Pityriasis Alba, Eczema in Children ?

Pityriasis Alba is a chronic skin disorder that affects some children usually between the ages of 6 to 12.  This rash is characterized by patches of lighter skin mainly on the face, although the neck, upper chest, and arms are sometimes involved.  The borders of the rash are not clearly visible.  The light colored patch seems to blend gradually into normal appearing skin.  Sometimes the rash is covered by very fine skin flakes resembling a light dust.

Pityriasis alba (PA) is a relatively common skin disorder in children and young adults. It is characterized by the presence of ill-defined, scaly, faintly erythematous patches that subside to leave areas of hypopigmentation. Lesions may progress through the following 3 clinical stages: Papular (scaling) erythematous, Papular (scaling) hypochromic and Smooth hypochromic

Lesions eventually subside, leaving areas of hypopigmentation that slowly repigment to normal. The duration of pityriasis alba varies from one month to 10 years, but most cases resolve over several months to one year. Diagnosis is made clinically, and treatment consists of skin care and education of the parents about the benign nature of the disorder. Hydrocortisone may decrease erythema, scale, and pruritus, if present. Pityriasis alba is a nonspecific finding that is commonly associated with atopic dermatitis. Xerosis that presents in individuals with atopic diathesis is an important element in the development of the disease.

Although the exact incidence has not been described, up to one third of school-aged children may have this disorder. Pityriasis alba is not seasonal, but the dry, slightly scaling appearance tends to worsen during cold months, when the air is relatively dry inside the home. In addition, sun exposure may make the lesions more obvious during spring and summer. The condition is more common in patients with a history of atopy.

In a large study of 9955 schoolchildren aged 6-16 years who lived in a tropical region, the prevalence of pityriasis alba was 9.9%. Pityriasis alba occurs in people of all races. One study found the incidence to be slightly higher in light-skinned people. The condition is frequently more apparent and cosmetically bothersome in patients with darker complexions. Pityriasis alba is more prevalent in males than in females. Pityriasis alba is most common in children aged 3-16 years. Ninety percent of cases occur in children younger than 12 years. Pityriasis alba occasionally occurs in adults.

Pityriasis alba is generally self-limited and asymptomatic. Cosmetic appearance may be an issue in some patients. Daycare facilities and schools may voice concern about the disorder and request the child be evaluated to rule out an infectious disease.


In a study of 9 patients with extensive pityriasis alba, the density of functional melanocytes was reduced in the affected areas without any change in cytoplasmic activity.The melanosomes tended to be fewer and smaller, but their distribution pattern in the keratinocytes was normal. Melanosomal transfer to keratinocytes was generally not disturbed. Histology was nonspecific. Hyperkeratosis and parakeratosis were not consistently present, and they are seemingly unlikely to play a significant role in the pathogenesis of the hypomelanosis. A variable degree of intercellular edema and intracytoplasmic lipid droplets were present. Hypopigmentation may be primarily due to the reduced numbers of active melanocytes and a decrease in number and size of melanosomes in the affected skin.

Sometimes pityriasis alba is confused with tinea versicolor, which is an autoimmune response to a fungus on the skin.  The diagnosis of tinea versicolor can be ruled out by a KOH examination of the flakes.  In this examination, a small amount of the surface flakes are scraped off the skin onto a glass slide.  KOH is added to the scraping and the slide is viewed under the microscope.  Fungal elements can be seen under the microscope with tinea versicolor but not with pityriasis alba.

Pityriasis alba can also be confused with vitiligo.  Pityriasis alba can be distinguished from vitiligo by the border of the rash.  The rash of vitiligo has a very distinct border with a sharp line between normal and lighter-colored skin.

Observation that the morphology of EPA lesions may not be different from that of classical PA is correct. The denomination of EPA is a misnomer that can create confusion. It is a condition not related to atopy, occurring in young adult females with chronic duration. To avoid misunderstanding, it should be regarded and identified possibly under the term progressive and extensive hypomelanosis, which is a different descriptive term defining the same disease.

The single skin lesions of EPA do not differ substantially from those of pityriasis alba, consistent differences are a widespread, symmetric involvement of the skin of the trunk by numerous, round, nonscaly, hypomelanotic patches without a preceding inflammatory phase and with long-lasting duration. Histologic examination shows a decrease of epidermal melanin; spongiosis is absent. Ultrastructural studies suggested that this hypopigmentation resulted primarily from a reduced number of active melanocytes and a decrease in the number and size of melanosomes.

Extensive pityriasis alba in a child with atopic (Children Allergy Clinic Jakarta Indonesia)


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