White patches on the face and other parts of the skin can be due to pityriasis alba. This skin condition is often seen in children and young adolescents. These light or white patches on the skin are harmless; however, it may take weeks or months for the patches to clear completely.
Usually, pityriasis alba does not require any specific treatment, although steroids and calcineurin inhibitors may be beneficial.
What is pityriasis alba?
Pityriasis alba is a skin disorder that is commonly seen in children and young adolescents, in the age group of 2-15 years. It is characterized by white or light-colored patches on the skin.
The term “pityriasis” refers to the fine, bran-like scales seen on the patches, while “alba” refers to the white or light-colored appearance of these patches.
Note: Pityriasis alba is different from pityriasis versicolor, which is a fungal infection of the skin.
Causes
The underlying cause of pityriasis alba is not clear. However, many individuals with this condition have co-existing atopic dermatitis. It is thought that these patches may be due to post-inflammatory hypopigmentation as a result of atopic dermatitis.
It is also seen more often in individuals with dry and sensitive skin, or in children who often take hot baths.
Sun exposure seems to make the pale or hypopigmented patches more prominent.
Symptoms and pictures
Pityriasis alba presents with white or light-colored spots on the skin, commonly seen on the face, especially the cheeks and chin. These white discolored patches can also be found on the neck, upper arms, and trunk, and may be more prominent in individuals with darker skin tones.
These spots can be flat skin lesions or slightly raised lesions (called plaques).
The patches may be round, oval, or irregular in shape and usually have ill-defined borders. There can be multiple patches, and they are usually asymptomatic, although occasionally some individuals may experience itching.
Pityriasis alba skin patches usually go through the following stages:
- First, pink patches or slightly raised spots called plaques appear, which have a scaly surface.
- These patches then become hypopigmented and appear as light-colored or white patches with fine scales.
- Over several weeks, these patches lose the surface scale and become smooth.
- Eventually, the skin regains its color, but this may take months to occur.
The white spots may become more prominent during the summer or after sun exposure, as the surrounding skin tends to tan while these spots do not, making them more visible. Similarly, the white spots may become very dry or scaly during the winter or in a dry environment.
Diagnosis
In most cases, pityriasis alba is diagnosed based on a clinical examination, such as by examining white spots on the face of a child and reviewing the medical history. In some instances, your doctor may recommend additional testing. These tests may include:
- Skin scrapings: This involves scraping the skin cells from the affected area and examining them under a microscope for fungal elements.
- Wood lamp examination: This involves the use of a special UV light to examine the affected area. In cases of pityriasis alba, there will be no fluorescence.
- Skin biopsy: A skin biopsy involves taking a small skin sample from the affected area. It is rarely needed.
Look-alikes
Many skin conditions can present with white patches on the skin. Due to this, it’s important to differentiate pityriasis alba from other skin conditions:
- Tinea versicolor (Pityriasis versicolor): This fungal infection can lead to brown, white, or pink spots on the skin. It is more commonly seen in adults and often occurs on the trunk. Additionally, a wood lamp examination will reveal fluorescence due to fungi. (Read more: Pityriasis Alba Vs. Tinea Versicolor)
- Seborrheic dermatitis: This can cause white spots on the skin, especially in darker skin tones. This condition usually involves the scalp, face, and chest, leading to oily patches covered with thick, greasy scales.
- Atopic dermatitis: Atopic dermatitis can result in dry, pink patches on the skin; however, these are typically associated with itching.
- Vitiligo: Vitiligo leads to smooth, white patches on the skin with well-defined borders, unlike the scaly patches of pityriasis alba with ill-defined borders.
Treatment
Pityriasis alba usually does not require treatment. However, if the appearance of white or light-colored spots on the face or other parts of the body is bothersome or if the patches are associated with dryness or itching, the following treatments may be recommended:
- Moisturizers: A moisturizer can help soften the affected area and reduce scaliness and dryness. There are many over-the-counter affordable options like Cerave, and Aveeno, which can be helpful. It’s best to use a moisturizer free of fragrance and essential oils.
- Topical steroids: Mild topical steroids may be prescribed for short-term use if there’s inflammation. It is important to use steroid medications under supervision, as misuse of steroids can damage the skin barrier and may lead to pigment alteration.
- Calcineurin inhibitors: These are non-steroidal medications that work by suppressing the immune system, such as 0.1% tacrolimus ointment and 1% pimecrolimus cream.
- Sunscreen: It is important to protect the skin from the sun as it can prevent making the white discolored patches more prominent.
It is important to educate patients that pityriasis alba is not contagious, is harmless, and may take time to resolve.
Key points
Pityriasis alba is a mild and generally self-limiting skin condition that often leads to white spots on the face of children. The underlying cause is not clear, but it is often associated with dry skin and atopic dermatitis.
Pityriasis alba presents with scaly pink patches, which over weeks become pale or white patches. Over time, these scaly patches become smooth and may take several months to clear.
Pityriasis alba does not require specific treatment and usually goes away on its own. Moisturizing creams and topical steroids may be helpful in relieving dryness.
References
- Rao M, Young K, Jackson-Cowan L, Kourosh A, Theodosakis N. Post-Inflammatory Hypopigmentation: Review of the Etiology, Clinical Manifestations, and Treatment Options. J Clin Med. 2023 Feb 3;12(3):1243. doi: 10.3390/jcm12031243. PMID: 36769891; PMCID: PMC9917556.
Disclaimer: This article is for information purposes only and does not replace medical advice.