Pediatric Pityriasis Alba Clinical Presentation

  • Author: Mark A Crowe, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 3, 2012
 

History

  • Pityriasis alba (PA) is generally asymptomatic but may be mildly pruritic.
  • Patients may describe any of the following 3 clinical stages:
    • Papular erythematous lesions
    • Papular hypochromic lesions
    • Smooth hypochromic lesions
  • Initially, erythema may be conspicuous, and minimal serous crusting of some lesions may occur; however, because the erythema is usually very mild, most parents do not recall the erythematous stage.
  • Recurrent crops of new lesions may develop at intervals.
  • The duration of pityriasis alba varies from one month to 10 years. The average duration of the common facial form in childhood is one year or more.
  • Important aspects of patient history include the following:
    • Patient or family history may include asthma, hay fever, or eczema in the characteristic areas of atopic dermatitis. Pityriasis alba is a nonspecific finding that is commonly associated with atopic dermatitis.
    • The patient may have prior history of rash or eczema at the sites of hypopigmentation; skin irritation produced by any of various causes may heal with postinflammatory hypopigmentation.
    • Ask about prior therapy; potent topical steroids may produce hypopigmentation. Patients may develop irritant or allergic contact dermatitis to various topical creams, lotions, and medications. When these are discontinued and the area recovers from the contact dermatitis, an area of postinflammatory hypopigmentation may occur.
    • Look for seasonal variations in appearance; the scaling areas of hypopigmentation frequently develop during winter but become more apparent following sun exposure during the spring and summer.
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Physical

  • Characteristic lesions
    • Pityriasis alba is characterized by hypopigmented, round-to-oval, scaling patches on the face, upper arms, neck, or shoulders. The legs and trunk are less commonly involved.
    • Lesions vary in size, usually 1-4 cm in diameter.
    • Most commonly, patients have multiple lesions that range in number from 4-5 to 20 or more.
    • Scales are fine and adherent.
  • Affected areas
    • In approximately one half of all patients, the lesions are limited to the face. In children, the lesions are often confined to the face. The areas around the mouth, chin, and cheeks are the most commonly affected.
    • In 20% of affected children, the neck, arms, and shoulders are involved in addition to the face.
    • Less commonly, the face is spared and scattered lesions are present on the trunk and limbs.
    • Rarely, the disease may be quite extensive. Patients with extensive pityriasis alba present with numerous lesions on the trunk and extremities. This form of pityriasis alba generally occurs in older patients, and the lesions may be more persistent.
  • Important aspects of examination
    • Examine patients for keratotic lesions on the elbows and knees and for small pits in the nails, which may suggest a diagnosis of psoriasis.
    • Examine for the following potential signs of atopic dermatitis:
      • Eczema in the popliteal or antecubital fossa
      • Nipple eczema
      • Cheilitis
      • Dennie-Morgan infraorbital fold
      • Anterior neck folds
      • Wool intolerance
      • White dermographism
      • Infra-auricular fissuring
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Causes

  • No definitive etiologic agent has been described.
  • Excessively dry skin, which is frequently exacerbated by cold dry environments, appears to be a common factor.
  • Lesions are visible primarily in contrast to dark skin. Increasing sunlight in spring and summer makes them more apparent.
  • The condition is not contagious, and no infectious agent has been identified.
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Contributor Information and Disclosures
Author

Mark A Crowe, MD  Assistant Clinical Instructor, Department of Medicine, Division of Dermatology, University of Washington School of Medicine

Mark A Crowe, MD is a member of the following medical societies: American Academy of Dermatology and North American Clinical Dermatologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Kevin P Connelly, DO  Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University School of Medicine; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center

Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Merrily P M Poth, MD  Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences

Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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  2. Zaynoun ST, Aftimos BG, Tenekjian KK, et al. Extensive pityriasis alba: a histological histochemical and ultrastructural study. Br J Dermatol. Jan 1983;108(1):83-90. [Medline].

  3. Bechelli LM, Haddad N, Pimenta WP, et al. Epidemiological survey of skin diseases in schoolchildren living in the Purus Valley (Acre State, Amazonia, Brazil). Dermatologica. 1981;163(1):78-93. [Medline].

  4. Sori T, Nath AK, Thappa DM, Jaisankar TJ. Hypopigmentary disorders in children in South India. Indian J Dermatol. Sep-Oct 2011;56(5):546-9. [Medline]. [Full Text].

  5. 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].

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

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  8. Jorizzo J, Levy M, Lucky A, et al. Multicenter trial for long-term safety and efficacy comparison of 0.05% desonide and 1% hydrocortisone ointments in the treatment of atopic dermatitis in pediatric patients. J Am Acad Dermatol. Jul 1995;33(1):74-7. [Medline].

  9. Queille C, Pommarede R, Saurat JH. Efficacy versus systemic effects of six topical steroids in the treatment of atopic dermatitis of childhood. Pediatr Dermatol. Jan 1984;1(3):246-53. [Medline].

  10. Rigopoulos D, Gregoriou S, Charissi C, Kontochristopoulos G, Kalogeromitros D, Georgala S. Tacrolimus ointment 0.1% in pityriasis alba: an open-label, randomized, placebo-controlled study. Br J Dermatol. Jul 2006;155(1):152-5. [Medline].

  11. 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].

  12. Blessmann Weber M, Sponchiado de Avila LG, Albaneze R, et al. Pityriasis alba: a study of pathogenic factors. J Eur Acad Dermatol Venereol. Sep 2002;16(5):463-8. [Medline].

  13. Di Lernia V, Ricci C. Progressive and extensive hypomelanosis and extensive pityriasis alba: same disease, different names?. J Eur Acad Dermatol Venereol. May 2005;19(3):370-2. [Medline].

  14. du Toit MJ, Jordaan HF. Pigmenting pityriasis alba. Pediatr Dermatol. Mar 1993;10(1):1-5. [Medline].

  15. Fink-Puches R, Chott A, Ardigo M, et al. The spectrum of cutaneous lymphomas in patients less than 20 years of age. Pediatr Dermatol. Sep-Oct 2004;21(5):525-33. [Medline].

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

  17. Relyveld G, Menke H, Westerhof W. Progressive and extensive hypomelanosis and extensive pityriasis alba: same disease, different names?. J Eur Acad Dermatol Venereol. Nov 2006;20(10):1363-4. [Medline].

  18. Thoma W, Kramer HJ, Mayser P. Pityriasis versicolor alba. J Eur Acad Dermatol Venereol. Mar 2005;19(2):147-52. [Medline].

  19. Whitmore SE, Simmons-O'Brien E, Rotter FS. Hypopigmented mycosis fungoides. Arch Dermatol. Apr 1994;130(4):476-80. [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.
The hypopigmentation produced by pityriasis alba may take a year or longer to return to normal.
This older patient with areas of hypopigmentation on the face has a common problem that would be included in the differential diagnosis of pityriasis alba. Several months earlier, he had areas of irritant contact dermatitis on his cheeks. When those resolved, he was left with areas of postinflammatory hypopigmentation. These should eventually repigment to an even skin tone.
 
 
 
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