Pityriasis alba pale/white spots signs symptoms diagnosis

Pityriasis alba > Causes > Diagnosis > Treatment
In the diagnosis of pityriasis alba its signs and symptoms must be analysed to arrive at the differential diagnosis to exclude other conditions and infections.

Signs and symptoms of pityriasis alba

Pityriasis alba is an asymptomatic, self-limiting and benign lesion.

It usually appears on kids of the age 3 -16 years.

The lesions are usually limited to face, especially cheeks, around mouth and chin.

Pityriasis alba may also affect shoulders, neck and arms.

In very rare cases extensive lesions of pityriasis alba may appear all over the body.

Pityriasis alba initially appear like raised red or pink patches sometime with mild itch.

After some time these pityriasis alba patches flatten out and look pale with depigmentation, which is not total.

The spots are oval or round, about 2cm in size and appearing in several numbers.

Pityriasis alba patches have small dry scales which can be seen on closer examination.

The spots appears to worsen during cold dry conditions and flake.

In summer the patches may appear prominent due to tanning of the surrounding areas of normal skin.

These lesions are not contagious and the causative agent is not known.

Pityriasis alba resolves by itself after some time and the patches may take a long time for repigmentation.

Diagnosis of pityriasis alba

Pityriasis alba is diagnosed by taking into account its symptoms and excluding the other skin conditions and diseases by differential diagnosis.

Diagnosis of hypopigmentation to exclude the other diseases

The complete history of dermatitis in the patient is noted with especial attention to the area under investigation. Old skin injuries, marks of dermatitis and infections may show hypopigmentations and take a long time to get normal pigmentation.

The possibility of the affected area being the old hypo pigmented spot of earlier conditions has to be ruled out.

Diagnosis to exclude tinea versicolor and other fungal infections

The possibility of the lesion being due to fungal infections is to be ruled out by conducting Wood's lamp test and KOH test.

Diagnosis to exclude psoriasis

The distribution of the lesions sparing scalp, knees and elbows excludes psoriasis.

Diagnosis to exclude vitiligo

In vitiligo the depigmentation is complete and it is usually a progressive condition. On the face usually the areas around the mouth and eyes are affected and margins are marked. There is no scale formation.

Diagnosis to rule out nummular dermatitis

Nummular dermatitis can be ruled out by its characteristic intense itch.

Nevus depigmentosus is present from birth and is stable.

If the diagnosis is pityriasis alba, relax and follow the skin care efforts given in the treatment post.

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Treatment of pityriasis alba - white spots/patches on children

Pityriasis alba > Causes > Diagnosis > Treatment
Treatment for pityriasis alba focuses primarily on healthy skin care efforts, understanding its benign, non-infectious and self-limited nature and educating the affected children about its universality and its resolution after some time.

Rule out other conditions and infections
For treatment of pityriasis alba it is very important for the parents to first rule out other conditions and infections like tinea versicolor, vitiligo and psoriasis.

Build the self-confidence of the affected child
The condition of pityriasis alba will resolve by itself after some time without treatment.
However the repigmentation process takes longer time. Self-assurance and confidence building measures should be undertaken as the affected children may face psychological stress due to the reactions of the school-mates and staff.

Avoid factors likely to trigger pityriasis alba
To reduce the lesion and to help in its resolution harsh soaps, solvents and detergents should be avoided.
Kids contact with allergy causing factors like dust, dust mites, molds, wool, dander from pets and pollen must be avoided.
Exposure to dry cold wind and sudden change of temperature and humidity should be avoided as as part of treatment.

Moisturize pityriasis alba affected area
As a treatment for pityriasis alba, to reduce and stop scaling, moisturising creams, cold creams and emollient lotions can be used.
For the treatment to be more effective it is advised to apply them within three minutes of washing the affected area to lock in moisture in the skin.


Possibility of pityriasis alba resolution with good balanced nutrition
The children food habits are to be monitored for any malnutrition.
A balanced food rich in proteins, vitamins and minerals should be given as part of the treatment.
Sufficient milk and milk products may be included in their diet.
Best part of the treatment for this non infective ailment is to find out whether the children are allergic to any food product and to stop use of such products.
Treatment of Pityriasis alba affected children for possible intestinal worms and parasites may resolve the condition.

Use of topical corticosteroid applications in pityriasis alba treatment
Treatment with mild nonprescription topical corticosteroids and hydrocortisone may be done.
The ointment may be applied for a week or two and stopped.
After sufficient gap of time it may be applied again for a week or two.
The treatment with corticosteroid topical ointments reduces scaling, inflamed appearance and pruritus if present.
Please note that prolonged use of corticosteroids must be avoided as this may give side effects like thinning of the skin.

Use of topical tacrolimus and pimecrolimus in pityriasis alba treatment
Topical Tacrolimus and pimecrolimus are approved medications to treat atopic dermatitis like pityriasis alba. They belong to calcineurin inhibitors and modulate the immune response.
They do not produce the side effects of long term use of corticosteroids like thinning of skin and decrease of effectiveness. However these ointments are very expensive.

Treatment of chronic and extensive pityriasis alba
Dermatologist's advice must be taken if the lesions are extensive.
He may consider oral psoralen and phototherapy.
Psoralen increases the sensitivity of the skin to ultraviolet light and sunlight.
Ultraviolet A light photochemotherapy may give improvement in the condition.
Depending on the extent of the lesions the dermatologist may consider prescribing cyclosporine A, a potent immunosuppressant as the last resort.

Sun protection for pityriasis alba affected children
Adequate sun protection should be given to pityriasis alba affected children.
Affected areas do not tan when compared to the surrounding normal areas and the differential tanning can worsen the cosmetic look of the children.
Taking the precautions and suggested treatments may resolve pityriasis alba early.

Causes of pityriasis alba-white/pale spots/patches on children

Pityriasis alba > Causes > Diagnosis > Treatment
A number of causes are related for the occurrence of pityriasis alba white/pale spots and patches on the face and body of children. But the knowledge of real reason is elusive.

Pityriasis alba is considered as an atopic dermatitis occurring in children, especially on their face, shoulders and arms and could be an independent eczema. The exact causes of these white spots is not known. The investigations of skin scrapings of a number of patients have indicated non involvement of bacteria and fungus.

Pityriasis alba is not contagious and has no definite etiologic agent. Studies have revealed that the hypopigmentation is due to reduction in the numbers of functional melanocytes and decrease of melanosomes in size and number. Dryness of skin, especially in winter appears to aggravate this ailment and increase the scale formation.

We can infer that cold dry condition may trigger and cause it in persons predisposed to it. In summer months, though the patches appear prominent due to tanning of the surrounding skin, there is no aggravation of the condition. Another hypothesis is that the deficiency of calcium and related vitamins precipitates this pityriasis ailment.

The explanation and reasoning is that pityriasis alba often occurs during the growing years of children. The growing children tend to get deficient in vitamins and calcium easily. Infestation with intestinal worms and parasites has been associated with pityriasis alba occurrence. In rural India deworming of the children is done by feeding them with a spoon of Castor oil with the belief that the condition will resolve.

Some theories have associated public swimming pools as one of the reasons of occurrence of pityriasis alba. Though the condition is asymptomatic for the affected child, it is of a big worry for the parents. Schools and daycare facilities will be very apprehensive about pityriasis alba and its causes and may insist on evaluation of the infective status of the condition.

Pityriasis alba pale or white spots/ patches on children faces

Pityriasis alba > Causes > Diagnosis > Treatment

Pityriasis alba is an atopic dermatitis with hypopigmentation affecting children mostly on the face as white/pale spots and patches.

Pityriasis alba is chronic in nature and affects children of the age between 3 and 16 years. It is non-cancerous and appears as oval and round dry pale patches, especially on the children's cheeks. To start with the patches may be pink or red. Later the rash fades and gives a pale look with depigmentation in the affected areas.

These hypopigmented pityriasis alba patches appear oval and round, slightly erythematous and scaly. These spots usually affect the chin, cheek and mouth areas of the face of the kids. The border of the pityriasis alba rash is not clearly marked. The spots appear to blend gradually with the normal skin. On closer examination the affected area show whitish scales and hence is the name pityriasis alba (white scales).

The lesions are not completely depigmented. 50% of the kids are affected only on the face by these patches. These white areas are more noticeable in kids with dark or tanned skin. In addition to face in some cases these hypopigmented patches may involve neck, arms and shoulders of the affected kids. The trunk and legs are rarely involved in pityriasis alba afflictions.

The affected kids may show multiple lesions numbering even up to twenty, varying in size from 1 - 5 centimetres. Both sexes are affected and boys are more prone to develop it. In dark skinned kids the pale lesions are very prominent. Though the children are asymptomatic, their cosmetic appearance is of concern to parents.

These lesions do not tan. In the summer months the pityriasis lesions appear more prominent due to tanning of the surrounding skin. In winter and in dry climate the lesions flake. These pityriasis alba affected spots may remain for months or years and resolve after some period of time with the growth of children.