What is the treatment for pityriasis alba?

Treatment of Pityriasis Alba

For pityriasis alba, start with regular application of alcohol-free moisturizers containing 5-10% urea twice daily combined with broad-spectrum sunscreen (SPF 15 or higher), and add low-potency topical corticosteroids (hydrocortisone 2.5% or alclometasone 0.05%) twice daily for 2-4 weeks if moisturizers alone are insufficient. 1

First-Line Treatment Approach

Mild Cases (Initial Management)

• Begin with alcohol-free moisturizers containing 5-10% urea applied at least twice daily to restore skin barrier function 2, 1
• Apply broad-spectrum sunscreen (SPF 15 or higher) to all affected areas daily, as sun exposure worsens the contrast between normal and hypopigmented skin 2, 1
• Avoid frequent washing with hot water and skin irritants including over-the-counter anti-acne medications 2
• If no improvement after 2 weeks, escalate to topical corticosteroids 1

Moderate Cases (Corticosteroid Therapy)

• Apply low-potency topical corticosteroids (hydrocortisone 2.5% or alclometasone 0.05%) twice daily for 2-4 weeks to reduce inflammation and scaling 2, 1, 3
• Continue concurrent use of moisturizers and sunscreen throughout treatment 1
• Hydrocortisone is FDA-approved for temporary relief of itching associated with minor skin irritations, inflammation, rashes due to eczema, and other dermatoses 3

Alternative Treatment Options

Topical Calcineurin Inhibitors

• Pimecrolimus cream 1% twice daily represents an effective alternative when corticosteroid side-effects are a concern, particularly for facial lesions 4
• In a 12-week study, pimecrolimus demonstrated near-complete resolution of uneven skin color by week 12, with scaling resolving by week 3 4
• This option avoids the risk of skin atrophy associated with long-term corticosteroid use on the face 4
• Use in combination with facial emollient containing SPF 15 sunscreen 4

Novel Formulations

• AR-GG27® (sorbityl furfural palmitate) cream showed statistically significant improvement in pityriasis alba associated with atopic dermatitis after 15 and 30 days of treatment (P=0.0007 and P=0.005 respectively) 5
• A combination cream containing 2% coal tar, 1% diiodohydroxyquinolin, and 0.5% hydrocortisone applied three times daily for one month demonstrated highly significant results compared to placebo (P<0.0005) 6

Treatment Duration and Maintenance

• Initial corticosteroid treatment course: 2-4 weeks 1
• Moisturizers and sun protection should be continued indefinitely to prevent recurrence 1
• Reassess at 2-week intervals; if no improvement with low-potency corticosteroids, consider moderate-potency agents or alternative treatments 1

Important Clinical Considerations

Differential Diagnosis

• Must differentiate from pityriasis versicolor alba (fungal etiology requiring antimycotic therapy), vitiligo, nevus depigmentosus, and nevus anemicus 7, 8
• Pityriasis versicolor alba is caused by Malassezia yeasts and requires rapid antimycotic treatment followed by UV therapy to accelerate repigmentation 7

Pathophysiology Context

• Poor cutaneous hydration is a common underlying mechanism, explaining why moisturizers are foundational therapy 8
• Sun exposure exacerbates the contrast between normal and lesional skin, making sun protection essential 8
• The condition is more visible in darker-skinned individuals but occurs in all skin types 8

Common Pitfalls to Avoid

• Do not use over-the-counter anti-acne medications, as these are skin irritants that worsen the condition 2
• Avoid frequent washing with hot water, which impairs skin barrier function 2
• Do not discontinue moisturizers and sun protection after corticosteroid course completion, as maintenance is essential 1
• Ensure proper differentiation from fungal causes (pityriasis versicolor alba) which require entirely different treatment 7