Updated: 9/23/2017

Pityriasis Alba

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Snapshot
  • PhotoA 5-year-old boy is brought to the pediatrician’s office for evaluation of “white patches.” His mother is worried that he has vitiligo. These white patches started a few weeks ago after a month-long summer camp. The child has a history of atopic dermatitis and severe food allergies. On physical exam, he has multiple 1-3 cm irregular but well-defined patches of hypopigmentation on his cheeks, upper arms, and chest. There is overlying scaling and minimal erythema. His mother is counseled about the benign nature of this disease and recommends topical moisturizers and topical corticosteroids to minimize symptoms.
Introduction
  • Clinical definition
    • cutaneous benign dermatosis of hypopigmentation of unknown etiology
  • Epidemiology
    • demographics
      • children ages 3-16 years of age
    • risk factors
      • atopic dermatitis
      • sun exposure
      • frequent bathing
  • Etiology
    • unknown
  • Pathogenesis
    • exact mechanim is unknown but this disease is thought to be due to residual postinflammatory hypopigmentation and may be related to sun exposure
  • Associated conditions
    • atopic dermatitis
  • Prognosis
    • self-limited disease
    • repigmentation takes months to years
Presentation
  • Symptoms
    • may be pruritic
  • Physical exam
    • < 5 cm in diameter macules and patches of hypopigmentation
      • location
        • face
        • neck
        • trunk
        • proximal extremities
      • features
        • well-defined but irregular borders
        • overlying fine scaling
        • faint erythema
Studies
  • Wood’s lamp examination
    • no fluorescence
  • KOH preparation
    • to rule out dermatophyte infection
  • Histology
    • nonspecific spongiosis
    • reduced pigment in epidermis
    • no significant reduction in melanocytes
Differential
  • Vitiligo
    • lesions fluoresce under Wood’s lamp
  • Tinea versicolor
Treatment
  • Conservative
    • sun protection and avoidance
      • indication
        • for all patients
  • Medical
    • topical emollients
      • indication
        • to decrease dryness and scaling
    • topical therapies
      • indications
        • to decrease dryness and scaling
        • to accelerate repigmentation
      • drugs
        • glucocorticoids
        • calcineurin inhibitors
Complications
  • Prolonged hypopigmentation

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