A 10-year-old boy of Southeast Asian descent presents for evaluation of ‘’white spots” on his face. According to his parents, the condition first presented approximately 3 months ago and has grown despite topical therapy with over-the-counter hydrocortisone. The patient denies itching or a rash elsewhere on the body. Personal and family history are negative for skin disorders including eczema. Examination reveals scattered hypopigmented patches on both cheeks.
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Pityriasis alba is a skin disorder that primarily affects children and younger adolescents; diagnosis in older individuals is uncommon.1 The disorder manifests as hypopigmented to faintly erythematous, irregularly configured macules predominately on the cheeks with occasional involvement of the head, neck, and forearms. Slight scale is often an associated finding, hence the name pityriasis, which connotes fine scales (alba refers to the pale color).2 Some cases are associated with mild pruritus although the condition is primarily of cosmetic concern.
Pityriasis alba is most noticeable in individuals with darker complexions and the appearance may be accentuated following sun exposure. The majority of patients have a personal or family history of atopic dermatitis.3
Pityriasis alba is a benign, self-limited disorder although the duration is variable and cases lasting a few years have been documented. Sunscreen is often recommended to prevent both sunburn within the hypopigmented macules and darkening of surrounding areas. Topical therapies with either low- to mid-potency steroids, calcitriol, or tacrolimus have demonstrated efficacy with the latter treatment proving the most efficacious in a recent comparative study.4
Stephen Schleicher, MD, is director of the DermDox Dermatology Centers, associate professor of medicine at Geisinger Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.
1. Lv Y, Gao Y, Lan N, et al. Analysis of epidemic characteristics and related pathogenic factors of 2726 cases of pityriasis alba. Clin Cosmet Investig Dermatol. 2022;15:203-209. doi:10.2147/CCID.S345106
2. Givler DN, Basit H, Givler A. Pityriasis alba. In: StatPearls [Internet]. StatPearls Publishing; Aug 24, 2022. https://pubmed.ncbi.nlm.nih.gov/28613715/
3. Gawai SR, Asokan N, Narayanan B. Association of pityriasis alba with atopic dermatitis: a cross-sectional study. Indian J Dermatol. 2021;66(5):567-568. doi:10.4103/ijd.ijd_936_20
4. Abdel-Wahab HM, Ragaie MH. Pityriasis alba: toward an effective treatment. J Dermatolog Treat. 2022;33(4):2285-2289. doi:10.1080/09546634.2021.1959014