para>Extended duration or potent topical corticosteroid use on the face should be avoided.
Black box warning for topical tacrolimus: Questionable increased risk of lymphoma and skin malignancies. Avoid long-term use.
Use judiciously in pediatric populations.
é á
ADDITIONAL THERAPIES
- Psoralen plus UVA (PUVA) considered for extensive involvement only
- Profound improvement of PA was observed after 308-nm excimer laser phototherapy, with no significant side effects (1).
- Topical vitamin D as monotherapy has a moderate to strong recommendation for use in PA, although higher quality studies are still needed (5).
INPATIENT CONSIDERATIONS
Admission Criteria/Initial Stabilization
Outpatient é á
ONGOING CARE
FOLLOW-UP RECOMMENDATIONS
Patient Monitoring
As needed, only if lesions become symptomatic é á
DIET
No special diet é á
PATIENT EDUCATION
- Stress long-term chronicity and likely permanent resolution of condition in 2nd or 3rd decade of life
- Sun protection
PROGNOSIS
- Permanent resolution during 2nd or 3rd decade of life in almost all cases
- Worse prognosis in patients with higher Fitzpatrick skin types (darker skin)
COMPLICATIONS
None expected é á
REFERENCES
11 Miazek é áN, Michalek é áI, Pawlowska-Kisiel é áM, et al. Pityriasis alba " öcommon disease, enigmatic entity: up-to-date review of the literature. Pediatr Dermatol. 2015;32(6):786 " ô791.22 Jadotte é áYT, Janniger é áCK. Pityriasis alba revisited: perspectives on an enigmatic disorder of childhood. Cutis. 2011;87(2):66 " ô72.33 In é áSI, Yi é áSW, Kang é áHY, et al. Clinical and histopathological characteristics of pityriasis alba. Clin Exp Dermatol. 2009;34(5):591 " ô597.44 Moreno-Cruz é áB, Torres- â ülvarez é áB, Hern â índez-Blanco é áD, et al. Double-blind, placebo-controlled, randomized study comparing 0.0003% calcitriol with 0.1% tacrolimus ointments for the treatment of endemic pityriasis alba. Dermatol Res Pract. 2012;2012:303275.55 Wat é áH, Dytoc é áM. Off-label uses of topical vitamin D in dermatology: a systematic review. J Cutan Med Surg. 2014;18(2):91 " ô108.
ADDITIONAL READING
- Al-Mutairi é áN, Hadad é áAA. Efficacy of 308-nm xenon chloride excimer laser in pityriasis alba. Dermatol Surg. 2012;38(4):604 " ô609.
- Di Lernia é áV, Ricci é áC. Progressive and extensive hypomelanosis and extensive pityriasis alba: same disease, different names? J Eur Acad Dermatol Venereol. 2005;19(3):370 " ô372.
- Fujita é áWH, McCormick é áCL, Parneix-Spake é áA. An exploratory study to evaluate the efficacy of pimecrolimus cream 1% for the treatment of pityriasis alba. Int J Dermatol. 2007;46(7):700 " ô705.
- Halder é áRM, Nandedkar é áMA, Neal é áKW. Pigmentary disorders in ethnic skin. Dermatol Clin. 2003;21(4):617 " ô628, vii.
- Kim é áD, Lockey é áR. Dermatology for the allergist. World Allergy Organ J. 2010;3(6):202 " ô215.
- Plensdorf é áS, Martinez é áJ. Common pigmentation disorders. Am Fam Physician. 2009;79(2):109 " ô116.
- Rigopoulos é áD, Gregoriou é áS, Charissi é áC, et al. Tacrolimus ointment 0.1% in pityriasis alba: an open-label, randomized, placebo-controlled study. Br J Dermatol. 2006;155(1):152 " ô155.
SEE ALSO
Keratosis, Actinic; Tinea Versicolor; Vitiligo é á
CODES
ICD10
L30.5 Pityriasis alba é á
ICD9
696.5 Other and unspecified pityriasis é á
SNOMED
- Pityriasis alba
- Localized pityriasis alba (disorder)
- Diffuse pityriasis alba (disorder)
CLINICAL PEARLS
- More common in patients with atopic dermatitis
- Use of KOH preparation and Wood lamp is a quick way to differentiate this from a fungal infection.
- Treatment is largely symptomatic, and sun protection is essential.
- Topical calcineurin inhibitor therapy may become primary treatment for extensive pityriasis alba or when associated with atopic dermatitis.