Pityriasis Alba: White Patches On The Skin

White patches on the face and other areas of the skin can be caused by pityriasis alba, a skin condition that typically affects children.

Although the white patches usually go away on their own, your healthcare provider can prescribe moisturizers or other topical treatments to ease symptoms

This article describes pityriasis alba, and how it differs from vitiligo and similar conditions. It presents information about the symptoms, causes, diagnosis, and treatment options.

What Is Pityriasis Alba?

Pityriasis alba is a common skin disorder affecting approximately 5% of children in the United States. The disorder typically presents before puberty in children between the ages of one and 14. It is benign, meaning that it is non-cancerous and will not spread or cause problems in other parts of the body.

What Are the Symptoms of Pityriasis Alba?

Pityriasis alba causes lightly colored or white spots on the skin. Most often, they are found on the cheeks. But they can also show up on the neck, chest, back, and upper arms. Symptoms include:

• Pink or red spots that fade to lighter than usual skin
• Affected areas ranging from a quarter-inch to an inch in size
• White spots in circle or oval shape
• Undefined borders that gradually blend into normally pigmented skin
• Flaky and itchy patches of skin

The patches themselves are often raised and may be scaly. The scaliness is most noticeable during the winter months when the air is drier. During the summer, the spots can be easier to see when other skin is tanned.

The lesions aren't painful, but they might be mildly itchy.

Picture of White Patches Caused By Pityriasis Alba

What Causes Pityriasis Alba White Patches?

Although an exact cause is still unknown, pityriasis alba may be related to other skin conditions. For example, it is thought that when a case of dermatitis (skin irritation) heals, it may leave behind a lighter patch of skin.

It may also happen if you use too much topical corticosteroids when treating eczema. This can cause areas of patchy rash to lighten as they heal.

Some genetic disorders are also believed to cause cutaneous hypopigmentation (loss of skin color). This can happen when melanocytes, the cells that produce the skin pigment melanin, have lower activity. Melanin makes the skin darker.

How Is Pityriasis Alba Diagnosed?

Usually, your healthcare provider can diagnose pityriasis alba by simply looking at the rash of white spots on the face, or other parts of the body, while reviewing your child's symptoms and medical history.

Pityriasis alba is often confused with tinea versicolor, where an overgrowth of fungus on the skin causes patchy white lesions. However, there are several ways to distinguish between the two disorders:

• A Wood's lamp examination uses a handheld ultraviolet (UV) light to highlight differences in skin color. It is usually used in a dermatologist's office in a darkened room.
• Potassium hydroxide (KOH) can be used to diagnose fungal infections, like tinea versicolor or other fungal conditions such as tinea corporis (ringworm). For this test, the skin is lightly scraped to remove some skin cells, which are mixed with potassium hydroxide and examined under a microscope.

Pityriasis alba can also be confused with vitiligo, an autoimmune disease where pigment is lost in some patches of skin. However, vitiligo has very distinct borders, which will help your healthcare provider to distinguish between the two.

Vitiligo patches appear first on sun-exposed parts of the body. It can often occur after a triggering event such as a sunburn. It can then spread to the armpits, eyes, groin, genitals, navel, and rectal areas.

Pityriasis alba also develops in sun-exposed areas. However, it isn't clear if sun exposure triggers the condition.

Does Pityriasis Alba Ever Go Away?

In most cases, pityriasis alba does go away. The light-colored or white spots on the face of children usually fade on their own in a matter of months.

Any treatment is meant to help make someone with pityriasis alba more comfortable. The skin disorder, which may be linked to atopic dermatitis, typically clears up entirely by adulthood.

What Are the Treatment Options for Pityriasis Alba?

Treatment of pityriasis alba is not always necessary. Most cases usually resolve on their own by adulthood. Still, many parents choose to treat it for cosmetic reasons, especially if their child is self-conscious about their skin.

Even with treatment, recovery can sometimes take several months. Your child should avoid tanning (natural or artificial) and consistently use sunscreen (at least 30 SPF) to speed healing.

Moisturizers

Moisturizers that contain petrolatum, mineral oil, squalane, or dimethicone can help soften the skin and reduce scaliness, especially on the face. Brands that are effective, inexpensive, and easy to find include:

• Aquaphor
• Aveeno Cream
• Eucerin

You may also ask your physician for recommendations. Good skin hygiene, in general, can help the patches heal faster.

Over-the-Counter Hydrocortisone

You can use an over-the-counter (OTC) 1% hydrocortisone cream (topical steroid) sparingly if there is itchiness. However, care should be taken when using hydrocortisone on the face.

Do not apply around the eyes or on the eyelids. Don't use OTC hydrocortisone for more than four weeks continuously unless you are following your healthcare provider's advice.

Topical Calcineurin Inhibitors

Elidel (pimecrolimus) and Protopic (tacrolimus) are non-steroidal medications that may be prescribed to clear the rash. They aren't often needed but are sometimes suggested in more severe cases.

Topical calcineurin inhibitors are most often used to treat eczema. They are used off-label for pityriasis alba. This means the Food and Drug Administration hasn't approved them specifically for this purpose. Because they are not steroids, you can safely use them around the eyes.

Summary

Pityriasis alba is a condition in which patches of skin lose pigmentation and are lighter in color than surrounding skin. It most often affects elementary-age children. The affected areas of skin are small—usually no bigger than an inch in diameter.

A diagnosis of pityriasis alba is based on a physical exam and skin tests. Most often, the white spots on the skin heal on their own without treatment. But, if your child feels self-conscious, your healthcare provider may advise treating the patches with moisturizers or other topical medications to speed the healing process.