Treatment of Pityriasis Alba
Start with low to moderate potency topical corticosteroids applied twice daily for 2-4 weeks combined with regular moisturizers containing 5-10% urea and broad-spectrum sunscreen (SPF 15 or higher). 1
First-Line Treatment Approach
The cornerstone of pityriasis alba management involves three concurrent interventions:
- Apply low to moderate potency topical corticosteroids (such as hydrocortisone 2.5% or alclometasone 0.05%) to affected areas twice daily for 2-4 weeks to reduce inflammation and scaling 1
- Use alcohol-free moisturizers containing 5-10% urea at least twice daily to restore the impaired skin barrier function 1
- Apply broad-spectrum sunscreen (SPF 15 or higher) daily to all exposed areas, as sun exposure worsens the appearance of hypopigmentation 1
Treatment Algorithm by Severity
For mild cases:
- Begin with moisturizers and sun protection alone 1
- If no improvement after 2 weeks, add low-potency topical corticosteroids 1
- Continue this regimen for 2-4 weeks 1
For moderate cases:
- Start immediately with low to moderate potency topical corticosteroids twice daily 1
- Use concurrent moisturizers and sunscreen from the outset 1
- Treat for 2-4 weeks 1
Alternative Treatment Options
If standard therapy fails or for patients concerned about long-term corticosteroid use on the face:
- Tacrolimus ointment 0.1% applied twice daily (12 hours apart) demonstrates significant efficacy, with complete resolution of hypopigmentation by 9 weeks in clinical trials 2
- Pimecrolimus cream 1% applied twice daily shows near-complete resolution of uneven skin color by 12 weeks, with excellent patient satisfaction and no adverse events 3
Both topical calcineurin inhibitors avoid the risk of skin atrophy associated with prolonged corticosteroid use, making them particularly suitable for facial lesions 3, 2
Duration and Maintenance
- Initial corticosteroid treatment should last 2-4 weeks 1
- Moisturizers and sun protection must be continued indefinitely to prevent recurrence 1
- Patients should understand that repigmentation occurs gradually, even after inflammation resolves 1
Important Clinical Considerations
Common pitfalls to avoid:
- Do not use alcohol-containing preparations, as they worsen the xerotic skin characteristic of pityriasis alba 4
- Avoid aggressive anti-acne treatments, as pityriasis alba is not seborrheic 4
- Do not discontinue sun protection after lesions improve, as ongoing UV protection prevents worsening of hypopigmentation 1
Key counseling points:
- Pityriasis alba is a benign, self-limited condition that eventually resolves spontaneously, though this may take months to years 5
- The cosmetic appearance improves more rapidly with treatment than without 5, 2
- Mild transient burning may occur with tacrolimus (reported in 11.5% of patients) but is generally well-tolerated 2