Definition

• Small pale spots on the face
• Called Pityriasis Alba (PA)

Health Information

Symptoms

• Small spots with less pigment than the normal skin.
• The spots are flat. Most are oval shaped.
• Their borders are vague and fade into the normal skin.
• Pale spots are usually less than ½ inch (12 mm) across.
• The face is always involved, but can also occur on the arms.
• The spots may be covered with very fine scales.
• Spots look worse (more pale) in the summer when the normal skin gets tan.
• It rarely causes any itching.

Causes

• A partial loss of skin pigment caused by skin irritation
• The main irritants are soap and dry winter weather.
• Soap removes the skin’s natural protective oils. Once they are gone, the skin can’t hold moisture.
• Dry climates make it worse, as does winter weather. Reason: low humidity inside.
• Can occur as early as 2 years
• More common in children with eczema
• Seen in up to 30% of children

Prevention of Recurrent Pityriasis Alba

• Don’t use soaps or bubble bath. Reason: It’s made worse by soaps.
• You may want to limit use of swimming pools or hot tubs. Reason: Pool chemicals are very drying.
• Run a humidifier in the winter if the air is dry.

Care Advice

1. Overview:
   • Pityriasis Alba (PA) is a common condition.
   • It will get better if you avoid soaps and other irritants on the face.
   • The normal pigment always returns, but it may take 6 months
   • PA has nothing to do with vitiligo. Vitiligo are spots with complete loss of pigment.
   • PA is harmless and can be treated at home.
   • Here is some care advice that should help.
2. Soap and Bathing:
   • Never use any soap on the areas with PA. This is very important.
   • Young children with PA should avoid all soaps. Soaps take the natural protective oils out of the skin. Bubble bath does the most damage.
   • For young children, the skin can be cleansed with warm water alone. Keep bathing to 10 minutes or less.
   • Most young children only need to bathe twice a week.
3. Moisturizing Cream:
   • Buy a large bottle of moisturizing cream. Avoid those with fragrances.
   • Put the cream on the PA areas 2 times per day.
   • After warm water baths or showers, trap the moisture in the skin. Do this by putting on the cream quickly. Use the cream within 3 minutes of completing the bath.
   • During the winter, apply the cream to all the skin. Do this every day to prevent dry skin.
4. Steroid Cream:
   • Usually PA is not itchy unless you scrub it with soap.
   • For very itchy spots, use 1% hydrocortisone cream. No prescription is needed.
   • Use up to 2 times per day as needed until the itching is better.
   • In time, the moisturizing cream will be all that you need for treating PA.
5. Prescription Creams:
   • There is no prescription cream that will help.
6. Humidifier:
   • If your winters are dry, protect your child’s skin from the constant drying effect.
   • Do this by running a room humidifier full time.
7. What to Expect:
   • With treatment, the skin should feel softer within 1 week
   • The normal skin pigment will take up to 6 months to return. But, it always does.
   • May recur in young children, but goes away by the teen years.

Call Your Doctor If

• After 2 weeks of treatment, dryness is not gone
• After 6 months, normal skin color has not returned
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC