# Pityriasis alba - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Pityriasis Alba - StatPearls (NCBI Bookshelf NBK431061) - https://www.ncbi.nlm.nih.gov/books/NBK431061/ · Pityriasis alba - disease-level clinical article (pityriasis-alba-full.txt) · Pityriasis alba - disease-level clinical article (pityriasis-alba-clinical.txt) - Verified date: 2026-08 ## Verified against - Pityriasis Alba - StatPearls (NCBI Bookshelf NBK431061) - https://www.ncbi.nlm.nih.gov/books/NBK431061/ - Pityriasis alba - disease-level clinical article (pityriasis-alba-full.txt) - Pityriasis alba - disease-level clinical article (pityriasis-alba-clinical.txt) ## Treatment metadata - Reassure, moisturise, protect from the sun (Recognition & Advice) - Hydrocortisone — topical ## Complete treatment card ```text PITYRIASIS ALBA Sources: Pityriasis Alba - StatPearls (NCBI Bookshelf NBK431061) - https://www.ncbi.nlm.nih.gov/books/NBK431061/ · Pityriasis alba - disease-level clinical article (pityriasis-alba-full.txt) · Pityriasis alba - disease-level clinical article (pityriasis-alba-clinical.txt) Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Most patients have painless, occasionally mildly itchy, pale patches most often on the face. [itching · pigmentation change] - A personal or family history of eczema, hay fever, or asthma is common. [allergic rhinitis] - The pale patches stand out more in spring and summer as surrounding skin tans with sun exposure. [pigmentation change] - It resolves on its own and the normal pigment comes back; that takes anywhere from several months to a few years, though most clear inside a year SIGNS - what you find (5) - Lesions are round or oval hypopigmented macules or patches with poorly defined borders. - Lesions usually number 4 to 20 and measure 0.5 to 5 cm, seen mainly on the face and neck, with the upper arms and trunk also affected. - Look for atopic stigmata such as Dennie-Morgan folds, extra neck folds, white dermographism, and flexural eczema. - The patches often start with a mild redness and only turn pale gradually [pallor · redness] - They stand out more the darker the skin TESTS (4) - Under Wood lamp the patches are accentuated but stay nonfluorescent, unlike vitiligo which fluoresces brightly with sharper edges. - KOH scraping is negative for fungal elements, unlike tinea versicolor or tinea corporis. - Biopsy is rarely needed but can distinguish the condition from mycosis fungoides when done. - Dermoscopy in darker skin types shows a distinctive semicircular pigment pattern around eccrine gland openings. IF NOT THIS - what else fits (7) - Nevus depigmentosus shows a segmental trunk distribution that stays fixed in size and number over time. - Sparing of the elbows, knees, and scalp, plus absence of salmon-colored scale, argues against psoriasis. - Tinea versicolor shows hyphal and yeast forms of Malassezia furfur on KOH exam. - Vitiligo causes complete depigmentation and tends to favor periocular and perioral sites. - Mycosis fungoides is suspected when lesions are persistent, symptomatic, and progressively changing in shape or color. - Pityriasis lichenoides chronica has a widespread trunk and extremity distribution. - Nummular eczema is marked by intense itching, which is not a feature of pityriasis alba. Source Pityriasis alba - disease-level clinical article (pityriasis-alba-full.txt) Status traced to the source above 1. REASSURE, MOISTURISE, PROTECT FROM THE SUN (RECOGNITION & ADVICE)[1st line] Adult Source Pityriasis Alba - StatPearls (NCBI Bookshelf NBK431061) - https://www.ncbi.nlm.nih.gov/books/NBK431061/ Why The consultation is almost entirely about the diagnosis: the family have come because they are frightened of vitiligo or of a fungus. Naming it, saying how long it takes, and stopping the sun from making it more obvious is the treatment. A low-potency steroid is offered below for the itchy or inflamed patch only. Caution WHAT IT IS AND WHO GETS IT - a common, harmless skin condition, mostly of children and adolescents, and usually regarded as a small expression of atopic dermatitis; most of these patients have atopy in the background. Ask about eczema, asthma and hay fever - the child's own history, or the family's, may carry atopic dermatitis, allergic rhinitis or asthma. WHAT IT LOOKS LIKE - on examination there are several round or oval pale macules or patches - sometimes thin papules and plaques - whose edges fade rather than stop. There may be a little redness, or some scale. Count is usually 4 to 20, size between 0.5 and 5 cm, and they sit mainly on the face, the neck, the upper arms and the upper trunk. Indistinct edges are the point; sharp edges are not this. WHY IT GETS WORSE IN SUMMER - the pale areas stand out more once the sun is on the skin, because the skin around them darkens through spring and summer; and they show up more in darker skin. The patch is not spreading; the skin around it is tanning. IT IS NOT VITILIGO, AND HERE IS HOW TO SHOW THAT - under a Wood's lamp the patches of pityriasis alba may stand out more, but they do not fluoresce. Vitiligo does - brighter, and with edges that stop sharply. Vitiligo also takes the pigment away completely, and it favours the skin around the eyes and the mouth. IT IS NOT TINEA EITHER, AND THE TEST IS CHEAP - scrape the skin, put it in potassium hydroxide, and no fungal element appears. That is what separates it from tinea versicolor and tinea corporis, where fungal elements do show. Do not put a child on an antifungal for months on a guess. ASK WHAT HAS ALREADY BEEN PUT ON IT - it matters to ask whether a potent topical steroid has been used before, because that itself can leave the skin pale. Other creams can set off an irritant or an allergic contact dermatitis, and the pigment loss follows the inflammation. In Cairo a strong steroid has often been bought over the counter before the visit, and it can be the cause of the white patch rather than the cure. THE TIMELINE IS THE HARDEST PART OF THE CONVERSATION - reassure the child and the parents that this is harmless and that it settles by itself. But be straight with them too: clearing is gradual, and it can run for months, occasionally a few years, though most clear inside 1 year. Say the number out loud or the family will doctor-shop. SUN PROTECTION IS ACTIVE TREATMENT HERE - keep the affected skin out of the sun, so the surrounding skin does not darken and make the patches look worse. Sunscreen helps: it stops the patches burning and holds back the darkening around them. Advise them to avoid the sun and to cover up - a wide-brimmed hat, long sleeves - since ultraviolet light makes the scaling worse. MOISTURISER DOES THE REST - a mild emollient, petroleum jelly or a simple cream, brings the scaling down. This is the part the family can do daily and see working. WHEN IT IS NOT PITYRIASIS ALBA - the article flags persistence and change: mycosis fungoides comes into the frame where lesions persist, cause symptoms, and go on altering in shape or in colour. It also lists the ash-leaf macules of tuberous sclerosis, and it names leprosy among the differentials. A hypopigmented patch that is numb, or one child with several plus seizures or developmental delay, is not a reassurance visit. 2. HYDROCORTISONE [add-on - not a substitute] Adult A thin layer to the affected patches only. The cached article states the strength but gives no application frequency and no duration - see the note below. Peds Topical, so there is no weight-based dose to encode. IMPORTANT AND DELIBERATE GAP: the cached article names the drug and the strength - hydrocortisone 1%, as cream or as ointment - and states no frequency and no duration. None has been invented here. Apply sparingly to the affected patches, review within a few weeks, and stop once the redness and itch have settled; the repigmentation takes months regardless. Source Pityriasis Alba - StatPearls (NCBI Bookshelf NBK431061) - https://www.ncbi.nlm.nih.gov/books/NBK431061/ Why Indication and strength come from one sentence in the article: a low-potency topical steroid - hydrocortisone 1%, as cream or ointment - can settle the redness and the itch, and speeds the return of pigment. It is second on the card because reassurance, emollient and sun protection are the stated mainstay and most children need nothing else. Caution USE IT FOR THE INFLAMMATION, NOT FOR THE WHITENESS - what the article credits it with is easing the redness and the itch. The pale colour resolves on its own over months to years, and a steroid does not shorten that to weeks. A family expecting the white to go in days will escalate to something stronger. THIS IS A CHILD'S FACE, WHICH IS THE WORST PLACE FOR STEROID HARM - keep to the low- potency preparation the article names. The same article warns that potent topical steroids can themselves cause hypopigmentation, so a stronger cream can produce exactly the problem the family came about. EXCLUDE FUNGUS BEFORE YOU APPLY A STEROID - a steroid on tinea makes it spread and lose its edge. The article's potassium hydroxide preparation takes minutes and settles it. THE ALTERNATIVES, AND WHY THEY ARE NOT THE FIRST CHOICE HERE - the topical calcineurin inhibitors work: tacrolimus ointment 0.1% and pimecrolimus cream 1% both treat pityriasis alba effectively. They are seldom used, though, because of what they cost. The article also notes that calcitriol, a topical vitamin D analogue, performed about as well as tacrolimus. No amount or frequency is given for any of them either, so none is printed as a row. PHOTOTHERAPY IS NOT A PRIMARY-CARE OPTION - the article keeps PUVA photochemotherapy - psoralen with ultraviolet-A - and targeted phototherapy from a 308-nm excimer laser for extensive disease. Widespread or persistent disease is a dermatology referral, not a stronger cream. Egypt NOVACORTIN 1% CREAM 15 GM PHAROPHARMA 4.75 EGP NOVACORTIN 1% OINT. 15 GM PHAROPHARMA 4.75 EGP MICORT 1% CREAM 20 GM MISR 12.50 EGP HYDROCORTISONE 1% OINT. 20 GM MISR 21.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)