Pityriasis alba pigmenting L30.5

Du Toit, 1993

Rare variant of pityriasis alba, which is mainly observed in dark-skinned, mostly atopic patients.

3-10 years, rarely adults, dark skinned individuals. No gender preference.

Mostly occurring on the cheeks, zygomatic region, temples and forehead, but also over a large area, e.g. on the sides of the upper arms.

5-10 or more, usually lasting several months, sometimes more than 1 year, sharply defined, large, hyperpigmented, scaly patches or slightly consistency increased, little or no itching, hardly elevated plaques surrounded by a hypopigmented halo. The lesions may occur individually, but may also confluent due to appositional growth, resulting in irregularly configured garland-like areas.

Mostly discrete superficial, interstitial, lymphocytic dermatitis with low epidermotropy and spongiosis Parakeratosis is usually absent. Focal pigment incontinence.

Tinea faciei: More pronounced itching, faster progression, more pronounced inflammatory lesions, more prominent edges, fungal evidence.

Eczema atopic: The pityriasis alba (faciei) can be interpreted as a minimal form of atopic eczema. The frequent association with other atopic stigmata speaks for this. However, it can also occur without an atopic relationship, as an independent clinical picture. A "classical" possibly also monotopic facial atopic eczema shows clearly stronger signs of inflammation.

Short-term (several weeks), daily mild corticoid externa. Trials with 0,1% Tacrolimus ointment were promising.

Permanent, chronic course over months, often more than 1 year. The foci heal completely without residual changes.

The anti-inflammatory therapy approaches lead to a complete repigmentation of the affected areas after a longer period of time.

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3. Du Toit MJ et al (1993) Pigmenting pityriasis alba. Pediatric Dermatol 10: 1-5
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5. In SI et al (2009) Clinical and histopathological characteristics of pityriasis alba. Clin Exp Dermatol 34:591-597

6. Wolf R et al (1985) Extensive pityriasis alba and atopic dermatitis. Br J Dermatol 112: 247