Pediatric Pityriasis Alba Medication

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

Medication Summary

Because the disease is usually self-limited and asymptomatic, medical therapy is not always necessary. Topical steroids, tacrolimus ointment 0.1%, and emollients are safe and usually effective treatment. Because of the high cost of tacrolimus, it is seldom indicated as therapy for pityriasis alba.

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Corticosteroids, topical

Class Summary

The low-strength class 5 or 6 topical steroids that may be used to treat pityriasis alba (PA) are extremely safe in young children. Prolonged use on the face is not recommended.

Very potent topical steroids may be absorbed to a degree that may cause significant metabolic effects and impede normal growth rates. This is more likely in children younger than 2 years, in whom the application is to a relatively large percentage of the body surface area. Potent topical steroids may also produce atrophy of the skin and an acneform eruption. They should not be used on the face.

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Hydrocortisone, topical (Cortaid, Cortizone-10, Dermacort)

 

This is an adrenocorticosteroid derivative with mild anti-inflammatory activity. Creams and ointments are generally well tolerated, but ointments may be more effective in patients with significant xerosis or scales.

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Immunosuppressant Agent

Class Summary

Tacrolimus ointment may be used to treat pityriasis alba and is extremely safe in young children. However, because it is expensive, it is seldom indicated for the treatment of pityriasis alba.

In 2005, the US Food and Drug Administration (FDA) issued a public health advisory to inform healthcare professionals and patients about a potential cancer risk from use of tacrolimus ointment. This concern is based on information from animal studies, case reports in a small number of patients, and knowledge of how drugs in this class work. Human studies of 10 years or longer may be needed to determine if use of tacrolimus ointment is linked to cancer. In the meantime, this risk is uncertain, and FDA advises tacrolimus ointment should be used only as labeled, for patients after other prescription treatments have failed to work or cannot be tolerated.

This information reflects FDA’s preliminary analysis of data concerning this drug. FDA is considering, but has not reached a final conclusion about, this information. FDA intends to update this sheet when additional information or analyses become available. For more information, see FDA MedWatch.

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Tacrolimus topical ointment (Protopic)

 

The mechanism of action of tacrolimus in atopic dermatitis is not known. Reduces itching and inflammation by suppressing the release of cytokines from T cells. Also inhibits transcription for genes that encode IL-3, IL-4, IL-5, GM-CSF, and TNF-alpha, all of which are involved in the early stages of T-cell activation. Additionally, may inhibit release of pre-formed mediators from skin mast cells and basophils, and downregulate expression of FCeRI on Langerhans cells. Can be used in patients as young as 2 years old. Drugs of this class are more expensive than topical corticosteroids. It is available as an ointment in concentrations of 0.03 and 0.1%. Indicated only after other treatment options have failed.

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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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  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].

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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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