Pityriasis Alba Treatment & Management
- Author: Sarah Sweeney Pinney, MD; Chief Editor: Dirk M Elston, MD more...
Pityriasis alba resolves spontaneously; treatment consists primarily of trigger avoidance, good general skin care, and education of the patient’s parents about the benign nature of this self-limited disorder.
Patients should use adequate sun protection to prevent darkening of the natural skin color. Lesions of pityriasis alba do not repigment well upon sun exposure, and darkening of the surrounding skin may worsen the cosmetic appearance.
Because pityriasis alba is usually self-limited and asymptomatic, pharmacologic treatment is often unnecessary.
Topical steroids (eg, hydrocortisone 1%, desonide 0.05%) may help with erythema and pruritus associated with the initial lesions and may accelerate repigmentation of existing lesions. Use should be limited, however, with frequent breaks from use, to avoid long-term skin atrophy and steroid changes. Only low-potency (class 5, 6) topical steroids should be prescribed.[29, 30, 31]
For chronic lesions on the trunk, a mild tar paste may be helpful. Bland emollient creams are used to reduce the scaling of lesions, especially on the face.
Psoralen plus ultraviolet light A (PUVA) photochemotherapy may be used to help with repigmentation in extensive cases, although the recurrence rate is high after treatment is stopped.
Tacrolimus ointment 0.1% and pimecrolimus cream 1% have also been reported to be beneficial in the treatment of 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.
Calcitriol, a topical vitamin D analog, has been shown to have comparable efficacy compared with tacrolimus in a double-blind, placebo-controlled trial of 28 patients.
In a double-blind, placebo-controlled trial, Patrizi and colleagues concluded that sorbityl furfural palmitate (AR-GG27®) cream was effective against mild to moderate atopic dermatitis in patients with pityriasis alba. Patients in the study, who were aged 2 months to 15 years, were assessed after 15 and 30 days, with a statistically significant improvement seen in the AR-GG27® patients compared with those on placebo.
In another study, an open-label, noncontrolled, nonrandomized trial by Bhat et al involving patients with eczema associated with pityriasis alba, as well as persons with various forms of irritant dermatitis, RV 2427B cream was found to be effective in 84% of patients as evaluated by an investigator, and in 76% of patients as evaluated through self-assessments. The cream contained 4% zinc oxide, 2.5% dry colloidal oat extract, 0.5% oat oil, 0.2% copper sulfate, and 0.1% zinc sulfate.
Treatment with a 308-nm excimer laser twice a week for 12 weeks has been shown to be effective against pityriasis alba.
Consultation with a dermatologist is usually unnecessary; the patient is typically monitored by the primary care provider.
Extensive pityriasis alba may warrant a referral to a dermatologist for possible oral psoralen plus ultraviolet-A (PUVA) photochemotherapy. PUVA for extensive pityriasis alba may achieve a marked degree of improvement; however, PUVA is not without risks and is seldom required.
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