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

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Media Gallery

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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Author

Sarah Sweeney Pinney, MD, FAAD Dermatologist, Clear Dermatology

Sarah Sweeney Pinney, MD, FAAD 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 Dermatological Association, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, American Society of Dermatopathology, Association of Professors of Dermatology, Society for Investigative Dermatology, Texas Dermatological Society

Disclosure: Book royalties from Elsevier publishers.

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.

Additional Contributors

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, Council for Nail Disorders, Houston Dermatological Society, International Society of Hair Restoration Surgery, Texas Dermatological Society, Texas Medical Association

Disclosure: Nothing to disclose.

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

Disclosure: Nothing to disclose.

Acknowledgements

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