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. [9, 10, 11] 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. [10]
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.
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.
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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Note the characteristic, ill-defined, hypopigmented macules in this 6-year-old child with pityriasis alba.
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Lesions of pityriasis alba are usually bilateral and located on the face, arms, and neck.
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The hypopigmentation produced by pityriasis alba may take a year or longer to return to normal.
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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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Pityriasis alba.
