Pityriasis alba is usually asymptomatic in nature. Individuals with such a type of skin disorder can be present in any of the followings stages:

• Papular erythematous lesions
• Smooth hypochromic lesions 
• Papualar hypochromic lesions

The most common site for occurrence of the lesions is the cheek region followed by upper arms, upper mid portion of the body and neck. The lesions that take an oval or round shape are dry, flaky and scaly in nature. New lesions may develop in intervals and last for about a year. There are also extensive variants of pityriasis alba that are less scaly and erythematous which abound in the trunk area [5].

• Pruritus

  Efficacy assessments were Investigator Global Assessment (IGA) of disease severity and evaluation of uneven skin color, scaling, eczema, follicular keratosis, and pruritus. [ncbi.nlm.nih.gov]

  […] vulvae L29.3 Anogenital pruritus, unspecified L29.9 Pruritus, unspecified L30 Other and unspecified dermatitis L30.0 Nummular dermatitis L30.1 Dyshidrosis [pompholyx] L30.2 Cutaneous autosensitization L30.3 Infective dermatitis L30.4 Erythema intertrigo [icd10data.com]

  Symptoms Mild Pruritus may occur Triggers Significant unprotected Sun Exposure V. Signs Characteristics Hypopigmented irregular patches More noticeable in skin types 3-6 Distribution Face, head and neck Forearm VI. [fpnotebook.com]

• Hypopigmented Macule

  2-5 mm hypopigmented macules Comments: This infant with a history of seborrheic dermatitis developed hypopigmented macules on his forehead and eye brows. [web.archive.org]

  Abstract Pityriasis alba (PA) is a relatively common skin disorder usually seen in children and young adults characterized by the presence of superficial hypopigmented macules. [ncbi.nlm.nih.gov]

  The advantage is that they don’t cause cutaneous atrophy. [2] Photos Hypopigmented macules on the trunk Hypopigmented macules in a patient with eczema Literature ↑ 1.0 1.1 In SI, Yi SW, Kang HY et al. [africanskindiseases.org]

  They usually present as well defined or ill-defined, hypopigmented macules with fine superficial scaling. 7 patients had presented with hypopig mented macules with central hyperpigmentation. [ijdvl.com]

  It presents as asymptomatic, multiple, oval, finely scaly, hypopigmented macules which range in size from 5 mm to 5 cm, typically on the face or extensor surfaces of the arms of infants or children. It begins with an erythematous inflammatory phase. [utmb.edu]

• Follicular Plugging

  plugging; (3) follicular spongiosis; and (4) atrophic sebaceous glands. [ncbi.nlm.nih.gov]

  A histopathologic diagnosis of pityriasis alba may be proposed when the following features are seen in a biopsy specimen taken from a skin lesion with follicular papules: (1) irregular pigmentation by melanin of the basal layer; (2) follicular plugging [doi.org]

  He suggested that a histopathological diagnosis of pityriasis alba may be proposed when the following features are seen in a biopsy specimen, 1) Irregular pigmentation by melanin of the basal layer. 2) Follicular plugging 3) Follicular spongiosis 4) Atrophic [ijdvl.com]

• Chronic Dermatitis

  A skin biopsy of a scaly hypopigmented papule showed changes consistent with a chronic dermatitis. [web.archive.org]

  Pityriasis alba Pityriasis alba is a chronic dermatitis that may be recurrent. [utmb.edu]

  Breast skin Microscopic (histologic) description Non-specific subacute or chronic dermatitis with focal hyperkeratosis and angulated parakeratosis with slight acanthosis Granular cell layer is absent beneath the foci of parakeratosis Intraepidermal cytoid [pathologyoutlines.com]

  Late stage PA shows a finding of typical chronic dermatitis and irregularly distributed melanization4. The histologic finding of our patient showed late stage PA. [synapse.koreamed.org]

• Lichenification

  Berth‐Jones, Eczema, Lichenification, Prurigo and Erythroderma, Rook's Textbook of Dermatology, (699-754), (2008). [doi.org]

• Incontinence

  Biopsy specimens from two patients showed similar features, namely, a subacute dermatitis with variable pigment incontinence. Immunohistochemical labeling revealed a preponderance of T lymphocytes. [ncbi.nlm.nih.gov]

A thorough examination of the lesions on the face and rest of the body is usually enough to diagnose the condition. However, in certain cases, potassium hydroxide test may be necessary to rule out other skin disorders such as tinea versicolor, tinea corporis or tinea faciei [6]. In severe cases, a biopsy of the affected skin may be required to be done for differential diagnosis [7].

A type of test known as Wood’s light examination is done which would determine whether the development of rash is due to vitiligo or some other cause. All these tests would be necessary to rule out other associated skin diseases.

Pityriasis alba is a benign condition that gets corrected by on its own. However, some treatment is necessary to correct the cosmetic appearance of the individual. In addition, parents of the affected children should always be educated about this skin disorder.

Patches are effectively treated with moisturizer creams and topical agents. Low potency steroid creams are advised due to the associated side effects of such topical agents. Immunomodulators are also found to be effective against pityriasis alba. 0.1% of tacrolimus ointment and 1% of pimecrolimus creams are effective in reducing the patches associated with this skin disorder [8].

The Psoralen with Ultraviolet Light A (PUVA) have been identified to help with the repigmentation process of the skin in extensive cases of pityriasis alba, although recurrence rate is high when the treatment is halted [9].

In addition to topical agents, laser therapy has also shown to be effective against pityriasis alba. In this method, 308-nm laser is given to affected individuals twice a week for a period of 12 weeks [10]. With laser treatment, the prognosis of the disease has been found to be good.

The prognosis of the disease condition is generally favorable as the patches may resolve by themselves. However, in some cases use of medicated creams may also be necessary. Patches on the face can last for about a year. Some children may often experience recurrent bouts of pityriasis alba until adulthood.

Complications

The most common and possible complication is the risk of sun burn in the hypopigmented areas. However, with application of sun protective agents the risk does decrease significantly. Apart from this, no other complications exist.

The exact cause that triggers the development of such a type of skin disorder is not yet known. Pityriasis alba is not a result of any infection. Some theories suggest that pityriasis alba is a mild form of either dermatitis or eczema [3]. Treatment of such skin diseases with corticosteroids may leave behind hypopigmented scars which can develop into fine scale, dry, white colored patches. In addition to these, the following are some more risk factors that are known:

• Excessive exposure to sun for longer duration and without any protection
• Poor personal hygiene
• Environmental factors such as temperature, altitude and humidity

The exact prevalence of pityriasis alba is not known as the disease condition requires little treatment and individuals seldom seek medical help. This skin disorder is common for individuals below 16 years of age. Such a condition is more common in males compared to females [4].

Pityriasis alba is a common accompaniment in children who are exposed to sun for long hours without any protection. The hypopigmentation of the skin is caused due to decrease in the number of active melanocytes as well as reduction in the number and size of melanosomes. Such sequence of events is known to give rise to pityriasis alba.

Pityriasis alba cannot be prevented as its exact etiology still remains a mystery. However, affected individuals should take appropriate steps to prevent the onset of complications.

Application of sun protective creams and prescribed topical agents would help faster relief from symptoms and would also provide protection against sun burn.

Pityriasis alba is a common disorder of the skin characterized by development of dry, pale and fine patches on the face [1]. The patches are white colored and develop in round or oval shape. The name of the disorder is derived from Latin words pityriasis meaning scaly and alba meaning white.

This condition commonly strikes children and young adults. There is no specific treatment and it gets corrected when the dryness is treated with moisturizer creams. The patches subside over a period of time, but leave behind hypopigmented areas that eventually get back to the original skin color [2].

Definition

Pityriasis alba is a common skin disorder affecting children and the young population. Such a type of skin disorder is characterized by development of patches on the face, upper neck and upper portion of the body. The patches are scaly and white in color.

Cause

The exact factor that triggers the development of pityriasis alba is unknown. However, research has suggested that such a type of skin disease is a form of eczema or dermatitis. Pityriasis alba is not contagious in nature.

Symptoms

The lesions that develop are usually scaly and white colored patches that commonly appear on the face. These patches do not get tan when exposed to sun; however can turn red. New patches can appear in regular intervals and can last for more than a year.

Diagnosis

A physical examination of the patches is enough to diagnose the disease condition. However, in some cases, Potassium hydroxide test may also be required to rule out other underlying associated skin disorders. Certain cases may also demand skin biopsy to conduct differential diagnosis of the disorder.

Treatment

Treatment requires application of topical agents and moisturizing creams. Low potency corticosteroids topical agents are prescribed to avoid side effects due to these agents. Individuals are also advised to apply sun protective lotions to prevent the affected area from sun burn.

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2. du Toit MJ, Jordaan HF. Pigmenting pityriasis alba. Pediatr Dermatol. Mar 1993; 10(1):1-5.
3. Brenninkmeijer EE, Spuls PI, Legierse CM, Lindeboom R, Smitt JH, Bos JD. Clinical differences between atopic and atopiform dermatitis. J Am Acad Dermatol. Mar 2008; 58(3):407-14.
4. 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.
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8. 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.
9. Gambichler T, Krämer HJ, Boms S, Skrygan M, Tomi NS, Altmeyer P, et al. Quantification of ultraviolet protective effects of pityriacitrin in humans. Arch Dermatol Res. Dec 2007; 299(10):517-20.
10. Al-Mutairi N, Hadad AA. Efficacy of 308-nm xenon chloride excimer laser in pityriasis alba. Dermatol Surg. Apr 2012; 38(4):604-9.