Pityriasis Alba 

Updated: Apr 03, 2020
Author: Sarah Sweeney Pinney, MD, FAAD; Chief Editor: Dirk M Elston, MD 

Overview

Practice Essentials

Pityriasis alba, a common skin disorder in children and young adults, most commonly between ages 3 and 16 years.[1] It is characterized by the presence of ill-defined, scaly, faintly erythematous patches. These lesions eventually subside, leaving hypopigmented areas (see the image below) that then slowly return to normal pigmentation. The term is derived from the words pityriasis (scaly) and alba (white).

Note the characteristic, ill-defined, hypopigmente Note the characteristic, ill-defined, hypopigmented macules in this 6-year-old child with pityriasis alba.

Signs and symptoms

Pityriasis alba lesions often occur on the face, with the cheek being a particularly common site.[2] Initially, erythema may be conspicuous, and minimal serous crusting of some lesions may occur. The individual lesions are characterized as follows:

  • Rounded, oval, or irregular plaques that are red, pink, or skin colored and have fine lamellar or branny scaling with indistinct margins

  • Usually 1-4 cm in diameter

  • Most commonly range in number from 4 or 5 to 20 or more

  • Found on the face, upper arms, neck, or shoulders; the legs and trunk are less commonly involved; in approximately one half of all patients, the lesions are limited to the face[3]

Uncommon variants of pityriasis alba are as follows:

  • Pigmenting pityriasis: Typical lesion has a central zone of bluish hyperpigmentation surrounded by a hypopigmented, slightly scaly halo of variable width; the lesions are usually confined to the face and are often associated with dermatophyte infection[4]   This entity is typically found in darker skin types from South Africa and the Middle East.[1]

  • Extensive pityriasis alba (see Differentials): Differentiated from the classic form by the widespread and symmetrical involvement of the skin, the absence of a preceding inflammatory phase, a higher female-to-male ratio, and, histologically, the absence of spongiosis[5]

In the extensive variant, lesions are less erythematous, less scaly, more persistent, asymptomatic, and more frequently seen on the trunk and less often on the face.[6]

See Clinical Presentation for more detail.

Diagnosis

A workup, as follows, may be undertaken to exclude other causes of hypopigmentation:

  • Wood's light examination: May help in determining the presence of vitiligo, which will glow more brightly and have edges with sharper demarcation

  • Potassium hydroxide (KOH) stain of a skin scraping: Will be positive if the patient has tinea versicolor (also called pityriasis versicolor), tinea faciei, or tinea corporis

  • Skin biopsy: Not usually necessary or particularly helpful in establishing a diagnosis of pityriasis alba but may be indicated if a diagnosis of mycosis fungoides (cutaneous T-cell lymphoma) is a significant possibility[7]

See Workup for more detail.

Management

Pityriasis alba resolves spontaneously; treatment consists primarily of good general skin care and education of a young patient’s parents about the benign nature of this self-limited disorder. Therapy may also include the following:

  • Low-potency 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, to avoid long-term skin atrophy and steroid changes

  • Tar paste: May be helpful for chronic lesions on the trunk

  • Bland emollient cream: 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; recurrence rate is high after treatment is stopped[8]

  • Tacrolimus ointment 0.1% and pimecrolimus cream 1%: Have been reported to be beneficial in the treatment of pityriasis alba[9, 10, 11]

  • Laser therapy: Treatment with a 308-nm excimer laser twice a week for 12 weeks has been shown to be effective against pityriasis alba[12]

See Treatment and Medication for more detail.

Background

Pityriasis alba, a relatively common skin disorder in children and young adults, is characterized by the presence of ill-defined, scaly, faintly erythematous patches. These lesions eventually subside, leaving hypopigmented areas that then slowly return to normal pigmentation (see the images below).[1, 13] Lesions may progress through the following three clinical stages (see Clinical Presentation):

  1. Papular (scaling) erythematous
  2. Papular (scaling) hypochromic
  3. Smooth hypochromic
Note the characteristic, ill-defined, hypopigmente Note the characteristic, ill-defined, hypopigmented macules in this 6-year-old child with pityriasis alba.
Pityriasis alba. Pityriasis alba.

The duration of pityriasis alba varies from 1 month to 10 years, with most cases resolving over a period of several months to a year.[2] Diagnosis is made clinically, and treatment consists of skin care and education of a young patient’s parents about the benign nature of the disorder. Hydrocortisone may decrease erythema, scaling, and pruritus, if present. (See Prognosis, Workup, and Treatment.)

Pityriasis alba, although a nonspecific finding, is commonly associated with atopic dermatitis. The etiology of pityriasis alba is unknown, but xerosis that presents in individuals with atopic diathesis is an important element in the development of the disease. (See Pathophysiology and Etiology.)

Extensive pityriasis alba

Extensive pityriasis alba is believed to be a primary, acquired hypopigmentation observed in females aged 18-25 years of mixed ethnic origin; it is characterized by hypochromic, nonscaly macules developing on the back and abdomen, increasing in number and progressively coalescing over the whole trunk into larger patches surrounded by smaller, well-defined macules. Although the single skin lesions of extensive pityriasis alba do not differ substantially from those of pityriasis alba, consistent differences are as follows[14] :

  • A widespread and symmetrical involvement of the trunk by numerous round, nonscaly, hypomelanotic patches without a preceding inflammatory phase and chronic in duration (this is as opposed to face predominance, as found in pityriasis alba)

  • A decrease in epidermal melanin, as found on histologic examination; spongiosis is absent

  • Ultrastructural studies suggest a reduced number of active melanocytes and a decrease in number and size of melanosomes

  • No reported atopy, associated pathologies, or familial occurrences

  • The age of occurrence and the sex ratio (female preponderance) differ from those of pityriasis alba

Widespread lesions of classical pityriasis alba can be observed in atopic dermatitis, but they should not be confused with those of extensive pityriasis alba

Debate exists as to the validity of the term extensive pityriasis alba, which some believe to be a confusing misnomer applied to a pathoetiologically different entity. Some authors believe that extensive pityriasis alba overlaps with another condition, described as "progressive and extensive hypomelanosis" in persons of mixed racial background and also reported as "progressive and confluent hypomelanosis of the melanodermic metis" or "creole dyschromia.” The alternate name of "progressive extensive hypomelanosis" has been proposed.[14]

Patient education

Educate the parents about the benign, self-limited nature of pityriasis alba.

Pathophysiology

Pityriasis alba

Ultrastructural studies in patients with pityriasis alba have noted that despite reduced pigment in lesional skin, there is no difference in melanocytes between lesional and nonlesional skin in the same patient, although this finding is still under debate. Degenerative changes in melanocytes and reduced keratonocyte melanosomes have also been noted.[15]

Extensive pityriasis alba

Hypopigmentation in extensive pityriasis alba may be primarily caused by the reduced numbers of active melanocytes and the decrease in the number and size of melanosomes in the affected skin.

In a study by Zaynoun et al of 9 patients with extensive pityriasis alba, the density of functional melanocytes was found to be reduced in affected areas, although cytoplasmic activity and the transfer of melanosomes to keratinocytes were generally normal. While the number and size of melanosomes tended to be reduced, they demonstrated a normal distribution pattern in the keratinocytes.[16]

In the same study, the presence of hyperkeratosis and parakeratosis was inconsistent, and these conditions were thought unlikely to contribute significantly to the pathogenesis of the hypomelanosis. Various amounts of intercellular edema were found.

Etiology

No known cause of pityriasis alba has been reported. The condition is not contagious, and no infectious agent has been identified.

Leading theories as to the origin of the lesions in pityriasis alba involve atopy and postinflammatory changes, with a large number of patients with pityriasis alba having a history of atopic disease, and atopic patients are being more prone to developing the condition.[17, 2]

Theories of origin also include hypopigmentation secondary to pityriacitrin, a substance produced by Malassezia yeasts that acts as a natural sunscreen.

In one study, atrophic sebaceous glands were noted in almost half the cases of pityriasis alba. In another study, iron deficiency anemia was reported in 16.5% of patients[2] ; this may be a coincidental finding, however, and the clinical relevance of anemia is not yet known. Excessively dry skin, which is frequently exacerbated by cold, dry environments, also appears to be a common factor in pityriasis alba.

Reported contributory factors related to the development of pityriasis alba are excessive and unprotected sun exposure, poor hygienic habits, and environmental influences such as temperature, humidity, and altitude.[18, 19] In addition, one study has shown patients with pityriasis alba were more likely to have low levels of serum copper, possibly contributing to tyrosinase dysfunction, and therefore a decrease in the production of melanin.[20]

Epidemiology

Occurrence in the United States

Although the exact incidence has not been described, up to 5% of children may have pityriasis alba.[21] The disorder is not seasonal, but the dry, slightly scaly appearance tends to worsen during cold months, when the air is relatively dry inside the home. In addition, sun exposure may make the lesions more obvious during spring and summer. The condition is more common in patients with a history of atopy.

International occurrence

In a study of 9955 schoolchildren aged 6-16 years who lived in a tropical region, the prevalence of pityriasis alba was 9.9%.[22, 23] Another study, in Nepal, showed that the prevalence of pityriasis alba within a wide range of dermatoses was 5.2%.[24]

Race-, sex-, and age-related demographics

Pityriasis alba occurs in people of all races. One study found the incidence to be slightly higher in light-skinned people, while other studies have demonstrated the opposite. The condition is frequently more apparent and cosmetically bothersome in patients with darker complexions.[17, 19] Both sexes are equally susceptible to the disease, but a slight male predominance has been noted.[2, 18]

Pityriasis alba is most common in children aged 3-16 years, with 90% of cases occurring in children younger than 12 years. The disease occasionally is found in adults.[17]

Prognosis

Pityriasis alba is generally self-limited, and the prognosis is good, with eventual complete repigmentation. No long-term residual effects are expected.

Cosmetic appearance while the lesions are present may be an issue with some pediatric patients but is more likely to be of concern to their parents. Risk of sunburn is slightly increased in areas of hypopigmentation.

The duration of symptoms is different for each patient. Recurrent crops of new lesions may develop at intervals, with the duration of pityriasis alba varying from 1 month to 10 years. Usually, however, cases resolve over a period of several months to a year.[2] Treatment may shorten the duration of the lesions to several weeks in certain cases. (See the image below.)

The hypopigmentation produced by pityriasis alba m The hypopigmentation produced by pityriasis alba may take a year or longer to return to normal.
 

Presentation

History

Pityriasis alba (PA) is generally asymptomatic but may be mildly pruritic. Patients may describe any of the following three clinical stages:

  1. Papular erythematous lesions

  2. Papular hypochromic lesions

  3. Smooth hypochromic lesions

Pityriasis alba lesions often occur on the face, with the cheek being a particularly common site.[2] Initially, erythema may be conspicuous, and minimal serous crusting of some lesions may occur. However, because the erythema is usually very mild, most parents of young patients do not recall the erythematous stage. Erythema later subsides completely to leave areas of hypopigmentation with or without fine scaling.

Recurrent crops of new lesions may develop at intervals, with the duration of pityriasis alba varying from 1 month to 10 years. Most cases, however, resolve over a period of several months to 1 year.

Associated factors

Patient or family history may include asthma and hay fever. It may also include eczema in the characteristic areas of atopic dermatitis, with pityriasis alba being a nonspecific finding commonly associated with this condition.[25]

The patient may have a prior history of rash or eczema at the sites of hypopigmentation; skin irritation produced by any of a variety of causes may heal with postinflammatory hypopigmentation.

The patient should be asked about prior therapy; potent topical steroids may produce hypopigmentation. Moreover, patients may develop irritant or allergic contact dermatitis from the use of various topical creams, lotions, or medications; when these are discontinued and the area recovers from the contact dermatitis, an area of postinflammatory hypopigmentation may occur.

The clinician should look for seasonal variations in appearance; the scaling areas of hypopigmentation frequently develop during winter but become more apparent following sun exposure during the spring and summer.

Physical Examination

The correct diagnosis of pityriasis alba (PA) is usually suggested by the age of the patient, fine scaling, hypopigmentation, and the distribution of lesions.

Characteristic lesions

Pityriasis alba is often diagnosed following an incidental finding on clinical examination. The individual lesions are rounded, oval, or irregular plaques that are red, pink, or skin colored and have fine lamellar or branny scaling with indistinct margins. (See the image below.)

Pityriasis alba. Pityriasis alba.

Usually 1-4 cm in diameter, the lesions most commonly number from 4 or 5 to 20 or more. They are visible primarily in contrast to dark skin; increasing sunlight in spring and summer also makes them more apparent.

Affected areas

The lesions appear on the face, upper arms, neck, or shoulders; the legs and trunk are less commonly involved. In approximately one half of all patients, the lesions are limited to the face.[3] The areas around the mouth, chin, and cheeks are the most commonly affected. (See the image below.)

Lesions of pityriasis alba are usually bilateral a Lesions of pityriasis alba are usually bilateral and located on the face, arms, and neck.

In 20% of affected children, the neck, arms, and shoulders are involved in addition to the face. Less commonly, the face is spared and scattered lesions are present on the trunk and limbs.

Variants

Uncommon variants of pityriasis alba are the pigmenting variety and the extensive type. In pigmenting pityriasis alba, the typical lesion has a central zone of bluish hyperpigmentation surrounded by a hypopigmented, slightly scaly halo of variable width. The lesions are usually confined to the face and are often associated with dermatophyte infection.[4] As previously mentioned, this is more commonly found in patients with darker skin from South Africa and the Middle East.[1]

Extensive pityriasis alba is differentiated from the classic form by the widespread and symmetrical involvement of the skin, the absence of a preceding inflammatory phase, a higher female-to-male ratio, and, histologically, the absence of spongiosis.[5] In the extensive variant, lesions are less erythematous, less scaly, more persistent, asymptomatic, and more frequently seen on the trunk and less often on the face.[6]

Important aspects of examination

Examine patients for keratotic lesions on the elbows and knees and for small pits in the nails, which may suggest a diagnosis of psoriasis.

Examine for the following potential signs of atopic dermatitis:

  • Eczema in the popliteal or antecubital fossa

  • Nipple eczema

  • Cheilitis

  • Dennie-Morgan infraorbital fold

  • Anterior neck folds

  • Wool intolerance

  • White dermographism

  • Infra-auricular fissuring

 

DDx

Diagnostic Considerations

The differential diagnosis of pityriasis alba includes the following:

  • Postinflammatory pigment alteration

  • Nevus depigmentosus

  • Pigmenting pityriasis alba

  • Extensive pityriasis alba

  • Psoriasis

  • Tinea versicolor

  • Vitiligo

  • Progressive and extensive hypomelanosis

  • Leprosy

  • Hypopigmented mycosis fungoides (cutaneous T-cell lymphoma)[26]

  • Delusional tinea

  • Nummular eczema

  • Pityriasis rosea

  • Progressive macular hypomelanosis

  • Eruptive hypomelanosis associated with viral syndromes[27]

  • Seborrhea

  • Tinea corporis

  • Discoid eczema

  • Nevus anemicus

  • Atopic dermatitis

  • Contact dermatitis

  • Ash-leaf macules of tuberous sclerosis

  • Pityriasis lichenoides chronica

Any inflammatory process that involves the skin, such as contact dermatitis, can leave areas of hypopigmentation upon healing. This may occur in other disorders as well, including fungal diseases (eg, tinea versicolor) and idiopathic disorders (eg, vitiligo), or may result from previous inflammatory conditions (ie, postinflammatory pigmentary alteration).

The most common disorders of hypopigmentation in children are pityriasis alba, vitiligo, nevus depigmentosus, and tinea versicolor.

Hypopigmentation may also result as a adverse effect of medications such as retinoic acid, benzoyl peroxide, and topical steroids.

Nevus depigmentosus

Nevus depigmentosus is a stable congenital leukoderma. The localized form this condition must be distinguished from an ash leaf spot, the earliest cutaneous manifestation of tuberous sclerosis, whereas the systematized form may be confused with hypomelanosis of Ito, another neurocutaneous disorder.

Nevus depigmentosus tends to occur on the trunk, is segmental in distribution, and does not change in size or number over time.

Pigmenting pityriasis alba

This condition seems to be a variant of classic pityriasis alba and shows a strong association with dermatophyte infection, especially tinea capitis. It may be related to lichenoid melanodermatitis. The characteristic morphology of pigmenting pityriasis alba includes a central zone of bluish hyperpigmentation surrounded by a hypopigmented, slightly scaly halo of variable width. Patients display lesions primarily on the face.

Extensive pityriasis alba

Extensive pityriasis alba is differentiated from the classic form by the widespread and symmetrical involvement of the skin, the absence of a preceding inflammatory phase, a higher female-to-male ratio, and, histologically, the absence of spongiosis.[5] Lesions are less erythematous and less scaly in the extensive variant, as well as asymptomatic, more persistent, and more frequently seen on the trunk and less on the face.[6]

Psoriasis

In older children and adults, the early erythematous lesions of pityriasis alba may be mistaken for psoriasis; however, the distribution, lack of psoriatic scales, and sparing of scalp, elbows, and knees exclude this diagnosis.

Tinea versicolor

The lesions of tinea versicolor favor the upper trunk of adolescents. Potassium hydroxide examination of the associated scales reveals hyphal and yeast forms of Malassezia furfur.

Vitiligo

Vitiligo is an acquired, progressive disorder, in contrast to nevus depigmentosus, which is a stable congenital leukoderma. The face is a common site for vitiligo, but the distribution is most commonly around the eyes or mouth, and, in contrast to pityriasis alba, the pigment loss is complete.

Progressive and extensive hypomelanosis

Widespread cases overlap with a condition termed progressive and extensive hypomelanosis.[5] This disorder occurs mainly in women aged 18-25 years, with progressive development of round, pale, coalescent macules mainly on the back that are unresponsive to therapy but spontaneously regress within 3-4 years.[28]

Leprosy

Leprosy must be considered in arid regions, including areas with armadillo exposure in the United States. In particular, association with the 7-banded armadillo in the southern United States has been described.

Mycosis fungoides

This is of particular concern for lesions that are atypical in any way, including lesions that are persistent or symptomatic or that change color or shape

Delusional tinea

Delusional disorders may result in chronic postinflammatory hypopigmentation changes; it may be possible for such lesions to resemble those of pityriasis alba

Nummular eczema

This condition is intensely pruritic.

Pityriasis lichenoides chronica

Lesion morphology is similar, but usually more widespread, affecting the trunk and extremities.

 

Workup

Approach Considerations

Hypopigmentation may occur in other disorders, such as those caused by fungi (eg, tinea versicolor), previous inflammatory conditions (eg, postinflammatory hypopigmentation), idiopathic disorders (eg, vitiligo), or malignancy (mycosis fungoides), or it may occur secondary to medications such as retinoic acid, benzoyl peroxide, and topical steroids. Clinicians should rule out these other disorders when evaluating a patient who may have pityriasis alba.

A workup may be undertaken to exclude other causes of hypopigmentation; however, most of this would be accomplished through a dermatology referral.

A Wood light examination may help in determining whether a patient’s rash is due to vitiligo, which will glow more brightly and have edges with sharper demarcation.

Potassium hydroxide (KOH) stain of a skin scraping will be positive if the patient has tinea versicolor (also called pityriasis versicolor), tinea faciei, or tinea corporis. This would likely be performed by a dermatologist.

A biopsy would be required for atypical lesions noted in the differential. This would likely be performed by a dermatologist.

Histologic Findings

Skin biopsy is not usually necessary or particularly helpful in establishing a diagnosis of pityriasis alba. Biopsy may be indicated, however, if a diagnosis of mycosis fungoides is a significant possibility. The biopsy should be performed by a skin disease specialist, considering the common location of the cheek and the potential approximation of this area to the facial artery.

Only a few histologic studies of pityriasis alba have been reported, and most maintain that the microscopic features of the disease are those of a mild, chronic, nonspecific dermatitis with decreased melanin production.[15, 16, 17, 29] The following features have been seen on biopsy specimens, although none are specific enough to make the diagnosis[2] :

  • Hyperkeratosis (33.33%)

  • Parakeratosis (40%)

  • Acanthosis (53.33%)

  • Spongiosis (80%)

  • Perivascular infiltrate (100%)

However, a histopathologic diagnosis of pityriasis alba may be proposed when the following features are observed in a biopsy specimen taken from a characteristic skin lesion:

  • Irregular or markedly reduced pigment by melanin of the basal layer

  • No significant difference in melanocyte count between lesional and normal skin

  • Reduced number of active melanocytes and decreased number and size of melanosomes in affected skin[12]

 

Treatment

Approach Considerations

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.

Pharmacologic therapy

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.[30, 31, 32]

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.[8]

Although sometimes cost-prohibitive, tacrolimus ointment 0.1% and pimecrolimus cream 1% have also been reported to be beneficial in the treatment of pityriasis alba.[9, 10, 11]

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.[33]

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.[34]

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.[35]

Laser therapy

Treatment with a 308-nm excimer laser twice a week for 12 weeks has been shown to be effective against pityriasis alba.[12]

Consultations

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.

 

Medication

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.

 

Questions & Answers

Overview

What is pityriasis alba?

How are pityriasis alba lesions characterized?

What are the variants of pityriasis alba?

What is included in the workup of pityriasis alba?

What are the treatment options for pityriasis alba?

What are the clinical stages of pityriasis alba lesions?

What is the duration of pityriasis alba?

What is extensive pityriasis alba and how does it differ from pityriasis alba?

What should be included in patient education about pityriasis alba?

What is the pathophysiology of pityriasis alba?

What is the pathophysiology of extensive pityriasis alba?

What causes pityriasis alba?

What is the prevalence of pityriasis alba in the US?

What is the global prevalence of pityriasis alba?

In which patient populations is pityriasis alba most common?

What is the prognosis of pityriasis alba?

Presentation

What are the clinical presentations of pityriasis alba?

Which parts of the body does pityriasis alba affect?

What should be the focus of history in the evaluation of pityriasis alba?

Which physical findings suggest pityriasis alba?

How are the lesions of pityriasis alba characterized?

Which body areas are affected by pityriasis alba?

What are variants of pityriasis alba?

How are psoriasis and atopic dermatitis differentiated from pityriasis alba?

DDX

How is leprosy differentiated from pityriasis alba?

Which conditions should be included in the differential diagnoses of pityriasis alba?

How is pityriasis alba differentiated from other disorders with hypopigmentation?

How is extensive pityriasis alba differentiated from classic pityriasis alba?

How is psoriasis differentiated from pityriasis alba?

How is tinea versicolor differentiated from pityriasis alba?

How is vitiligo differentiated from pityriasis alba?

How is progressive and extensive hypomelanosis differentiated from pityriasis alba?

What other conditions should be differentiated from pityriasis alba?

Workup

Which studies are performed in the workup of pityriasis alba?

When is biopsy indicated in the workup of pityriasis alba?

Which histologic findings are characteristic of pityriasis alba?

Treatment

What are the treatment options for pityriasis alba?

What is the role of pharmacologic therapy in the treatment of pityriasis alba?

What is the role of laser therapy in the treatment of pityriasis alba?

Which specialists should be consulted in the treatment of pityriasis alba?

Medications

What medications are used in the treatment of pityriasis alba?

Which medications in the drug class Topical Skin Products are used in the treatment of Pityriasis Alba?

Which medications in the drug class Immunosuppressant Agent are used in the treatment of Pityriasis Alba?

Which medications in the drug class Corticosteroids, topical are used in the treatment of Pityriasis Alba?