Pediatric Pityriasis Alba Treatment & Management

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

Medical Care

  • Treatment of pityriasis alba (PA) primarily consists of good general skin care and education of the parents about the benign nature of this self-limited disorder.
  • Hydrocortisone, desonide,[8, 9] or a bland emollient cream may decrease erythema, scale, and pruritus, if present. For chronic lesions on the trunk, a mild tar paste may be helpful.
  • Tacrolimus ointment 0.1%[10] and pimecrolimus cream 1%[11] have been reported to be beneficial in treating pityriasis alba.
  • 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.
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Consultations

  • Extensive pityriasis alba may warrant a referral to a dermatologist for possible oral psoralen and UVA photochemotherapy (PUVA). PUVA for extensive pityriasis alba may achieve a marked degree of improvement; however, PUVA is not without risks and is seldom required.
  • Consultation with a dermatologist is usually unnecessary; the patient is typically monitored by the primary care provider.
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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

  1. Jadotte YT, Janniger CK. Pityriasis alba revisited: perspectives on an enigmatic disorder of childhood. Cutis. Feb 2011;87(2):66-72. [Medline].

  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].

  7. Martin RF, Lugo-Somolinos A, Sanchez JL. Clinicopathologic study on pityriasis alba. Bol Asoc Med P R. Oct 1990;82(10):463-5. [Medline].

  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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