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Pityriasis Alba Medication

  • Author: Sarah Sweeney Pinney, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Apr 08, 2016
 

Medication Summary

Although the most commonly used remedies (eg, emollients, topical steroids) are safe and usually effective, their efficacy nonetheless appears to be limited. Only low-potency (class 5, 6) topical steroids should be prescribed.

Tacrolimus ointment 0.1% and pimecrolimus cream 1%, both of which are immunomodulators, have also been reported to be effective against pityriasis alba.[8, 9, 10] Because of the high cost of tacrolimus, however, it is seldom indicated. Pimecrolimus 1% has been proposed as a therapeutic option over a 3-month period.[9]

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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 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.

Hydrocortisone, topical (Ala Cort, U-Cort, HydroSKIN)

 

An adrenocorticosteroid derivative, hydrocortisone has mineralocorticoid and glucocorticoid effects, resulting in anti-inflammatory activity. Creams and ointments are generally well tolerated, but ointments may be more effective in patients with significant xerosis or scales.

Fluocinolone (Capex, Derma-Smoothe/FS)

 

Fluocinolone is a fluorinated corticosteroid of moderate potency at the 0.025% concentration (class 4-5) and low potency at the 0.01% concentration (class 6). It has anti-inflammatory, antipruritic, and vasoconstrictive properties.

Desonide (DesOwen, LoKara)

 

Desonide stimulates the synthesis of enzymes that decrease inflammation. It suppresses mitotic activity and causes vasoconstriction.

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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 truly is linked to cancer. In the meantime, this risk is uncertain, and the FDA advises that tacrolimus ointment be used only as labeled, for patients after other prescription treatments have failed to work or cannot be tolerated.

Tacrolimus topical ointment (Protopic)

 

The precise mechanism of action of tacrolimus in atopic dermatitis is not known. It reduces itching and inflammation by suppressing the release of cytokines from T cells, and it also inhibits transcription of genes that encode interleukin (IL)–3, IL-4, IL-5, granulocyte-macrophage colony-stimulating factor (GM-CSF), and tumor necrosis factor (TNF)–alpha, all of which are involved in the early stages of T-cell activation.

Additionally, tacrolimus may inhibit the release of preformed mediators from skin mast cells and basophils and may down-regulate expression of FCeRI on Langerhans cells. It is available as an ointment in concentrations of 0.03 and 0.1% and can be used in patients as young as age 2 years. However, drugs of this class are more expensive than topical corticosteroids. It is indicated only after other treatment options have failed.

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Topical Skin Products

Class Summary

A variety of lotions, creams, and ointments that contain hydrocarbons, oil, waxes, and long-chain fatty acids aid in retaining moisture in the skin, especially if applied immediately after bathing. A bland emollient may be used to reduce the scaling in pityriasis alba.

Aqueous cream (Curel, Cetaphil, Nivea)

 

This is an oil-in-water emulsion that spreads easily and helps to retain moisture in the skin. It counteracts dry and itchy skin and aids in protection, healing, and pain experienced with various types of dermatoses.

Lanolin, cetyl alcohol, glycerin, petrolatum, and mineral oil (Lubriderm)

 

This agent counteracts dry and itchy skin and aids in protection, healing, and pain experienced with various types of dermatoses.

Emollients (Atopiclair, Moisturel, Eletone)

 

This agent counteracts dry and itchy skin and aids in protection, healing, and pain experienced with various types of dermatoses.

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Contributor Information and Disclosures
Author

Sarah Sweeney Pinney, MD Assistant Professor, Department of Dermatology, University of Texas Medical School at Houston

Sarah Sweeney Pinney, MD is a member of the following medical societies: American Academy of Dermatology, Texas Dermatological Society, Texas Medical Association, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Ronald P Rapini, MD Professor and Chair, Department of Dermatology, The University of Texas MD Anderson Cancer Center; Distinguished Chernosky Professor and Chair of Dermatology, Professor of Pathology, University of Texas McGovern Medical School at Houston

Ronald P Rapini, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Society for Investigative Dermatology, Texas Medical Association

Disclosure: Received royalty from Elsevier publishers for independent contractor; May receive consulting fee from FDA panel for consulting in future, since I am on one of their committees, but at this time so far have received zero from FDA.

Rashid M Rashid, MD, PhD Director, Mosaic Clinic Hair Transplant Center of Houston

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

Disclosure: Nothing to disclose.

Fadwah M Abdallah, RPh Assistant, Mosaic Clinic Hair Transplant Center of Houston

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Acknowledgements

Mohsin Ali, MBBS, FRCP, MRCP Consulting Staff, Department of Dermatology, Amersham General Hospital, UK

Disclosure: Nothing to disclose.

David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

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.

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.

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.

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.

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.

Dara A Kass, MD Clinical Assistant Instructor, Department of Emergency Medicine, State University of New York Downstate Medical Center, Kings County Hospital

Disclosure: Nothing to disclose.

Reza Keshavarz, MD

Disclosure: Nothing to disclose.

Mark G Lebwohl, MD Chairman, Department of Dermatology, Mount Sinai School of Medicine

Mark G Lebwohl, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Amgen/Pfizer Honoraria Consulting; Centocor/Janssen Honoraria Consulting; DermiPsor Honoraria Consulting; GlaxoSmithKline Honoraria Consulting; HelixBioMedix Honoraria Consulting; Novartis Honoraria Consulting; Ranbaxy Lectures; Can-Fite Biopharma Honoraria Consulting; DermaGenoma Honoraria Consulting; Biosynexus Honoraria Consulting

Sohail Mansoor, MBBS, MSc Dermatologist and Lead Physician in Dermatologic Surgery, Department of Dermatology, Barnet Hospital, UK

Sohail Mansoor, MBBS, MSc is a member of the following medical societies: American Academy of Anti-Aging Medicine, American Academy of Dermatology, American Society for Dermatologic Surgery, Royal College of Physicians and Surgeons of Glasgow, and Royal College of Physicians of the United Kingdom

Disclosure: Nothing to disclose.

Andrew C Miller, MD Fellow, Critical Care Medicine Department, National Institutes of Health; Fellow, Department of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center

Andrew C Miller, MD is a member of the following medical societies: American College of Emergency Physicians and Society of Critical Care Medicine (USA)

Disclosure: Nothing to disclose.

Christen M Mowad, MD Associate Professor, Department of Dermatology, Geisinger Medical Center

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

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: Pfizer Salary Employment

Nicole Sakka, MBBS Foundation Year 2, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK

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.

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.

Richard H Sinert, DO Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

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

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.

Bassam Zeina, MD, PhD Consulting Staff, Department of Dermatology, Milton Keynes Hospital, UK

Bassam Zeina, MD, PhD is a member of the following medical societies: British Association of Dermatologists, British Medical Association, and Royal Society of Medicine

Disclosure: Nothing to disclose.

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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.
Pityriasis alba.
 
 
 
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