What is the treatment for pityriasis (pityriasis) alba?

Treatment of Pityriasis Alba

The most effective treatment for pityriasis alba includes low to moderate potency topical corticosteroids for 2-4 weeks, combined with regular moisturization and sun protection. 1

First-Line Treatment Options

• Low to moderate potency topical corticosteroids applied to lesional skin twice daily for 2-4 weeks are effective for reducing inflammation and scaling in pityriasis alba 1
• Regular application of alcohol-free moisturizers containing 5-10% urea at least twice daily helps restore skin barrier function and improve the appearance of hypopigmented patches 1, 2
• Daily use of sunscreen (SPF 15 or higher) on exposed areas is essential to prevent worsening of hypopigmentation and promote even skin tone 1

Treatment Algorithm

For Mild Cases:

• Start with regular moisturizers and sun protection as first-line therapy 1
• If no improvement after 2 weeks, add low-potency topical corticosteroids 1
• Continue moisturizers and sunscreen throughout treatment and afterward to prevent recurrence 1

For Moderate Cases:

• Apply low to moderate potency topical corticosteroids twice daily for 2-4 weeks 1
• Use moisturizers concurrently with corticosteroids to enhance barrier repair 1, 2
• Apply sunscreen daily to prevent further hypopigmentation 1

Alternative and Adjunctive Therapies

• Tacrolimus ointment 0.1% has shown significant efficacy in treating pityriasis alba, with complete resolution of hypopigmentation after 9 weeks in clinical studies 3
• Pimecrolimus cream 1% applied twice daily may be an effective alternative to topical corticosteroids, especially for facial lesions where steroid-induced atrophy is a concern 4
• A cream containing sorbityl furfural palmitate (AR-GG27®) has demonstrated efficacy in treating pityriasis alba associated with mild to moderate atopic dermatitis 5
• For cases with significant scaling, a combination of coal tar, diiodohydroxyquinolin and hydrocortisone has shown beneficial effects 6

Treatment Duration and Follow-up

• Initial treatment course with topical corticosteroids typically lasts 2-4 weeks 1
• Moisturizers and sun protection should be continued indefinitely to prevent recurrence 1
• Improvement in hypopigmentation may take several months, even after inflammation and scaling have resolved 1, 3

Special Considerations

• Pityriasis alba is often associated with atopic dermatitis and may represent an atypical manifestation of this condition 5
• The condition is more noticeable in darker skin types (Fitzpatrick IV-V) and in those with significant sun exposure 4
• Avoid high-potency topical corticosteroids, especially on the face, to prevent skin atrophy and other adverse effects 4
• Patient education about the benign, self-limiting nature of the condition is important to ensure compliance with treatment 1

Common Pitfalls to Avoid

• Using high-potency topical corticosteroids for prolonged periods, especially on the face, can lead to skin atrophy and other adverse effects 4
• Neglecting sun protection can worsen hypopigmentation and delay resolution 1
• Discontinuing moisturizers after resolution may lead to recurrence 1
• Expecting immediate repigmentation; patients should be counseled that restoration of normal skin color may take several months even after inflammation has resolved 3