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Pityriasis alba
https://www.symptoma.com/en/info/pityriasis-alba
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].

Etiology

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

Epidemiology

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].

Pathophysiology

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.

Prognosis

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

There are also extensive variants of pityriasis alba that are less scaly and erythematous which abound in the trunk area [5]. parents of the affected children should always be educated about this skin disorder. flaky and scaly in nature. The lesions that take an oval or round shape are dry. potassium hydroxide test may be necessary to rule out other skin disorders such as tinea versicolor. no other complications exist. tinea corporis or tinea faciei [6]. upper mid portion of the body and neck. However. Immunomodulators are also found to be effective against pityriasis alba.1% of tacrolimus . Complications The most common and possible complication is the risk of sun burn in the hypopigmented areas. Treatment Pityriasis alba is a benign condition that gets corrected by on its own. Some children may often experience recurrent bouts of pityriasis alba until adulthood. 0. All these tests would be necessary to rule out other associated skin diseases. a biopsy of the affected skin may be required to be done for differential diagnosis [7]. with application of sun protective agents the risk does decrease significantly. 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. New lesions may develop in intervals and last for about a year. Presentation Pityriasis alba is usually asymptomatic in nature.on the face can last for about a year. Low potency steroid creams are advised due to the associated side effects of such topical agents. In addition. However. Apart from this. However. 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. some treatment is necessary to correct the cosmetic appearance of the individual. In severe cases. Workup A thorough examination of the lesions on the face and rest of the body is usually enough to diagnose the condition. in certain cases. Patches are effectively treated with moisturizer creams and topical agents.

Pityriasis alba is not contagious in nature. These patches do not get tan when exposed to sun. laser therapy has also shown to be effective against pityriasis alba.ointment and 1% of pimecrolimus creams are effective in reducing the patches associated with this skin disorder [8]. however can turn red. Cause The exact factor that triggers the development of pityriasis alba is unknown. Application of sun protective creams and prescribed topical agents would help faster relief from symptoms and would also provide protection against sun burn. although recurrence rate is high when the treatment is halted [9]. However. However. affected individuals should take appropriate steps to prevent the onset of complications. research has suggested that such a type of skin disease is a form of eczema or dermatitis. Certain cases may also demand skin biopsy to conduct differential diagnosis of the disorder. the prognosis of the disease has been found to be good. 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. upper neck and upper portion of the body. Diagnosis A physical examination of the patches is enough to diagnose the disease condition. Symptoms The lesions that develop are usually scaly and white colored patches that commonly appear on the face. Potassium hydroxide test may also be required to rule out other underlying associated skin disorders. With laser treatment. Patient Information Definition Pityriasis alba is a common skin disorder affecting children and the young population. In this method. Such a type of skin disorder is characterized by development of patches on the face. Treatment . Prevention Pityriasis alba cannot be prevented as its exact etiology still remains a mystery. In addition to topical agents. New patches can appear in regular intervals and can last for more than a year. The patches are scaly and white in color. 308-nm laser is given to affected individuals twice a week for a period of 12 weeks [10]. in some cases. However.

Several patches may be observed at once usually on the face and arms. lasting from several months to over a year. A moisturizer cream or lotion may be recommended to retain moisture in the skin. or lighter coloration. Dermatology for the Allergist https://waojournal. Elidel. The lesions may be round. Diagnosis is usually made solely on clinical signs and symptoms. The cause of pityriasis alba is unknown. Lesions can appear several times. can also reduce itching and redness associated with pityriasis alba for those over the age of two.biomedcentral. pink or skin colored. Pityriasis alba sometimes works itself out spontaneously and does not always require treatment. These patches resolve leaving areas of scaling hypo-pigmentation. 2. Young children are most often affected but pityriasis alba tends to go away by adulthood.com/articles/10. Low potency corticosteroids topical agents are prescribed to avoid side effects due to these agents.1097/WOX.1097/WOX.0b013e3181e2eb2e  Dennis KimEmail author and  Richard Lockey World Allergy Organization Journal20103:202 DOI: 10.Treatment requires application of topical agents and moisturizing creams. A low potency topical corticosteroid may also be prescribed to decrease inflammation and reduce symptoms. oval or irregular in shape and red. Patients do not usually seek treatment of the lesions until this stage because of the concern for the appearance of the scales. Pityriasis Alba http://www. although it has been regarded as a manifestation of another skin disorder called atopic dermatitis. scaly patches.org/?page=PityriasisAlba Pityriasis alba is a common skin condition first characterized by red. A biopsy may be performed but usually will show unimpressive changes under the microscope.aocd. The lesions are obvious on those with darker skin. The loss of pigment associated with pityriasis alba is not permanent. a nonsteroidal topical cream. The duration of the rash is variable.0b013e3181e2eb2e . 3. Individuals are also advised to apply sun protective lotions to prevent the affected area from sun burn. Patients with lighter skin will notice the rash more frequently during the summer months as their skin tans.

Pityriasis Alba Pityriasis alba is often considered to be a mild form of atopic dermatitis [10]. Keywords dermatology dermatitis allergy allergic allergist skin disease Introduction Allergists/immunologists see patients with a variety of skin disorders. 2010 Published: 15 June 2010 Abstract Allergists/immunologists see patients with a variety of skin disorders. 0. lack an immunologic basis. The disease affects 5% of children aged 3 to 16 years with improvement after puberty. This review summarizes a select group of dermatologic problems commonly encountered by an allergist/immunologist. whereas others. The lesions are usually asymptomatic. This review summarizes a select group of dermatologic problems commonly encountered by an allergist/immunologist. licensee BioMed Central Ltd. such as seborrheic dermatitis or rosacea. are caused by abnormal immunologic reactions. such as seborrhoic dermatitis or rosacea. such as atopic and allergic contact dermatitis. followed by hypopigmentation (Figure 2). but patients may complain of local itching or burning.© World Allergy Organization. such as atopic and allergic contact dermatitis. whereas others. lack an immunologic basis. but can remain for more than 1 year. The hypopigmentation may be more conspicuous in dark-skinned individuals and typically lasts several months. are caused by abnormal immunologic reactions. . The lesions mostly affect the face. Some. and upper extremities but can also occur on the trunk and lower extremities. The rash initially appears as mildly erythematous and scaly circular plaques. neck. Some.5 to 2 cm in diameter.

It is not contagious. Pityriasis means skin scaling and alba means white. The lesions typically resolve spontaneously without further treatment. It appears as pink scaly patches which later leave pale areas on the skin. What causes pityriasis alba? The cause is unknown. 2009. thus making it important to inquire about personal or family history of atopic diseases such as asthma. allergic rhinitis. related to eczema.5%) or tacrolimus can be used to relieve symptoms such as itching caused by inflammation. Etiology is unknown.bad. Although unnecessary for diagnosis. Differential diagnosis includes other disorders that cause hypopigmentation such as vitiligo.bad. Figure 2 Pityriasis alba hypopigmentation. but a connection with atopy has been suggested.uk/for-the-public/patient-information-leaflets/pityriasis- alba/?showmore=1&returnlink=http%3A%2F%2Fwww. What are the symptoms of pityriasis alba? . Reprinted with permission from Habif. Elsevier. It is thought to be due to a minor form of inflammation in the skin. 4. or eczema. The condition can be exacerbated by excessive. and nevus depigmentosus. Pityriasis alba responds very well to topical moisturizers and emollients. unprotected sun exposure and environmental factors such as temperature and humidity [11]. 5th ed. halo nevus. PITYRIASIS ALBA http://www. tinea versicolor. histology will show nonspecific acanthosis and mild spongiosis with moderate hyperkeratosis and patchy parakeratosis [12].org. Is pityriasis alba hereditary? No. but it can occur in people who have no history of eczema at all. and more pronounced after exposure to the sun and the tanning of the non-affected skin.org. These pale areas are more noticeable in people with dark skin.uk%2Ffor- the-public%2Fpatient-information-leaflets What is pityriasis alba? Pityriasis alba is a common skin complaint of children and young adults. Clinical Dermatology. but topical hydrocortisone (1% or 2.

and may come and go during this period. How is pityriasis alba diagnosed? This condition is usually diagnosed by its appearance and tests are not needed. as these areas don’t tan as usual. particularly in summer when the patches become prominent due to the tanning of non-affected skin. If the patches are red or itchy. Self care (What can I do?)  Use moisturisers for the dryness  Do not use soap  Avoid sun especially in summer and in holiday by using high sunscreen products (no less than 30 SPF) BRITISH ASSOCIATION OF DERMATOLOGISTS PATIENT INFORMATION LEAFLET PRODUCED DECEMBER 2015 REVIEW DATE DECEMBER 2018 . The dryness can be helped by using a moisturiser and avoiding soap. Sunscreens in summer may prevent the patches becoming more noticeable by reducing the tanning of the non-affected skin. particularly in people with darker skin.The rash can be mildly itchy but usually causes no problems. a mild steroid cream (hydrocortisone) can be applied for a short period to improve symptoms. What does pityriasis alba look like? It starts as rounded or oval pink rough patches of skin that fade to leave areas with reduced pigment. It often goes unnoticed when it first starts. It can also affect the trunk. arms and legs. Can pityriasis alba be cured? Pityriasis alba usually resolves spontaneously. Sometimes it can be dry. How can pityriasis alba be treated? Medical treatment is not needed unless the skin is uncomfortable from itching. The pale areas are often more noticeable after sun exposure. it may persist for a few years. and the skin colour gradually returns back to normal with no scarring. chin and skin around the mouth. but it is the loss of pigment that triggers people to seek medical advice. However. The most commonly affected areas are the cheeks.

Applying sunscreen and using other sun protection can help prevent sunburn. the patches turn light-colored (hypopigmented). The patches do not tan. Causes The cause is unknown but may be linked to eczema and a history of allergies. Possible Complications Patches may get sunburned when exposed to sunlight. Exams and Tests The health care provider can usually diagnose the condition by looking at the skin.htm Pityriasis alba is a common skin disorder of patches of light-colored (hypopigmented) areas. a skin biopsy is done. may be done to rule out other skin problems. 5. After these lesions go away. but often return.nih. Outlook (Prognosis) Pityriasis alba usually goes away on its own with patches returning to normal pigment over time. The disorder is most common in children and teens. Tests. but may get red quickly in the sun. It is more noticeable in children with dark skin. Treatment The provider may recommend the following treatments:  Moisturizer to help with the scales  Mild steroid creams  Medicine called immunomodulator applied to the skin to reduce inflammation  Laser treatment The patches may clear up. upper arms.gov/medlineplus/ency/article/001463. Symptoms The problem areas on the skin (lesions) start as slightly red and scaly patches that are round or oval. neck. In very rare cases. They usually appear on the face. and upper middle of the body. such as potassium hydroxide (KOH).nlm. . Pityriasis alba https://www.

however.1 and Craig N. In: Habif TP. MD. which may be advantageous with affected individuals. An evaluation into causative factors translates into alternative therapeutic options. Burkhart *. it is possible that one is looking at slightly different diseases with similar clinical characteristics. Burkhart 2 1 University of Toledo College of Medicine. Atlanta Center for Dermatologic Disease. The Open Dermatology Journal. Patterson JW. MHA. North Carolina. Editorial team.D. Weedon's Skin Pathology. This list includes dermatitis. 6th ed.When to Contact a Medical Professional Call your health care provider if your child has patches of hypopigmented skin. 2009. and post-inflammatory alterations. PhD. There is no specific known cause for this condition. . In: Patterson JW. 2016:chap 19.M. Review provided by VeriMed Healthcare Network. Update Date 4/14/2015 Updated by: Kevin Berman. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. USA 2 University of North Carolina at Chapel Hill. Philadelphia. 7-8 71874-3722/09 2009 Bentham Open https://www. 3. photosensitivity. ed. Disorders of pigmentation. Atlanta. and the A. 4th ed. PA: Elsevier Mosby. 6. Also reviewed by David Zieve. Light-related diseases and disorders of pigmentation. PhD. MD.net/publication/50434863_Pityriasis_Alba_Revisited_Perspectives_ on_an_Enigmatic_Disorder_of_Childhood Pityriasis Alba: A Condition with Possibly Multiple Etiologies Craig G. 2015:chap 10. fungal and bacterial pathogenesis. Isla Ogilvie. USA Abstract: Pityriasis alba is a common hypomelanosis which is generally seen in young children. ed.A.researchgate. Philadelphia. Chapel Hill. GA. studies to elucidate pathogenic factors seem to suggest that there are at least five separate causes for the condition. PA: Elsevier Churchill Livingstone. When a disease has diverse clinical presentations and no known cause. References Habif TP.

pityriasis lichenoides chronica. Hypopigmentation can also be explained by damage to . The condition often begins as a pale pink or light brown macule with very indistinct margins. how- ever. and upper chest may predominate in others. The hypopigmentation with pityriasis alba is due to both reduced activity of melanocytes as well as fewer and smaller melanosomes. the condition reveals subacute spongiotic dermatitis with decreased melanin within the epidermis. Thus. Tel: 419-885-3403. on the other hand. and mycosis fungoides. defined as showering over once daily [1]. tinea ver- sicolor. often the flakiness is not present.5 to 6 cm in diameter. The condition is so named as ‘pityriasis’ means scaly and ‘alba’ is the word for white in Latin. pale patches. any in- flammation of the skin may affect pigment cell function. Fax: 419-885-3401. Macules vary from 5 to 30 mm or larger. there is total loss of both melanocytes and melanosomes. particularly the mid-forehead. It is symmetrical in distribution. Certainly. how- ever. neck. the melanocytes appear to be sensitive to sun in these patients. Typical location of lesions is in sun-exposed areas. many consider the disease to be a mild form of ec- zema. back. 5600 Monroe Street. in vitiligo. Indeed. *Address correspondence to this author at the University of Toledo School of Medicine. This could infer that removal of normal epidermal defensins and other natural protective substances from the skin surface. First.com makes one more prone to this condition. adult T-cell leukemia/lymphoma. the patches in pityriasis alba are not totally depigmented as with vitiligo. It usually appears as dry. fine scaled. USA. follicular mucinosis. ma- lar ridges. The rash is limited to the face in 50 % of cases. and around the eyes and mouth. A differential diag- nosis would include vitiligo. nevertheless. Also prolonged sun exposure of several hours also increases one’s chances of developing the condition. studies to elucidate pathogenic factors seem to suggest that there are at least five separate causes for the condition. OH 43560. Histologically. photosensitivity may also play a role in this entity [1]. Of note. E-ma il: cgbakb@aol. Suite 106B. 0. There is no specific known cause for this condition. but can be additionally seen in young adults. but it often just appears suddenly with decreased pigmenta- tion. in- volvement of the shoulders. there is an increased incidence in individuals who bath excessively.Pityriasis alba is a common condition in practice mostly occurring in children between the ages of 3 and 16. The peak incidence of the condition coincides with the age when children begin to do more outdoor activi- ties. but sometimes only marginally. psoriatic leukoderma. Sylvania. Secondly. sarcoidosis.

some pityriasis alba patients have a sensitivity to the byproducts of this fungus. Thus. and/or tryptophan-derived metabolites produced by normal yeast. India 533296. Andhra Pradesh. pityriasis alba may be merely sec ondary to postinflammatory changes. 8]. World Journal of Pharmaceutical Research AN UPDATED REVIEW ON PITYRIASIS ALBA Sripada Ramam*. the organism is not increased in numbers in pityriasis alba. a yeast that is part of the skin surface’s normal flora [2.net Vol 3. 2014. Additionally. namely Malassezia furfur . which is advantageous with con- ditions which lack a definitive cure.wjpr. Department of Pharmacy practice. has been considered as a possible producer of a hypothetical depigmenting factor [5. pathogenic fungus are not involved with this condition [4]. 6]. GIET School of Pharmacy. An evaluation into causative factors translates into alter- native therapeutic options. Propionibacterium acnes was yielded from cultured biopsy specimens taken from follicular lesional skin [6]. 3]. azelic acid (a competitive inhibitor of tyrosinase).melanocytes and inhibition of tyrosinase by decarboxylic acid. Magharla Dasaratha Dhana Raju. Unlike tinea versicolor. Evaluations of causes of pityriasis alba are therefore warranted. AN UPDATED REVIEW ON PITYRIASIS ALBA www. Issue 6. Propionibacterium acnes produces a number of bioactive virulence factors and is known for its inflammatory and im- munomodulatory properties [7. Bondada Bharatha Pushya Raja Sanjay. 7. which live in the hair follicles. . Indeed. Gudimetla Lilli Sailaja. studies of alterations of the stratum corneum by both hygroscopicity and water- holding capacity detectable by water sorption-desorption testing support this theory [10]. Pityriasis alba is frequently noted in children with early comedonal and popu- lar acne. A number of exocellular enzymes and metabolites can directly damage host tissue including melanocytes [9]. Bondada Neelima. Propionibacterium acnes bacteria. 2162 Ramam et al. Also. Rajahmundry. Bonam Jyothi.

It was first described by fox in 1923. 2014. Alba that includes endemic P. diagnosis and effective therapeutic plans to provide better patient care for individuals with P.05%). Andhra Pradesh. neck [3] and around the mouth [4]. hyperkeratosis. Impetigo furfuracea.1%). pityriasis streptogenes. histological pattern and effective treatment approaches. They are often characterized by hypo pigmented patches with 0. Spongiosis. Alba.5%) and (1%). This skin disorder is also called as erythema streptogenes.wjpr. The exact etiology of P. Rajahmundry. 2162-2171. He was unable to account for its pathogenesis and kept unnamed for many years.ABSTRACT Pityriasis Alba (P. Lesions are usually oval or round or irregular in shape with red or pink or skin coloured and may ranges from 4-20 in number.0003%). Alba is not known. Spongiosis. Key words: Pityriasis Alba. Pityriasis simplex. Alba is derived from two Latin words pityriasis (scaly) and alba (white patches) [2]. Pimecrolimus (1%). Issue 6. India 533296. Lac-Hydrin. There are two types of P.net Vol 3. 2163 Ramam et al. Alba remained mysterious to understand because of no exact etiology. These white patches are most commonly seen in the areas like face. Accepted on 20 August 2014 *Correspondence for Author Sripada Ramam Department of Pharmacy practice. Issue 6. It was first described by fox in 1923. Elidel. World Journal of Pharmaceutical ReseaRch SJIF Impact Factor 5. Low potency topical steroids like Hydrocortisone (0.5-6cms in diameter. Alba) is a relatively common skin disorder characterized by the presence of fine scaly hypo pigmented macules or patches. World Journal of Pharmaceutical Research INTRODUCTION Pityriasis Alba (P. Desonide (0. . Lesions become prominent in sun exposure so in order to reduce the discrepancy. Erythema streptogenes. Tacrolimus (0. The term P. Calcitriol (0. Zetar (2%) in Cordran cream. Treatment with 308nm excimer laser twice a week for 12 weeks is also an effective treatment approach. In some circumstances. Vioform cream (1%) were found to be effective in treating this disorder. Alba and atopic dermatitis related P. acanthosis. parakeratosis are the histological findings that can be observed during diagnosis.045 Volume 3. Patients should be strictly advised not to expose to harsh sunlight. Alba) is a relatively common skin disorder characterized by the presence of fine scaly hypo pigmented macules or patches [1]. Review Article ISSN 2277 – 7105 Article Received on 30 June 2014. Pityriasis streptogenes. Hence there is an urgent need for the evaluation of etiology. sunscreen creams or lotions are recommended. P. Sorbityl furfural palmitate cream. impetigo furfuracea and pityriasis simplex [6].. GIET School of Pharmacy. There was no gender variability for this skin disorder and was prevalent all over the world. trunk. He was unable to account for its pathogenesis and kept unnamed for many years [5]. pathogenesis. www. Revised on 25 July 2014.

This skin disorder was affecting 5% of pediatric population among the worldwide distribution [10. Alba is best characterized as a form of dermatitis which occurs due to reduction in melanocytes and melanosomes with no defect in melanosomal transfer to keratinocytes [8]. P. Endemic P. A retrospective analysis revealed that around 90% of patients who were diagnosed with P. Alba were between the ages of 6-12years and the remaining 10% patients were between the ages of 13-16years [15]. females are more prone to this skin disorder than males and in some investigations male predominance has been reported slightly [10]. Loss of pigment is not permanent in this skin disorder [9]. It results primarily from inflammation involving the epidermis and superficial dermis. Alba is not known.2% Nepal 5. Symptoms Lesions are usually oval or round or irregular in shape with red or pink or skin coloured and may ranges from 4-20 in number [3]. World Journal of Pharmaceutical Research existing literature. which interferes the normal pigmentation. Issue 6. and aspergillus are known to be the causing factors but are not yet confirmed [25]. 19-24] Name of the country Prevalence rates Brazil 9. 26. The prevalence of P. and was more predominant in children between the ages of 3-16 years. Triggering factors that may cause P. the higher incidence of P. A ten year survey on P. Alba in different parts of the world. P.49% Hong Kong 1% India 8. humidity and excessive sunlight exposure (iii) frequent bathing (iv) usage of various harsh detergents & soaps (v) dry and itching skin (vi) hypo pigmentation (vii) worms & parasites (viii) stress (ix) deficiency of copper and (x) atopic diseases and/or a family history of eczema [3.9-5. Hence. Some microorganisms such as pityrosporum.9% Egypt 13. Alba showed a prevalence rate of 81% and the patients were at the age of ≤ 15 [16]. Alba usually occurs in infants and children of low socioeconomic condition [7]. A study was conducted among 9955 school going children who were between the ages of 6-16 years in topical region have reported a prevalence rate of 9. 13. Alba spots are common in all skin colours but are more often noticeable in darker skin [20].25% [14]. Table 1 represents the prevalence rates of P.Alba with post inflammatory hypo pigmentation. pigmentary changes among blacks and whites were found to be 9% and 1. we can describe that there was no gender variability for this skin disorder [11]. 10.1% Turkey 12% United States 5% (approximately) Etiology The exact etiology of P. 27].4-31% Iraq 38. Epidemiology According to some investigations.2% Romania 5. Alba in school children is due to poor socioeconomic background [19]. This disorder was prevalent all over the world and the prevalence may vary from country to country [12]. Alba includes (i) deficiency of vitamins & calcium (ii) temperature variations. 2164 Ramam et al. Alba among preadolescent children may ranges from 1. According to a study. Table 1: Prevalence rates of Pityriasis Alba in different parts of the world [17. Alba occurs in all age groups.wjpr.9% [17. staphylococcus. 2014. P.7% respectively [10]. streptococcus. 13].net Vol 3. According to the www. They are often characterized by hypo pigmented patches . 18].

extensive P. Alba. Issue 6. Sometimes pityriasis alba is often confused with tinea versicolor.net Vol 3. 2014. and mycosis fungoides [13]. A recent study revealed that P. According to Vargas-Ocampo et al. progressive macular hypomelanosis. nummular eczema. In P. The first (early) stage begins as erythematous with an elevated border that may lasts for weeks. these appear as a visible. 2165 Ramam et al. Alba and Koebner’s phenomena [20]. . The diagnosis can be carried out by a Potassium Hydroxide (KOH) examination. Alba usually seen with 2 or 3 macules or patches at a time in several stages. post inflammatory hypo pigmentation. malar ridges. Other histological findings such as acanthosis. neck. These two stages are marked by the presence of pinpoint follicular papules. Alba (ii) close association between vitiligo and P. Differential diagnosis includes vitiligo. around the eyes and mouth. Fungal elements can be observed in conditions like tinea verscicolor but not with P. adult tcell leukemia/ lymphoma. where as in vitiligo the loss of pigmentation is usually complete. Issue 6. the intermediate stage is known as papular hypo chromic stage which is also called as follicular pityriasis alba and the final stage is described as smooth hypo chromic stage. KOH stain shows a positive result not only in case of tinea verscicolor but also in the cases of tinea fociei and tinea corposis [30]. 2014. Skin Biopsy is not usually necessary or recommended in diagnosing P. The early stage is known as papular erythematous stage. round and hypo pigmented macule with well defined borders. Sometimes P. 18].5-6cms in diameter. Alba is not symptomatic. Alba in the same patients (iii) a huge percentage of P. During winter the patients may experience dry scaly appearance [17. pytiriasis lichenoides chronica. P. the patch may be replaced by a smooth scaly layer.wjpr. tuberous sclerosis. there are 3 stages of P. Alba but may be indicated in the diagnosis of mycosis fungoides. back and upper chest [10]. tinea verscicolor.. hyperkeratosis. Alba. because of skin tans.with 0. Sometimes it may be associated with mild itching [4]. World Journal of Pharmaceutical Research are (i) genetic susceptability as confirmed by strong family history of vitiligo among individuals with P. parakeratosis can often be seen [28]. nevus depigmentosus. World Journal of Pharmaceutical Research Figure 1: White patches of p alba on cheeks and around the mouth Diagnosis P. Alba. Both P. follicular mucinosis.net Vol 3. P. The patient usually seeks medical treatment during this stage [29]. Alba the loss of pigmentation starts at the centre and extends peripherally. Alba may become worse during summer. The other areas that may be affected by this skin disorder are shoulders. classic P. Patch distribution is symmetrical and sometimes marginal. In third stage.wjpr. www. Alba progressed to vitiligo and (iv) the high association of P. Alba and vitiligo are hypo pigmented inflammatory skin diseases. pigmenting P. Alba can be diagnosed by using clinical findings. Mostly P. Then add potassium hydroxide and observe under the microscope. Alba. Mostly lesions are found on the upper extremities and occasionally on the lower extremities [14]. many patients do not mention lesions and are often found incidentally [16]. nevus anemicus. Lesions are more commonly limited to the face especially. Alba. 2166 Ramam et al. sarcoidosis. In the second stage (intermediate). Spongiosis is a consistent histological finding in the diagnosis of P. in areas like mid forehead. Alba may get confused with vitiligo. Alba.Alba might convert into vitiligo and the four findings that might justify the above statement in their study www. psoriatic leukoderma. The surface of the skin was scrapped off in a small amount onto a glass slide.

prominent care towards the health is a significant aspect. Tacrolimus ointment had shown efficacy and safety in 60 pediatric patients with P. patients who were between the ages of 2 months to 15 years. Patient Education The precautions to be taken by the P. 36]. can also be prescribed to reduce itching and erythema associated with P. sunscreen creams or lotions are recommended. promotes melanin synthesis and has immuno-modulation properties.34]. Prefer moisturizing soaps for bathing and apply moisturizers like petroleum jelly or fragrance free ointments and creams to get the skin to be moisturized.1%) for pediatrics was not approved [34. Alba no clinical trials were reported. Zetar (2%) in Cordran cream and Vioform cream (1%) were also found to be effective in treating this disorder [35.1%) and Pimecrolimus (1%) had shown an excellent response in atopic related P. Lac- Hydrin. Alba do not darken in sunlight. Alba patients.wjpr. Elidel. a significant improvement was observed with this cream when compared to those with on placebo after 15 and 30 days [1].Treatment Corticosteroids and Immuno suppressors Low potency topical steroids like Hydrocortisone (0. a non steroid topical cream. In severe cases. Cosmetic camouflage can be considered as a choice for this [33. we can prescribe Tacrolimus (0. Several sunscreens have emollient information (eg: water based vs oil based) listed on the label. These are extremely safe for prescribing in young children but prolonged use on face is not recommended. Alba for those over the age of 2 years. These features are useful in treating endemic P.03%) which was indicated as an off-labeled drug [29]. Alba. For chronic lesions on the trunk. Advice the patients to attend for the periodic skin examination . placebo controlled study. Other treatment approaches Usually. In an open label. 2167 Ramam et al. Bland Emollient creams should be prescribed to reduce scaling of lesions on www. Alba [37-41]. For endemic P. Lesions become prominent in sun exposure so in order to reduce the discrepancy. Recently immunosupressors like Tacrolimus (0. World Journal of Pharmaceutical Research face [42]. Presence of chlorine in pool water may cause tanning. Sorbityl furfural palmitate cream was found to be effective in treating mild to moderate atopic dermatitis in P. According to some small open label studies. tar paste can be used.1%). Alba. Calcitriol and Other Drugs Calcitriol (0. if not listed it is better to check with the pharmacist/ physician. prescribing of Tacrolimus (0. Instead of Tacrolimus (0. effective sun protection is essential. pruritis associated with initial lesions and repigmentation of existing lesions [31-33]. According to a double blind placebo-controlled trail. swimming should be avoided. Sunscreens use can be recommended to all patients with various skin types. Alba patients are: Patients should be strictly advised not to expose to harsh sunlight.05%) are required for treating the symptoms like erythema. Desonide (0. Issue 6. 35]. Alba. fungal infections. In order to decrease the discrepancy in colouration against the surrounding normal skin. 2014. Psoralen ultra violet light A (PUVA) therapy was considered but the recurrence rate will be more after discontinuation of the treatment. the patches of P.0003%) is an endogenous hormonally active derivative of vitamin D.5%) and (1%). Hence. It activates melanocytes. But. Tar containing topicals are unfavorable in terms of patient adherence and efficacy too.alba among African and American adult patients [36]. Hence. In another study. Treatment with 308nm excimer laser twice a week for 12 weeks is also an effective treatment approach for treating this skin disorder [42]. In some countries. nutritional deficiencies and anemia are more frequent in case of patients with P.net Vol 3. parasitic infections. Bacterial infections. Pimecrolimus cream was found to be effective in treating p.

www. 83:915-919. remaining the term P. Mohammed AA. 11. O’Farrell NM. Goldsmith LA. Pinto FJ. 6. 82:183-189. Prevalence of hypo pigmented macules in a healthy population. Dermatol. Pityriasis Alba: a form of atopic dermatitis. In some circumstances. Prasad AS. 2012. Alba. AMA Arch Dermatol. Miale AJ.without fail. JEADV. P. 1985. Pityriasis alba revisited: perspectives on an enigmatic disorder of childhood. Jadotte YT. Arch Dermatol. 1956. Patrizi A. 25(3): 373–382. Pityriasis Alba: A Condition with Possibly Multiple Etiologies. Cutis. 1991. Bassaly M. New York. 10. Pediatr Dermatol. . Pityriasis alba: a study of pathogenic factors. 2009. 2007. placebo-controlled clinical trial. Sudhaus BD. 15. 16:31–33. De Oliveira OLM. 1999. pathogenesis. 2014.net Vol 3. Cestari TF. Periodic synopsis on pigmentation. Issue 6. 5. Paller AS. Nordlund JJ. 38 (4): 991–1017. 1996.wjpr. A double-blind. histological pattern and effective treatment approaches. Hypomelanoses and hypermelanoses. 3. Francis JS. Pediatr.net Vol 3. 12. Arch Dermatol. 9. Craig NB. Katz SI. North Am. 12:361. Alba more pertinent and precise. 3:7-8. JAAD. Al-Hasawi F. 87(2):66–72. Kierland RR. Alba remained mysterious to understand because of no exact etiology. www. Springer: 2008. 16: 463-468. 1963. Weber MB. 10(1):1-5. World Journal of Pharmaceutical Research 13. Craig GB. Du Toit MJ. Vanderhooft SL. Alsaleh QA. Journal of the Saudi Society of Dermatology & Dermatologic Surgery.wjpr. 7th ed. Clin. Pediatr. Hypomelanotic Conditions of the Newborn and Infant. 2169 Ramam et al. Wells BT. Neri I. Pigmenting pityriasis alba: Case report and review of the literature. Jordaan HF. Watkins DB. 147(6. Raone B. Pigmenting pityriasis alba. 14. Raboni R. Bolognia JL. Janniger CK. Gilchrest BA. diagnosis and effective therapeutic plans to provide better patient care for individuals with P. Provide awareness regarding health education on personal hygiene and clean environment [15. Hence there is an urgent need for the evaluation of etiology. Studies on pityriasis alba: a common facial skin lesion in Egyptian children. The Open Dermatology Journal. REFERENCES 1. 2168 Ramam et al. Efficacy and tolerability of a cream containing ARGG27 ® (sorbityl furfural palmitate) in the treatment of mild/moderate childhood atopic dermatitis associated with pityriasis alba. Leffell DJ. Issue 6. 1960. Pediatr. 2014. 7. 624–625. Suppl 1):1-8. Whyte HJ. 16. Pityriasis alba.Disorders of hypo pigmentation in children. J. G Ital Dermatol Venereol. 2. Nanda A. Pityriasis Alba: a tenyear survey and review of the literature. Arch Dermatol. 73:376-377. 129: 355–361. Ruiz Maldonado R. 16:6–11. 4. In: Fitzpatrick’s Dermatology in General Medicine. Sober AJ. Dermatologic Clinics. 88:272-275. 44]. 2002. Pagon RA. Hansen TW. 2011. 43. 1993. World Journal of Pharmaceutical Research CONCLUSION The presence of hypo pigmented lesions remains difficult to find. Wolff K. pp. De Avila LGS. A preliminary report. 1961.000 cases. 8. 2012. Albaneze R. A prospective survey of pediatric dermatology clinic patients in Kuwait: an analysis of 10.

30. Aftimos BG. World Allergy Organ J. Pityriasis Alba versus vitiligo Journal of the Saudi Society of Dermatology & Dermatologic Surgery. 2003. Popescu CM. Harper J. Dermatol. 27. 2nd ed.net Vol 3. Singh G. 1981. Bol Asoc Med PR. Rigopoulos D. 2002. randomized. 1995. Parneix Spake A. Vargas-Ocampo. Charissi C. 28. Kalogeromitros D. 2003. 34. JAAD. Williams HC. 2006. Queille C. Pilot trial of 1% pimecrolimus cream in the treatment of seborrheic dermatitis in African American adults with associated hypopigmentation. Hofny ER. 20. 3(6): 202- 215. Saurat JH. Sanchez JL. 2011. Br J Dermatol. World Journal of Pharmaceutical Research 29. 2013. 2007. J. Gunduz K. Dermatologica. Georgala S. Adil AN. 33(1):74-77. Suppl 5): 34-37. 19:307- 311.wjpr. 24. 2002. Kontochristopoulos G. Clinicopathologic study on pityriasis alba. Bechelli LM. 1990. 22. 46(7):700-705. Multicenter trial for long-term safety and efficacy comparison of 0. Extensive pityriasis alba: a histological histochemical and ultra structural study. An exploratory study to evaluate the efficacy of pimecrolimus cream 1% for the treatment of pityriasis alba. 19. J Am Acad Dermatol. pp. Thappa DM. Int J Dermatol. 1984. 2014. 155(1): 152-155. Abdel-Aty MA. Indian J Dermatol. Haddad N. 1992.05% desonide and 1% hydrocortisone ointments in the treatment of atopic dermatitis in pediatric patients. Efficacy versus systemic effects of six topical steroids in the treatment of atopic dermatitis of childhood. 108: 83–90. 18. Int. 82: 463-465. New York. 1993. 17: 51–54. Brazil). BJD. 42 (11): 887–892. Zaynoun ST. 32. Galadari E. Issue 6. Forsea D. Pediatric dermatology. Sahin MT. Levy M. 54: 1083. Nath AK. Epidemiological survey of skin diseases in schoolchildren living in the Purus Valley (Acre State. Pediatr Dermatol. 25. placebo-controlled study. Gregoriou S. 1983. Jaisankar TJ. Pandya AG. Dermatology. . 36. 163(1):78-93. Inanir I. 31: 525-526. Upper Egypt. 1(3): 246-253. Drugs. 68:338-340. Haitham MS. Sori T. Fujita WH. Dermatol. Tacrolimus ointment 0. Indian J Dermatol Venereol Leprol. Epidemiology of skin diseases in school children: a study from northern India. 26. Abdel-Hafez K. 140 (5): 891–896. Clinico epidemiological study of pityriasis alba. 2170 Ramam et al. 2006. 1999. 21. Hypopigmentary disorders in children in South India.17. Helmy M. 23. Pityriasis Alba: a histologic study. Tenekjian KK. Prevalence of skin conditions in primary school children in Turkey: differences based on socioeconomic factors. Pediatr Dermatol. 2010. The prevalence of skin conditions in Romanian school children. Amazonia. J. 32(12): 870–873. Kumar B. Martin RF. Pimenta WP.1% in pityriasis alba: an open-label. Int J Dermatol. (36. International Journal of Dermatology. Otto Braun F. Pommarede R. Springer Science & Business Media: 2000. Grover S. Khalifa ES. Lugo-Somolinos A. Popescu R. www. 20 (6): 470–473. Lockey R. 1684. 33. 31. Vinod S. Dermatology for the allergist. High WA. Kim D. 1988. Jorizzo J. Lucky A. Prevalence of skin diseases in rural areas of Assiut Governorate. Dash K. Ahmed M. 35. Trace elements in serum of pityriasis alba patients. Br. 56(5):546-549. Dogra S. McCormick CL. Topical corticosteroids for skin disorders in infants and children.

www. Reichrath J. 25-dihydroxyvitamin D3) treatment of psoriasis: an immunohistological evaluation. Interaction of 1. Adams JS. A double-blind. 1986. Effect of 1α. 77(4): 268–272. Van de Kerkliof PCM. Journal of Investigative Dermatology. 25-dihydroxyvitamin-D3 with keratinocytes and fibroblasts from skin of normal subjects and a subject with vitamin- Ddependent rickets. type II: a model for study of the mode of action of 1. Janniger CK.wjpr. Quantification of ultraviolet protective effects of pityriacitrin in humans. Horiuchi N. Smith EL. Korver JEM. proliferation and differentiation. Gambichler T. Acta Dermato-Venereologica. Clemens TL. Walworth NC. Vissers WHPM. Cutis. 25- dihydroxyvitamin D3. Journal of Investigative Dermatology Symposium Proceedings. Kramer HJ. Robinson JK. Reduction of epidermal abnormalities and inflammatory changes in psoriatic plaques during treatment with vitamin D3 analogs. Muller SM. Perez A. Holick MF. 56(4): 824–830. Rigel DS. Van Rens DWA. Pityriasis Alba. 42: 74. randomized quantitative comparison of calcitriol ointment and calcipotriol ointment on epidermal cell populations. 1996. British Journal of Dermatology. 2007. 61:11-13. World Journal of Pharmaceutical Research 40. 299(10): 517-520. Galan EB. Boms S. Am Acad Dermatol. 1983. 25-dihydroxyvitamin D3 on the morphologic and biochemical differentiation of cultured human epidermal keratinocytes grown in serum-free conditions. Issue 6. 38. Amonette RA. 42. 2014. Journal of Clinical Endocrinology and Metabolism. Tomi NS. 43. Arch Dermatol Res. 1998.37. 41. . 1(1):78–81. 2000. 86(6):709– 714. 44. 156(1): 130–137.net Vol 3. 2007. Topical calcitriol (1. Altmeyer P. Skrygan M. 2171 Ramam et al. Summertime sun protection used by adults for their chiidren. 1997. 39.