What is the treatment for pityriasis alba?

Treatment of Pityriasis Alba

The recommended treatment for pityriasis alba includes topical corticosteroids, moisturizers, and sun protection, with topical calcineurin inhibitors as an effective alternative for facial lesions. 1, 2

First-Line Treatment Options

• Topical corticosteroids: Low to moderate potency topical steroids applied to lesional skin twice daily for 2-4 weeks are effective for reducing inflammation and scaling 1
• Moisturizers: Regular application of alcohol-free moisturizers containing 5-10% urea at least twice daily helps restore skin barrier function 1
• Sun protection: Use of sunscreen (SPF 15 or higher) on exposed areas is essential to prevent worsening of hypopigmentation 1

Second-Line Treatment Options

• Topical calcineurin inhibitors: Tacrolimus ointment 0.1% applied twice daily has shown significant improvement in hypopigmentation, scaling, and pruritus within 9 weeks, with complete resolution in many cases 2
• Pimecrolimus cream 1%: Applied twice daily for 12 weeks has demonstrated efficacy in reducing uneven skin color and scaling with high patient satisfaction 3
• Combination therapy: A cream containing 2% coal tar, 1% diiodohydroxyquinolin, and 0.5% hydrocortisone applied three times daily for one month has shown acceptable results in controlled trials 4

Treatment Algorithm

1. For mild cases:

   • Start with regular moisturizers and sun protection 1
   • Add low-potency topical corticosteroids if no improvement after 2 weeks 1

2. For moderate cases:

   • Low to moderate potency topical corticosteroids twice daily for 2-4 weeks 1
   • Concurrent use of moisturizers and sunscreen 1
   • Consider topical calcineurin inhibitors for facial lesions to avoid steroid-related side effects 2

3. For persistent cases:

   • Switch to topical calcineurin inhibitors (tacrolimus 0.1% or pimecrolimus 1%) 2, 3
   • Consider combination therapy with coal tar preparations 4

Special Considerations

• Facial lesions: Prefer topical calcineurin inhibitors over corticosteroids to avoid skin atrophy with long-term use 3
• Darker skin types: More aggressive treatment may be needed as hypopigmentation is more noticeable 2
• Post-inflammatory hypopigmentation: May persist for months after inflammation resolves; continued sun protection is essential 5

Treatment Duration and Follow-up

• Initial treatment course typically lasts 2-4 weeks for corticosteroids 1
• Calcineurin inhibitors may require 6-12 weeks for optimal results 2, 3
• Moisturizers and sun protection should be continued indefinitely to prevent recurrence 1
• Follow-up after 4-6 weeks to assess response and adjust treatment if necessary 2

Common Pitfalls to Avoid

• Misdiagnosis: Pityriasis alba must be differentiated from pityriasis versicolor alba, which requires antifungal therapy 5
• Overuse of topical steroids: Prolonged use on the face can lead to skin atrophy, telangiectasia, and steroid-induced acne 3
• Inadequate sun protection: Failure to use sunscreen can worsen hypopigmentation and delay recovery 1
• Unrealistic expectations: Patients should be informed that repigmentation may take several months even with appropriate treatment 5, 2