Treatment of Pityriasis Alba
Pityriasis alba is a self-limited condition that typically requires only reassurance and emollients, as it resolves spontaneously over months to years without specific antifungal treatment.
Important Clarification
Pityriasis alba is not a fungal infection and should not be confused with tinea (dermatophyte infections). The term "tinea alba" in your question appears to be a misnomer—pityriasis alba is a common benign hypopigmented skin condition, particularly in children, characterized by ill-defined pale patches typically on the face and upper arms.
Primary Management Approach
Reassurance is the cornerstone of management, as pityriasis alba is a self-limiting condition that gradually resolves without intervention over several months to years.
Regular use of emollients and moisturizers helps improve the appearance of the dry, scaly patches and may accelerate resolution through skin barrier restoration.
Sun protection is important because the hypopigmented areas lack melanin and are more susceptible to sunburn; additionally, tanning of surrounding normal skin makes the pale patches more noticeable.
Treatment Options for Symptomatic Cases
Low-potency topical corticosteroids (such as hydrocortisone 1%) may be applied to reduce any associated inflammation or pruritus, though evidence for accelerated repigmentation is limited.
Topical calcineurin inhibitors (tacrolimus or pimecrolimus) can be considered as steroid-sparing alternatives, particularly for facial lesions where prolonged steroid use carries risks of skin atrophy.
Phototherapy is not indicated for pityriasis alba, unlike vitiligo where narrow-band UVB may be considered for widespread disease in darker skin types 1.
Common Pitfalls to Avoid
Do not treat with antifungal medications—pityriasis alba is not caused by fungi and will not respond to antifungal therapy (topical or oral).
Avoid misdiagnosis as tinea versicolor or vitiligo—pityriasis alba patches are hypopigmented (not completely depigmented like vitiligo) and have fine scale, while tinea versicolor typically shows more prominent scale and positive KOH preparation 1.
Do not use high-potency topical steroids on the face, as this can lead to skin atrophy, telangiectasia, and perioral dermatitis.
Patient Education Points
Explain that the condition is benign and cosmetic only, with no long-term health consequences.
Set realistic expectations that repigmentation occurs gradually over months, and patches may become more noticeable in summer when surrounding skin tans.
Emphasize that consistent moisturizer use and sun protection are the most practical interventions.