The clinical picture of pityriasis alba was first described in 1860 by the French physician Camille-Melchior Gilbert. Although the skin disease is not serious, it can be emotionally distressing for the mostly childish patients. Although it has been known since the 19th century, its cause has not yet been clarified.
What is pityriasis alba?
The harmless pityriasis alba mostly affects children between the ages of six and twelve. Two to five percent of children in this age group suffer from the sometimes chronic skin disease. Boys are slightly overrepresented. The non-infectious disease sometimes even occurs in adults. Black people and their children are at increased risk of developing pityriasis alba. See definitionexplorer for Atelosteogenesis Definitions.
The disease presents as patches covered with light-colored scales. There is reduced skin pigmentation at the site of these lesions. It is caused by the reduced activity of the melanocytes. They form fewer and smaller melanosomes. The pigment disorder is mainly found on the face, but also on the body and usually with larger spots.
In some young children, pityriasis alba first appears after prolonged exposure to the sun without adequate sun protection or in child patients who take frequent hot baths. Histologically, the skin disease is a form of interstitial dermatitis in which the melanocytes are degeneratively altered.
The exact cause of pityriasis alba is still unknown. Some medical professionals consider it a mild form of atopic eczema because its lesions initially resemble the reddish patches of neurodermatitis, only later fading and then contrasting sharply with the surrounding skin color.
Some doctors suspect the overuse of corticosteroid creams in the treatment of eczema to be the cause of hypopigmentation. Other medical professionals consider pityriasis alba to be a weakened form of normal eczema caused by an overactive immune response.
Symptoms, Ailments & Signs
The reddish lesions are not sharply demarcated and are covered with fine skin flakes that develop into light, dry patches on the skin of the face. The light areas are not completely depigmented, only hypopigmented.
The predominantly round, oval or map-like discoloration, 0.5 to 2 cm in diameter, is sometimes associated with severe itching and sebaceous gland atrophy. On the face, they are mostly located on the sides of the cheeks and forehead. Larger lesions with a pronounced border are usually found on the body. There are four or five, in extreme cases even more than 20 such skin changes.
About one fifth of pityriasis alba patients have the conspicuous spots on the shoulders, large areas on the extensor sides of the upper arms and on the neck. The skin disease disappears at the latest with the entry into adulthood. Up to this point, however, it recurs again and again in some of the child patients.
Diagnosis & course of disease
The course is usually chronic and occurs in three stages: At the beginning, the patient recognizes a slightly reddened, slightly raised, scaly area of skin. After that, the raised lesion fades. Finally, a pale flat smooth area of skin remains. The healing of pityriasis alba sometimes takes several months. In some patients, the healing process can take up to 10 years.
In summer, the area remains bright despite the tanning of the rest of the skin. Pityriasis alba is diagnosed by thoroughly examining the surface of the skin on the face and, if necessary, the entire body. In order to differentiate them from pityriasis versicolor alba, tinea corporis and tinea faciei, the doctor carries out the potassium hydroxide (KOH) test.
The differentiation from Vitiligo (white spot disease) can already be made by the external appearance: With her, the white spots are always only in the mouth and eye area. In addition, in this skin condition, the light spots are completely depigmented and therefore also appear white.
As a rule, pityriasis alba is not life-threatening and not particularly dangerous to health. However, this disease causes considerable discomfort to the skin of those affected. Most patients are ashamed of the symptoms and therefore feel uncomfortable with their skin. Bullying and teasing can also occur, especially at a young age.
Furthermore, pityriasis alba can also lead to depression or other mental disorders and limitations. The skin itself is covered in red patches from the disease and sufferers suffer from hypopigmentation in some cases. Persistent itching on the skin can also significantly reduce the quality of life of those affected. The symptoms of pityriasis alba can be very uncomfortable, especially on the face or neck.
Pityriasis alba can be treated with medication and is usually successful. There are no complications. However, a completely positive course of the disease cannot be guaranteed in every case. The symptoms of pityriasis alba may recur. Scars can also form on the skin as a result of this disease.
When should you go to the doctor?
If the characteristic patches of skin appear, a doctor should be consulted. Reddish, slightly scaly patches of skin that appear in groups of four to five spots indicate pityriasis alba, which is best clarified quickly. If a rash occurs on the neck and arms at the same time, immediate clarification is necessary, as the skin condition may be severe. In mild forms, the doctor must prescribe a medicinal preparation.
This is usually enough for the spots to disappear within a few days. People who suffer from dry skin are particularly likely to develop pityriasis alba. People with children’s eczema and other skin diseases are also among the risk groups and should see their family doctor or dermatologist if they have the symptoms mentioned. Other contacts are the internist or a therapist if the skin changes cause mental problems. In the case of long-term symptoms that cannot be alleviated by conservative measures, an alternative doctor can also be involved in consultation with the doctor.
Treatment & Therapy
Sometimes pityriasis alba is not treated at all because the patches heal on their own. Otherwise, the therapy is only symptomatic: the patient is given a moisturizing skin cream to combat the dryness and dandruff. Creams containing low-dose hydrocortisone are also applied to the itchy and scaly areas. Other dermatologists treat pityriasis alba with ointments containing urea so that the scales come off.
Child patients over the age of two sometimes also receive the immunosuppressive drugs tacrolimus 0.1 percent and pimecrolimus (1 percent), which are intended to speed up the healing process. The creams stop the release of neurotransmitters that cause eczema. In severe cases, the patient receives PUVA therapy with psoralen and long-wave UV-A light or longer-lasting laser therapy.
In summer, those affected by pityriasis alba do not go out in the sun at all or cover the light-colored lesion with sunscreen with a high sun protection factor so that the hypopigmented area of skin is not further damaged. Also, he shouldn’t wash his skin with normal soap as it irritates the skin even more, but only use an O/W emulsion or hydrophilic oil.
If the conspicuous skin lesion still does not disappear after a while, he can also cover it up cosmetically so that it is no longer so clearly visible, at least temporarily.
Outlook & Forecast
If pityriasis alba is present, a positive prognosis can almost always be expected. This skin condition almost always heals on its own. However, the affected skin areas remain noticeably light for a long time. However, this pigment disorder also diminishes over time.
The reason why this skin disease occurs has not yet been clarified. Pityriasis alba is not contagious. It is obviously favored by dry skin and cold, dry air. However, it is not known why this causes light red, slightly scaly skin reddening. In some cases there is already a tendency to atopic dermatitis, but in others there is not. Children are almost always affected by pityriasis alba. It rarely affects adults as well. The course of pityriasis alba varies from person to person.
Some of those affected experience only one flare-up with an asymptomatic course. Others have multiple episodes in a row. It can also take different amounts of time for lighter areas of skin to remain. Overall, however, these differences do not change the positive prognosis for pityriasis alba. As a rule, there is not even a doctor’s visit because of pityriasis alba. If this happens because of the expansion of the scaly patches of skin, the doctor will probably not start any treatment. At best, a light hydrocortisone gel will help.
Since the exact cause of pityriasis alba is unknown, no prophylactic measure is possible.
You can do that yourself
Since pityriasis alba usually goes away on its own, no medical treatment is required. Parents of affected children must ensure that the child does not scratch the skin eczema. In addition, the affected areas should be cooled regularly. The affected children are usually very irritable and sensitive to pain. It is all the more important for the parents to remain calm. The causes and symptoms of pityriasis alba can be explained to slightly older children. This often means that the children scratch the skin areas less often and thus contribute to the rapid healing of the symptoms.
Good personal hygiene is essential to overcome the condition quickly. In addition to the medically prescribed ointments, natural medicine can also be used if necessary. Lotions with aloe vera relieve itching and help against dandruff. The use of these funds should be discussed with the pediatrician beforehand. Otherwise, allergic reactions may occur.
Sufficient sun protection for the entire skin is also important. This can reduce the color differences on the arms and legs as well as on the face. In severe cases, the spots can be covered with cosmetic products.