Tinea versicolor in 8 year old???

[SheryB]

Posted by SherryB on August 08, 1999 at 16:46:58
My son  is 8 and extraordinarily healthy -- the kind of kid that, thank goodness, almost never even has a cold. Anyway, early in the summer his dad and I noticed that behind is right ear, he had a red, scaly rash.. it was nothing major , didn't seem to bother him and we thought it just went away. then,  between his ear and his hairline, about 2 months ago, we noticed an area of de-pigmentation. My child is white , by the way, but has dark olive skin and tans very quickly and deeply ( and , yep, i use GOBS of sunscreen on him) and this area was very obvious. I thought perhaps it was where a scab had been or something like that that hd protected from suntan. but the area continued to grow larger.. actually it was sort of two irregular quarter sized patches.
Then I noticed some smaller white patches, not so clearly delineated, on his face. We took him to the pediatrician . I was concerned  the discoloration was vitiligo so I was most relieved with the pediatrician said he didn't know for sure, but he thought it was  fungal condition called Tinea versicolor ( he examined the white spots under some kind of a black light and visually; no scrapings were done). He advised treated the areas with a solution (selenium? i can't remember -- the same stuff that's in dandruff shampoos).. you leave it on for 10 minutes and rinse it off .
Anyway, we have only done these treatments twice in as many weeks. I can't noticed a big improvement. The area behind his ear may be smaller. at least it is not larger, but  his cheek white area seems bigger!
I am concerned because
1. I thought  kids this young didn't get Tinea versicolor ( however we do live in the south , and he swims a lot and also had a habit of going to bed after his shower with his hair wet.. and before  i noticed this discoloration , his hair had been quite long -- i.e. like  the length of an "early Beatles" haircut, if you are old enough to know what I mean!Now he has short hair).
2. How long should we give the treatment a chance before insisting on a referral to a dermatologist ( yep, we have the old PPO which does not like us to go specialists unless absolutely necessary).
3. Do you think it might be vitiligo? or do most pediatricians know Tinea versicolor when they see it??
By the way, there is no itching associated with this problem and the initial red, scaly rash went away. the whole thing seems so odd to me..
Thanks so much....
Sherry

Posted by Derm M.D. ASR on August 08, 1999 at 20:27:20
Sherry:
Tinea versicolor is rare in prepubertal children --  I don't think I've ever seen it.  Also, this condition affects the torso and rarely the face.
In all probability, you are describing vitiligo.  I covered that condition a little bit in my posting on this Forum on August 1st.
My advice is that you consult a Dermatologist, who can perform a Wood's Light (ultraviolet) examination in the office, which will help determine whether the pigment loss is complete in affected areas.  If so, this would suggest vitiligo.  There are less complete forms of pigment loss which appear on the cheeks of children, called pityriasis alba.  These are tempprary and reversible.  To be honest, however, the patch behind the ear suggests that vitiligo is more likely.
Please do not draw unneccesarily alarming conclusions from what you are likely to read about vitiligo on the Web, or elsewhere.  Most children with the condition do not have systemic problems, do not experience widespread involvement, and adapt quite well to the condition.  Your Dermatologist may recommend a course of s topical (external) cortisone cream, together with sun protection with a wide-spectrum (UVA blocking) screen, not so much to prtoect against skin cancer, which is really not much of an issue, but to lessen the contrast between affected and unaffected skin and make it less noticeable.
Of course, I am jumping the gun a bit, because the diagnosis is not yet established.  That should be your next step.
Good luck.
Dr. R
keywords: vitiligo, hypopigmenatation, depigmentation, Wood's light, pityriasis alba, Rockoff
Disclaimer: The information provided in this forum is presented for general educational purposes only. Specific questions you have pertaining to your health should always be directed to your personal physician.