Where
Plot No D13B, Wellington Rd, Vikrampuri Colony, Karkhana, Secunderabad, Telangana 500009.
- Serves Trimulgherry, West Marredpally, Bowenpally, Alwal
- Formerly BNR Skin & Vitiligo Hospital
Secunderabad
White patches that are not a vitamin deficiency
Pale patches appearing on a child’s face, neck, chest or back in the hot months are most often pityriasis versicolor, an overgrowth of a yeast that lives on everyone’s skin. It is routinely mistaken for vitamin D deficiency, for worms, and for early vitiligo. It is none of those, and it is treatable.
45 years in dermatologyDermatologist & dermatosurgeonKarkhana, SecunderabadPreparations mixed on the premises
At a glance
- What it is
- Overgrowth of Malassezia, a normal skin yeast
- Not
- Vitamin D deficiency, worms or vitiligo
- Season
- Appears in the heat, fades in winter
- Where
- Chest, back, neck, upper arms, face in children
- Treated with
- A preparation that reaches the hair follicle
- Colour returns
- Slowly — well after the yeast is gone
What it actually is
A yeast that everybody already has.
Malassezia lives on normal skin, on everyone, all the time. In heat and humidity, and where there is sweating and oil, it can multiply beyond its usual numbers. Where it does, it interferes with the pigment-producing cells underneath, and the skin there stops tanning at the same rate as the skin around it. That is the pale patch.
This explains the pattern families describe. It appears as the weather turns, it is more obvious after sun because the surrounding skin darkens while the patch does not, and it fades in winter. It is not caught from anyone and it is not a sign of being unwashed — the organism is already there on clean skin.
The same yeast, in a different pattern, causes dandruff and seborrhoeic dermatitis. One organism, three presentations, which is why the same person often has more than one of them.
Where the organism actually sits
Why an ordinary cream misses it.
The yeast is not spread evenly across the surface of the skin. It sits down inside the follicle, in the oil it feeds on, and a cream wiped over the top of the skin does not reach that far. That is the reason the preparation used here is a lotion thin enough to run down the shaft rather than an ointment that rests on it.
- 1
- 2
- 3
- 4
- 1Cream rests on the surface
- 2Pigment shuts down here
- 3Yeast packed inside the follicle
- 4The oil it feeds on
It also explains the relapse. Treat only the surface and the surface does clear — then the colony still in the follicle repopulates it.
- Cream rests on the surface
- Pigment shuts down here
- Yeast packed inside the follicle
- The oil it feeds on
Illustration, not a photograph.
The confusion
What it gets mistaken for
| Mistaken for | Why | How it differs |
|---|---|---|
| Vitamin D deficiency | Pale patches are widely believed to mean a deficiency | No deficiency produces discrete patches like this; blood levels do not change them |
| Intestinal worms | A common family belief about pale marks in children | Deworming has no effect on it; the patches are a skin surface infection |
| Vitiligo | Both are pale patches | Vitiligo patches are chalk-white with no scale and a sharp border; these are off-white, finely scaly, seasonal |
| Pityriasis alba | Also pale, also common on children’s faces | Follows eczema-prone dry skin rather than heat; different treatment |
| Leprosy | A fear that brings many families in | A patch with genuinely reduced sensation is a different matter and is examined for specifically |
Where the picture is not clear it is examined rather than guessed at. Distinguishing this from early vitiligo matters, because the two go in opposite directions if left alone.
How it is treated
Reaching where the yeast actually sits
Confirm what it is
Scale, distribution and appearance under examination usually settle it. Treating a pale patch as fungal when it is early vitiligo loses time that matters.
A preparation that penetrates
The yeast sits in the opening of the hair follicle, below the surface. A lotion is prepared here to carry the antifungal down into the follicle rather than sit on top of it — which is why an ordinary surface cream so often fails.
Treat the whole area, not the patches
The visible patches are where pigment has been affected. The yeast is spread more widely than that. Treating only what you can see is the commonest reason it comes straight back.
Then expect to wait for colour
The infection clears well before the skin matches again. This is the part nobody is told, and it is why families think treatment failed.
The part that gets misread
The patch stays pale after the yeast is gone.
Killing the organism does not restore the colour. The pigment cells have to resume normal production and the skin has to even out, and that takes weeks to a few months, usually faster once there is some sun exposure again.
So a patch that is still visible at four weeks is not evidence that treatment failed. It is the expected course. Families who are not told this stop treatment early, or start a second course that was not needed, and some conclude the child has vitiligo after all.
If the patches are chalk-white insteadInfection cleared
Scale gone, no new patches, edges no longer spreading. This happens first.
Colour matched
Weeks to a few months later. Judged separately from whether the infection cleared.
What recovery looks like
Colour is the last thing to come back.
The infection is over well before the skin looks even. Once the scale has gone the yeast has usually been dealt with, and the pale patch left behind is pigment that has not been made again yet. It fills in slowly, and from the edges inward.
- 1
- 2
- 3
- 1Scaly and pale, yeast still active
- 2Scale gone, colour not yet back
- 3Colour back, months later
This is the point at which treatment gets abandoned as a failure. The patches in the middle panel no longer carry the yeast — the colour simply has not caught up with them.
- Scaly and pale, yeast still active
- Scale gone, colour not yet back
- Colour back, months later
Illustration, not a photograph.
Why it comes back every summer
The organism is a normal resident of skin, so treatment reduces it rather than eliminating it for good. In a hot, humid climate recurrence is common and is not a sign that anything went wrong. For people who get it every year, a short preventive course before the season is more effective than treating each episode after it appears.
Where to book
One clinic, in Secunderabad
Examined, and the preparation mixed, at one address in Secunderabad. The practice was formerly known as BNR Skin & Vitiligo Hospital.
How to book
On WhatsApp: one number, answered by the clinic team, who confirm a time and say what to bring.
- Photographs welcome before you travel
- Video consultation arranged the same way
Questions patients actually ask
White patch questions
My child’s blood test showed low vitamin D. Isn’t that the cause?
Low vitamin D is common and worth correcting on its own merits, but it does not cause patches like these. The two often coexist simply because both are common, and correcting the vitamin does not clear the patches.
Is it contagious? Should I separate towels?
No. The yeast already lives on everyone’s skin, including yours. It is an overgrowth of what is normally there, not something passed from person to person.
Could it be vitiligo?
It is examined for exactly that. Vitiligo patches are chalk-white with a sharp edge and no scale, and they do not follow the seasons. Where there is any doubt it is looked at properly rather than treated on assumption.
Why did the cream from the pharmacy not work?
Usually one of two reasons: the yeast sits inside the hair follicle where a surface cream does not reach, or only the visible patches were treated while the organism was spread more widely across the area.
How long until the skin looks normal?
The infection clears in weeks. The colour usually evens out over one to three months after that, and faster with some sun. Those are two separate things and are judged separately.
References
The clinical statements on this page follow the guidance and evidence below. They are independent sources. None of them is connected to this clinic, and none of them sells the treatments described here.
- Pityriasis versicolorDermNet (New Zealand Dermatological Society)
- Malassezia infectionsDermNet (New Zealand Dermatological Society)
- Pityriasis albaDermNet (New Zealand Dermatological Society)
- Seborrhoeic dermatitisDermNet (New Zealand Dermatological Society)
Keep reading
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