Pityriasis alba

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Pityriasis alba
ICD-10 L30.5
ICD-9 696.5
DiseasesDB 31121
eMedicine ped/1813  derm/333 emerg/425

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Overview

Pityriasis alba is a common skin condition mostly occurring in children and usually seen as dry, fine scaled, pale patches on their faces. It is self limiting and usually only requires use of moisturiser creams.

The condition is so named for the fine scaly appearance initially present (pityriasis) and the palor of the patches that develop (whilst "alba" is Latin for white, the patches in this condition are not totally depigmented)[1].

Aetiology

There is no specific known cause for this condition, but any dermatitis inflammation of the skin may heal leaving pale skin, as may excessive use of corticosteroid creams used to treat episodes of eczema. The hypopigmentation is due to both reduced activity of melanocytes with fewer and smaller melanosomes.[2]

The condition is most often seen in children between the ages of 3 and 16 years and is more common in males than females.[3] It possibly occurs more frequently in those of light-skin, but is more apparent in those of darker complexion.[4]

Up to a third of US school children may at some stage get this condition. Single point prevalence studies from India have shown variable rates from 8.4%,[5] to 31%.[6] Other studies have shown prevalence rates in Brazil of 9.9%,[7] Egypt 13.49%,[8] Romania 5.1%,[9] Turkey 12% where higher rates were seen in those with poor socioeconomic conditions,[10] and just 1% in school children in Hong Kong.[11]

Symptoms and signs

The dry scaling appearance is most noticeable during the winter as a result of dry air inside people's homes. During the summer, tanning of the surrounding normal skin makes the pale patches of pityriasis alba more prominent.

Individual lesions develop through 3 stages and sometimes are itchy:

  1. Raised and red - although the redness is often mild and not noticed by parents
  2. Raised and pale
  3. Smooth flat pale patches

Lesions are round or oval, of 0.5-2 cm in size although may be larger if they occur on the body (up to 4cm), and usually number from 4 or 5 to over 20. The patches are dry with very fine scales. They most commonly occur on the face (cheeks), but in 20% appear also on the upper arms, neck, or shoulders.

Diagnosis

Physical Examination

Skin

Face

Treatment

No treatment is required and the patches in time will settle.[13] The redness, scale and itch if present may be managed with simple emollients and sometimes hydrocortisone, a weak steroid, is also used.[14]

As the patches of pityriasis alba do not darken normally in sunlight, effective sun protection helps minimise the discrepancy in colouration against the surrounding normal skin. Cosmetic camouflage may be required.

Tacrolimus has been reported as speeding resolution.[15]

In exceptionally severe cases PUVA therapy may be considered.[16]

Prognosis

The patches of PA may last from 1 month to 10 years, but commonly on the face last a year or more.

See also

  • Vitiligo which, by comparison, causes total loss of skin colour and on the face tends to occur around the mouth.[1]

References

  1. 1.0 1.1 Pinto FJ, Bolognia JL (1991). "Disorders of hypopigmentation in children". Pediatr. Clin. North Am. 38 (4): 991–1017. PMID 1870914. 
  2. Vargas-Ocampo F (1993). "Pityriasis alba: a histologic study". Int. J. Dermatol. 32 (12): 870–3. PMID 8125687. 
  3. Blessmann Weber M, Sponchiado de Avila LG, Albaneze R, Magalhães de Oliveira OL, Sudhaus BD, Cestari TF (2002). "Pityriasis alba: a study of pathogenic factors". Journal of the European Academy of Dermatology and Venereology : JEADV. 16 (5): 463–8. PMID 12428838. 
  4. Laude TA (1995). "Approach to dermatologic disorders in black children". Seminars in dermatology. 14 (1): 15–20. PMID 7742234. 
  5. Dogra S, Kumar B (2003). "Epidemiology of skin diseases in school children: a study from northern India". Pediatric dermatology. 20 (6): 470–3. PMID 14651562. 
  6. Faye O, N'Diaye HT, Keita S, Traoré AK, Hay RJ, Mahé A (2005). "High prevalence of non-leprotic hypochromic patches among children in a rural area of Mali, West Africa". Leprosy review. 76 (2): 144–6. PMID 16038247. 
  7. Bechelli LM, Haddad N, Pimenta WP, Pagnano PM, Melchior E, Fregnan RC, Zanin LC, Arenas A (1981). "Epidemiological survey of skin diseases in schoolchildren living in the Purus Valley (Acre State, Amazonia, Brazil)". Dermatologica. 163 (1): 78–93. PMID 7274519. 
  8. Abdel-Hafez K, Abdel-Aty MA, Hofny ER (2003). "Prevalence of skin diseases in rural areas of Assiut Governorate, Upper Egypt". Int. J. Dermatol. 42 (11): 887–92. PMID 14636205. 
  9. Popescu R, Popescu CM, Williams HC, Forsea D (1999). "The prevalence of skin conditions in Romanian school children". Br. J. Dermatol. 140 (5): 891–6. PMID 10354028. 
  10. Inanir I, Sahin MT, Gündüz K, Dinç G, Türel A, Oztürkcan S (2002). "Prevalence of skin conditions in primary school children in Turkey: differences based on socioeconomic factors". Pediatric dermatology. 19 (4): 307–11. PMID 12220273. 
  11. Fung WK, Lo KK (2000). "Prevalence of skin disease among school children and adolescents in a Student Health Service Center in Hong Kong". Pediatric dermatology. 17 (6): 440–6. PMID 11123774. 
  12. 12.0 12.1 "Dermatology Atlas". 
  13. Lin RL, Janniger CK (2005). "Pityriasis alba". Cutis; cutaneous medicine for the practitioner. 76 (1): 21–4. PMID 16144284. 
  14. Harper J (1988). "Topical corticosteroids for skin disorders in infants and children". Drugs. 36 Suppl 5: 34–7. PMID 2978289. 
  15. Rigopoulos D, Gregoriou S, Charissi C, Kontochristopoulos G, Kalogeromitros D, Georgala S (2006). "Tacrolimus ointment 0.1% in pityriasis alba: an open-label, randomized, placebo-controlled study". Br. J. Dermatol. 155 (1): 152–5. PMID 16792767. 
  16. Di Lernia V, Ricci C (2005). "Progressive and extensive hypomelanosis and extensive pityriasis alba: same disease, different names?". Journal of the European Academy of Dermatology and Venereology : JEADV. 19 (3): 370–2. PMID 15857470. 

Cost Effectiveness of Pityriasis alba

| group5 = Clinical Trials Involving Pityriasis alba | list5 = Ongoing Trials on Pityriasis alba at Clinical Trials.govTrial results on Pityriasis albaClinical Trials on Pityriasis alba at Google


| group6 = Guidelines / Policies / Government Resources (FDA/CDC) Regarding Pityriasis alba | list6 = US National Guidelines Clearinghouse on Pityriasis albaNICE Guidance on Pityriasis albaNHS PRODIGY GuidanceFDA on Pityriasis albaCDC on Pityriasis alba


| group7 = Textbook Information on Pityriasis alba | list7 = Books and Textbook Information on Pityriasis alba


| group8 = Pharmacology Resources on Pityriasis alba | list8 = AND (Dose)}} Dosing of Pityriasis albaAND (drug interactions)}} Drug interactions with Pityriasis albaAND (side effects)}} Side effects of Pityriasis albaAND (Allergy)}} Allergic reactions to Pityriasis albaAND (overdose)}} Overdose information on Pityriasis albaAND (carcinogenicity)}} Carcinogenicity information on Pityriasis albaAND (pregnancy)}} Pityriasis alba in pregnancyAND (pharmacokinetics)}} Pharmacokinetics of Pityriasis alba


| group9 = Genetics, Pharmacogenomics, and Proteinomics of Pityriasis alba | list9 = AND (pharmacogenomics)}} Genetics of Pityriasis albaAND (pharmacogenomics)}} Pharmacogenomics of Pityriasis albaAND (proteomics)}} Proteomics of Pityriasis alba


| group10 = Newstories on Pityriasis alba | list10 = Pityriasis alba in the newsBe alerted to news on Pityriasis albaNews trends on Pityriasis alba


| group11 = Commentary on Pityriasis alba | list11 = Blogs on Pityriasis alba

| group12 = Patient Resources on Pityriasis alba | list12 = Patient resources on Pityriasis albaDiscussion groups on Pityriasis albaPatient Handouts on Pityriasis albaDirections to Hospitals Treating Pityriasis albaRisk calculators and risk factors for Pityriasis alba


| group13 = Healthcare Provider Resources on Pityriasis alba | list13 = Symptoms of Pityriasis albaCauses & Risk Factors for Pityriasis albaDiagnostic studies for Pityriasis albaTreatment of Pityriasis alba

| group14 = Continuing Medical Education (CME) Programs on Pityriasis alba | list14 = CME Programs on Pityriasis alba

| group15 = International Resources on Pityriasis alba | list15 = Pityriasis alba en EspanolPityriasis alba en Francais

| group16 = Business Resources on Pityriasis alba | list16 = Pityriasis alba in the MarketplacePatents on Pityriasis alba

| group17 = Informatics Resources on Pityriasis alba | list17 = List of terms related to Pityriasis alba


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