What is the treatment for pityriasis alba?

Treatment for Pityriasis Alba

The most effective treatment for pityriasis alba includes topical corticosteroids for the inflammatory phase, followed by moisturizers and sun protection, with topical calcineurin inhibitors as an alternative for maintenance therapy.

Understanding Pityriasis Alba

Pityriasis alba is a common, benign skin condition characterized by hypopigmented patches that typically affect the face, neck, and upper arms of children and young adults. It is more noticeable in individuals with darker skin tones and often worsens with sun exposure.

First-Line Treatment Approach

Inflammatory Phase Management

• Low to medium-potency topical corticosteroids for short-term use (2-4 weeks)
  • Apply to affected areas twice daily during active inflammation
  • Examples: hydrocortisone 2.5%, clobetasone butyrate 0.05%
  • Helps reduce inflammation and scaling 1

Maintenance Therapy

• Topical calcineurin inhibitors (TCIs) are effective alternatives to corticosteroids:
  • Tacrolimus 0.03% ointment twice daily 2, 1
  • Pimecrolimus 1% cream twice daily 2
  • Benefits: No risk of skin atrophy, effective for repigmentation, suitable for facial lesions
  • TCIs showed superior repigmentation compared to other treatments in recent studies 1

Essential Adjunctive Measures

• Moisturizers/Emollients:

  • Apply liberally and frequently (3-8 times daily) 3
  • Use immediately after bathing to trap moisture
  • Choose fragrance-free products in tubes rather than jars 3

• Sun Protection:

  • Use broad-spectrum sunscreen (SPF 15+) daily 3, 2
  • Sun exposure increases contrast between normal and affected skin 4

Advanced Treatment Options

For Resistant Cases

• Soak and Smear Technique:

  • Soak hands/affected areas in plain water for 20 minutes
  • Immediately apply moisturizer to damp skin
  • Continue nightly for up to 2 weeks 3

• Occlusive Therapy:

  • Apply moisturizer followed by occlusive covering at night 3
  • Enhances penetration of topical medications

Alternative Treatments

• Calcipotriol 0.005% cream twice daily for 8 weeks 1

  • Shows effectiveness in repigmentation, though slightly less effective than tacrolimus

• Combination therapy with coal tar 2%, diiodohydroxyquinolin 1%, and hydrocortisone 0.5% has shown efficacy in older studies 5

Special Considerations

For Darker Skin Types

• More aggressive treatment may be warranted as hypopigmentation is more noticeable
• Tacrolimus 0.03% ointment showed the best repigmentation results in darker skin 1

For Children

• Use lower potency corticosteroids (hydrocortisone 1-2.5%)
• Tacrolimus 0.03% is approved for children ≥2 years 3

Duration of Treatment

• Inflammatory phase: 2-4 weeks of topical corticosteroids
• Repigmentation phase: 8-12 weeks of maintenance therapy
• Patient should be informed that complete repigmentation may take several months

Pitfalls to Avoid

• Do not use high-potency corticosteroids on the face or for prolonged periods
• Do not discontinue treatment prematurely; repigmentation takes time
• Do not confuse with other hypopigmented conditions like pityriasis versicolor alba, vitiligo, or nevus depigmentosus 4
• Avoid hot water for washing affected areas 3

When to Refer

• If no improvement after 8-12 weeks of appropriate therapy
• If diagnosis is uncertain
• If lesions are widespread or atypical

Pityriasis alba is a self-limiting condition that typically resolves with age, but appropriate treatment can accelerate resolution and address the cosmetic concerns of patients.