Pityriasis Alba in Emergency Medicine Workup

  • Author: Rashid M Rashid, MD, PhD; Chief Editor: Pamela L Dyne, MD   more...
 
Updated: Feb 27, 2012
 

Laboratory Studies

  • A workup may be undertaken to exclude other causes of hypopigmentation; however, most of this would be accomplished through a dermatology referral.
    • As an emergency physician, a Wood's light examination may help in evaluating the patient whose rash is due to vitiligo. Vitiligo will glow more brightly and will have edges with sharper demarcation.
    • Potassium hydroxide stain of a skin scraping will be positive if the patient has tinea versicolor, which has an alternate name of pityriasis versicolor. This would likely be performed by a dermatologist.
    • A biopsy would be required for atypical lesions as noted in the differential. This would likely be performed by a dermatologist.
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Other Tests

  • Hypopigmentation may occur in other disorders, such as those caused by fungi (eg, tinea versicolor), previous inflammatory conditions (eg, postinflammatory hypopigmentation), idiopathic disorders (eg, vitiligo), or malignancy (mycosis fungoides), or it may occur secondary to medications such as retinoic acid, benzoyl peroxide, and topical steroids. Clinicians should rule out these other disorders when evaluating a patient who may have pityriasis alba.
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Procedures

  • A biopsy of the lesions usually is not necessary and is not indicated in the emergency department. Pathologic findings are nonspecific; however, findings may include a basal layer with irregular pigmentation, follicular plugging, edema between epithelial cells (ie, spongiosis), or atopy of the sebaceous glands. However, this is required in atypical cases and should be performed in the office of a specialist in skin disease. It is of particular concern, considering the common location of the cheek and the potential approximation of this area to the facial artery.
  • Details of biopsy results are noted in Pathophysiology.
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Contributor Information and Disclosures
Author

Rashid M Rashid, MD, PhD  Resident Physician, Department of Dermatology, University of Texas, Houston, MD Anderson Cancer Center, and Morzak Research Initiative

Rashid M Rashid, MD, PhD is a member of the following medical societies: American Academy of Dermatology, Council for Nail Disorders, Houston Dermatological Society, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Andrew C Miller, MD  Fellow, Department of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center (UPMC); Attending Physician, Department of Emergency Medicine, UPMC St Margaret's Hospital

Andrew C Miller, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Mark A Silverberg, MD, MMB, FACEP  Assistant Professor, Associate Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate Medical Center

Mark A Silverberg, MD, MMB, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

David A Peak, MD  Assistant Residency Director of Harvard Affiliated Emergency Medicine Residency, Attending Physician, Massachusetts General Hospital; Consulting Staff, Department of Hyperbaric Medicine, Massachusetts Eye and Ear Infirmary

David A Peak, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Mark W Fourre, MD  Program Director, Department of Emergency Medicine, Maine Medical Center; Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD  Professor of Clinical Medicine/Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Dara A Kass, MD, Richard H Sinert, DO, and Reza Keshavarz, MD, to the development and writing of this article.

References

  1. Di Lernia V, Ricci C. On atopic and idiopatic extensive pityriasis alba. Pediatr Dermatol. Sep-Oct 2007;24(5):578-9. [Medline].

  2. Vinod S, Singh G, Dash K, Grover S. Clinico epidemiological study of pityriasis alba. Indian J Dermatol Venereol Leprol. Nov-Dec 2002;68(6):338-40. [Medline].

  3. In SI, Yi SW, Kang HY, Lee ES, Sohn S, Kim YC. Clinical and histopathological characteristics of pityriasis alba. Clin Exp Dermatol. Jul 2009;34(5):591-7. [Medline].

  4. Brenninkmeijer EE, Spuls PI, Legierse CM, Lindeboom R, Smitt JH, Bos JD. Clinical differences between atopic and atopiform dermatitis. J Am Acad Dermatol. Mar 2008;58(3):407-14. [Medline].

  5. Fujita WH, McCormick CL, Parneix-Spake A. An exploratory study to evaluate the efficacy of pimecrolimus cream 1% for the treatment of pityriasis alba. Int J Dermatol. Jul 2007;46(7):700-5. [Medline].

  6. Al-Mutairi N, Hadad AA. Efficacy of 308-nm Xenon Chloride Excimer Laser in Pityriasis Alba. Dermatol Surg. Nov 28 2011;[Medline].

  7. Lin RL, Janniger CK. Pityriasis alba. Cutis. Jul 2005;76(1):21-4. [Medline].

  8. Ortonne JP, Passeron T. Melanin pigmentary disorders: treatment update. Dermatol Clin. Apr 2005;23(2):209-26. [Medline].

  9. Rakel RE, Bope ET. Conn's Current Therapy 2005. 57th ed. St Louis: WB Saunders; 2005:999.

  10. Sams WM. Principles and Practice of Dermatology. New York: Churchill; 1990:369.

  11. Vargas-Ocampo F. Pityriasis alba: a histologic study. Int J Dermatol. Dec 1993;32(12):870-3. [Medline].

 
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Note the characteristic, ill-defined, hypopigmented macules in this 6-year-old child with pityriasis alba.
Lesions of pityriasis alba are usually bilateral and located on the face, arms, and neck.
 
 
 
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