation.

Fordyce spots on the lips (enlarge)

Idiopathic guttate hypomelanosis

White bumps on skin, lips, fingernails, teeth, tonsils and genitalia > Idiopathic guttate hypomelanosis > Causes - symptoms - diagnosis > Treatment Idiopathic guttate hypomelanosis are acquired white spots of hypopigmentation on the skin usually on shins and forearms.

The name of this disorder is self-explaining about the problem.

The reason for these white spots is not clearly known (Idiopathic).

The spots (macules) are 'drops' like (guttate), small in size (2-5 mm) and hypopigmented (hypomelanosis).

In some cases lesions measuring up to 10 mm diameter have been observed.

The causes for these white spots is not completely investigated and it is believed that sun exposure causes it.

It is further believed that the UV range of the sunlight could be the culprit.

These tiny white spots are usually formed on the forearms and shin regions of the body which are usually exposed more to sunlight.

They may also form on the other exposed parts of the body like shoulders, neck and face.

These white spots have been found to affect far more women than men.

Fair skinned people are found to be affected more frequently and at a younger age.

This disorder usually begins around the age of 30 years and it is also believed to be the part of the aging process.

Idiopathic guttate hypomelanosis on forearm

Idiopathic guttate hypomelanosis, typically develops on the legs, more particularly on the shins of the fair-skinned women in their early thirties.

Later idiopathic guttate hypomelanosis slowly progresses to cover forearms, shoulders and neck.

A familial (genetic) acquirement of these idiopathic guttate hypomelanosis white spots has been noted, requiring further research in this aspect.

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Idiopathic guttate hypomelanosis white spots - treatment

White spots on skin, lips, fingernails, teeth, tonsils and genitalia > Idiopathic guttate hypomelanosis > Causes - symptoms - diagnosis > Treatment - medication
Idiopathic guttate hypomelanosis treatment includes application of topical steroids or retinoids, dermabrasion or microdermabrasion, cryotherapy, cosmetic cover-up, surgery and grafting. As the white spots are completely harmless best way for this hypomelanosis is to cover them up with cosmetics and forget.

Even if treatment is carried out fresh white spots may keep appearing at new areas.
For individuals conscious about aesthetic appearance cure is available.

Idiopathic guttate hypomelanosis treatment with retinoids

Retinoids like tretinoin have been used with some success in removing guttate hypomelanosis.
Tretinoin is the acidic form of vitamin A and it should be used with caution by people with sensitive skin as it can cause redness, burning and itching.
To avoid these problems the frequency of application must be increased slowly.
Tretinoin applied hypomelanosis lesions can get severe sunburn and exposure of these areas to sunlight must be avoided.
Topical corticosteroids have been found to alleviate the white spots condition to some extent.

Dermabrasion or microdermabrasion for idiopathic guttate hypomelanosis

Dermabrasion or microdermabrasion may also be considered in the treatment of this disorder.
These procedures must be done by a trained Aesthetician or a dermatologist as improper therapy may leave greater scar marks.
Dermabrasion is a painful process to be done under general or light anesthesia. Microdermabrasion is not very painful and can be done at cosmetic spas.

Idiopathic guttate hypomelanosis treatment by cryotherapy and surgery

Cryosurgery or cryotherapy also have been tried successfully. In this method of therapy white spots are frozen resulting in the death of thin layer of skin at the affected area.
Soon the normal skin takes over and cover-up the dead skin and the white spots disappear.
Surgical removal of the affected skin and grafting of the healthy skin has been successful.
Although these procedures may remove the current hypomelanosis, there is no treatment to stop fresh lesions from appearing. Idiopathic guttate hypomelanosis on leg
Hence it is advised to tackle the root cause. Sun tanning and tanning beds may be avoided by young fair-skinned individuals, especially young women, to prevent possible idiopathic guttate hypomelanosis white spots at a later life.

Nevus depigmentosus

Home › White bumps on skin, lips, fingernails, teeth, tonsils and genitalia › Fordyce spots overview › Fordyce spots treatment and cure › Nevus depigmentosus
Nevus depigmentosus is usually a congenital benign non progressive white macule (white patch or spot) with hypopigmentation. Nevus depigmentosus is stable in size and distribution, during the lifetime of the affected individual. The investigation on the histopathology and pathogenesis of this ailment is not complete and its cause is not fully understood.

Symptoms of nevus depigmentosus

These white spots appears as stable spots affecting any part of the body. However they have been found to affect the trunk, hands and feet often.
They do not grow in size. They are usually present from birth and in rare cases they are formed at a later stages of life.
These lesions appear round or oval and grow only with proportion to the growth of the person.
In rare cases certain neurological afflictions have been associated with this ailment; delayed development, seizure disorder and mental retardation have been associated.

Causes of nevus depigmentosus

These white spots are believed to form due to functional abnormalities of the melanocytes and morphological anomalies of melanosomes.
This results in the lowered pigment production in the affected area giving the characteristic pale white spots in the skin.

Differential diagnosis of nevus depigmentosus

Differential diagnosis for this disorder is done to rule out the possibility of affliction by vitiligo (leucoderma) and leprosy.
Unlike leucoderma the white patches or spots are usually present right from birth.
Leucoderma normally show hyperpigmented border to the lesions, whereas in this disorder there is no clear cut hyperpigmented border.
Vitiligo white spots normally grow in size and spread. In rare cases they disappear altogether.

In nevus depigmentosus disorder the white spots are stable and do not spread.
Vitiligo white spots normally occur around the orifices of the body like eyes, ears, nostrils, mouth, umbilicus and genitalia.
Nevus depigmentosus white spots are usually found on the trunk, hands and legs.
The back, chest and buttocks are the most common sites of affliction.

These white spots do not show any alteration of sensitivity or texture of the affected area.
In leprosy the white pale spots occur at a later stage of life and show mild inflammation, hair loss, shine in the skin and numbness. Histological study can differentiate leprosy.
The differential diagnosis for nevus depigmentosus includes hypomelanotic macules of tuberous sclerosis, vitiligo, and anemicus. Nevus depigmentosus on the belly

Treatment for nevus depigmentosus

Treatment is not necessary for this ailment. Use of sunscreen and avoiding exposure to sun is advised as the affected area may not pigment on sun exposure; increase in the contrast between the normal skin and the lesion area will affect the aesthetic appearance. There is also the danger of severe sunburn of nevus depigmentosus area on prolonged exposure to sun.

Sep 18, 2015

Skin care - Fordyce spots treatment and cure

White bumps on skin, lips, fingernails, teeth, tonsils and genitalia → Fordyce spots overview → Fordyce spots treatment and cure → Nevus depigmentosus
Fordyce spots require no treatment as they are benign and harmless. However for aesthetic appearance, treatment and complete cure is available.

Topical applications for fordyce therapy

The acidic form of vitamin A is Tretinoin and it is also known as ATRA (all-trans retinoic acid).
It is a medicine most commonly used in treating acne.
The topical form is available as gel and cream. For the cure of fordyce spots this ointment must be applied daily till the condition resolves.

Individuals with sensitive skin must use this cautiously and if any adverse reaction starts must discontinue immediately.

Women who are pregnant or who are planning a pregnancy should not use it as tretinoin is a teratogen and can cause fetal abnormalities.
They can only consider the therapy for fordyce spots after child birth.
Better results are achieved when tretinoin used along with AHAs (alpha hydroxy acids) which is another topical solution for acne.
Individuals undergoing therapy for fordyce disease with the above drugs should protect themselves from sun exposure as the treated skin can get severe sun-burn and sun poisoning.

Fordyce spots on the upper lips (enlarge)

Use of super pulsed laser therapy

For patients seeking improvement of aesthetic appearance from this condition, therapy with CO₂ super pulsed laser has been found to be very effective and safe.

Excellent results with complete re-epithelization was achieved.

No side effects were observed and in the medicated area no remnants of the fordyce condition were seen in 15 days.

Diathermy, liquid nitrogen freezing and TCA peels have been used for fordyce spots treatment and cure with varying levels of success.

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Milk spots - Baby milk spots - Milia causes

Overview > Milia Causes, signs and symptoms >
Treatment, cure and prevention

Keratin (from dead epidermal cells) causes milia (small epidermoid cysts), when it gets trapped in small pockets on the epidermal surface as cysts/bumps, instead of getting exfoliated (sloughed off) naturally.

The symptoms of milia milk spots are that these small white bumps have no mouth (opening) and on abrasion redden on the edges leaving the central portion white.

Causes of milia in newborn babies

• This mild skin disorder of baby milk spots or milia show the signs and symptoms as small bead-like raised white bumps on the skin around nose, ears, eyes, cheeks and chin of newborn babies.
• In some babies these show symptoms like small bumps on the roof of the mouth, gums or genitalia.
• Milia is very common in newborn babies and its signs and symptoms are found in almost half of them. They usually appear 3-4 days after birth of babies and last for about 20-30 days and resolve naturally.
• In infants born prematurely the affliction is less and these oil seeds form late (after 2-3 weeks).
• In rare cases rough bedlinen and clothing has been found to induce the formation of this ailment.

Milk Spots (image by http://www.dermnet.com)

Causes of milia in adults

• Milk spots can also appear on adult body more often on the face with unknown reasons.
• Injured or inflamed epidermal region of the body also can form milia in some individuals due to set back in the skin exfoliating process.
• Among the common and less understood causes of milk spots are the cosmetics and hair care products containing chemicals.
• Facial creams sometimes smother our skin, preventing sloughing of keratin , dead epidermal cells and sebaceous matter.
• Comedogenic nature of some facial make-ups, moisturizers and sunscreens (contrary to their claims of being non-comedogenic) causes milia, especially on the eye lids.
• Some lip balms and lip sticks may be the causes of milk spots on the edge of lips vermilion border.
• Regular exposure to sun and aging also leads to this skin condition.
• Certain diseases like PCT (Porphyria Cutanea Tarda ) and epidermolysis bullosa can give rise to these bumps as the secondary disorder.
• Skin stress and trauma due to radiotherapy and dermabrasion and the use of potent topical corticosteroid, develop symptoms of milia in some persons.

Genetic familial dominant autosomal inheritance disorders have been found to be one of the causes of milia.

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Milk spots - milia - baby milk spots - small white bumps on skin

Causes > Treatment, cure and prevention
Milk spots also called milia, oil seeds or baby milk spots are benign cysts filled with keratin.
They appear as small whitish or slightly pinkish bumps on the skin.

The top most layers of skin die and exfoliate. Milia are actually dead skin trapped as small bumps in pockets on the skin without natural exfoliation.
They also arises in undeveloped sebaceous glands. No opening is visible in it.
They appear usually on the skin around eyes, forehead, cheeks, chin and nose; sometimes they may appear on the genitalia.

Baby milk spots may also appear on gums and the roof of infants mouth (Epstein's pearls).
Baby spots are usually associated with newborns and infants.
About half of the newborn babies develop these. Both boys and girls are affected equally.

In young children baby spots usually disappear within 15-30 days. In infants no treatment is necessary and there are no lasting effects.

However this can affect persons of any age. In older children and adults they may persist and may require removal.
In adults who are very particular about looks, these can be removed.
Removal by an aesthetician or dermatologist is advised.

Secondary oil seeds have been found to occur in persons with sensitive skin stressed by harsh chemicals and heat.
They can also occur on inflamed or injured parts of the body.
They can also arise after a treatment with topical corticosteroids.
Milia (milk spots) on eye lids
It is believed that the milia in some cases have hereditary predisposition and reports of dominant autosomal inheritance of this familial disorder have been documented.

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Pale white spots/patches on children skin face and body

Home › Skin discoloration › White spots on the face of children

The cause of pale white spots and patches on the face and the body of children must be diagnosed and treated or else it may leave a psychological impact on the kids, apart from the physiological problems.

Various conditions and diseases can cause pale white spots/patches on the skin of children. Some are harmless and resolve by themselves. Many can cause health problems. It is very important for the parents to get the causes diagnosed and have the children treated if necessary.

Pale/white spots and patches arising out of injuries, burns and infections

These white spots are due to skin damage.
Repigmentation of these areas may take a long time or may not develop pigments fully.
These patches can be corrected by chemo or
cosmetic laser treatments.

Deficiency of vitamins (avitaminosis) causes pale white spots/patches on the skin

Vitamins are very essential components of our nutrition and the deficiency of them in children can cause many diseases and also affect their skin. Deficiency of B complex vitamins affect our skin in a number of ways.

The deficiency of Vitamin B₁₂ causes pale white spots/patches on the skin especially on the forearms of the kids.These pale patches arise out of depigmentation of the skin and may later turn pink/red causing itching and distress to the kids. Giving food rich in vitamin B₁₂ to the kids makes the pale white vitamin B₁₂ deficiency spots/patches to disappear gradually.

Pale white spots and patches on the children caused by pityriasis alba

This is an asymptomatic condition, the cause of which is not known. The lesions initially appear slightly raised pinkish or reddish in color. Later they flatten out and turn pale white. This condition affects particularly children, more often boys. It usually affects the face of the child, especially cheeks, area around mouth and chin.

Pale white patches may also appear on shoulders arms and hands of kids. By puberty in most of the kids it resolves by itself. The condition may last to a few months or to years. Pityriasis alba may also recur. No specific treatment is required. Protective and preventive measures may be taken to avoid these pale white spots and patches on your children faces.

Milia (oil seeds or milk spots) causes small raised spots on the face, mouth roof and genitalia

Milia is quite often present in newborns and infants. These white baby milk spots may also affect older children and adults. Milia are keratin filled cysts and are benign and asymptomatic. Usually in newborns they disappear after a few weeks. In adults they may persist and can be removed by opening the cyst.

Fordyce pale white spots

These Fordyce spots geanules are usually found on the lips and genitalia. These white spots are actually sebaceous glands which do not have hair follicle association (ectopic sebaceous gland). These are harmless and of cosmetic worry only.

Pale patches caused by nevus depigmentosus

Nevus depigmentosus are hypopigmentation areas in the skin and may be present right from the birth. These pale spots are stable, harmless and non- contagious.

Pale white or brown patches/spots caused by tinea (pityriasis) versicolor

Skin yeast Malassezia furfur and M.globosa cause tinea versicolor infections. This ailment usually affects teenagers and young adults. Kids are rarely affected. Malnourished children and kids with suppressed immunity are affected. The fungus can be treated with a number of anti-fungal topical and oral medications.

Pale white spots and patches caused by vitiligo (leucoderma)

Vitiligo is a skin disorder and gives rise to hypopigmentation of some areas of the skin. Autoimmunity is the main cause of vitiligo. In this ailment the immune cells kill the pigment producing cells (melanocytes) in some areas of the skin leading to white patches.

Pale white spots and patches of leprosy

Leprosy initially shows as pale white spots and patches on the skin, which are numb to touch. Though this skin disease is eradicated from most parts of the world, it is still persisting is some pockets of Africa and South east Asia. This is a curable bacterial disease. Areas of skin which lack sensation require immediate medical attention.

Sudden appearance of tender feeling to touch can be a hint of progressive damage to the peripheral nerves or even the spinal cord and the brain.

Pale white spots and patches arising on children must not neglected and immediate diagnosis and treatment must be given.

Causes of pityriasis alba-white/pale spots/patches on children

Pityriasis alba > Causes > Diagnosis > Treatment
A number of causes are related for the occurrence of pityriasis alba white/pale spots and patches on the face and body of children. But the knowledge of real reason is elusive.

Pityriasis alba is considered as an atopic dermatitis occurring in children, especially on their face, shoulders and arms and could be an independent eczema. The exact causes of these white spots is not known. The investigations of skin scrapings of a number of patients have indicated non involvement of bacteria and fungus.

Pityriasis alba is not contagious and has no definite etiologic agent. Studies have revealed that the hypopigmentation is due to reduction in the numbers of functional melanocytes and decrease of melanosomes in size and number. Dryness of skin, especially in winter appears to aggravate this ailment and increase the scale formation.

We can infer that cold dry condition may trigger and cause it in persons predisposed to it. In summer months, though the patches appear prominent due to tanning of the surrounding skin, there is no aggravation of the condition. Another hypothesis is that the deficiency of calcium and related vitamins precipitates this pityriasis ailment.

The explanation and reasoning is that pityriasis alba often occurs during the growing years of children. The growing children tend to get deficient in vitamins and calcium easily. Infestation with intestinal worms and parasites has been associated with pityriasis alba occurrence. In rural India deworming of the children is done by feeding them with a spoon of Castor oil with the belief that the condition will resolve.

Some theories have associated public swimming pools as one of the reasons of occurrence of pityriasis alba. Though the condition is asymptomatic for the affected child, it is of a big worry for the parents. Schools and daycare facilities will be very apprehensive about pityriasis alba and its causes and may insist on evaluation of the infective status of the condition.