Pityriasis alba

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Classification according to ICD-10
L30.5 Pityriasis alba faciei
ICD-10 online (WHO version 2019)

Pityriasis alba (also known as pityriasis alba faciei or as pityriasis simplex ) is a common, non-contagious and usually harmless skin disease that occurs mainly in children. It manifests itself as dry, fine, scaly , light-colored spots that appear mainly on the face. The disease heals on its own and usually only requires the use of a moisturizer .

The name of the disease is derived from the fine, scaly appearance (from ancient Greek πίτυρα / pityra : the bran ) and from the pallor of the spots (from Latin alba : the white , although the spots are not completely depigmented , but rather hypopigmented ). Pityriasis alba is considered to be the minimal variant of atopic eczema .

distribution

Pityriasis alba is most common in children between the ages of 3 and 16, and more often in boys than girls. It may be more common in fair-skinned people, but it is more noticeable in darker-skinned people.

The skin disease occurs at least once in almost every third US school child up to the age of 18, so the period prevalence is around 30%. When determining the prevalence at a certain point in time (point prevalence), the values ​​ranged between 8.4% in northern India and 31% in Mali. Other studies showed point prevalence rates of 13.49% in Egypt, 12% in Turkey, with children from poor socio-economic backgrounds showing a higher prevalence, 9.9% in Brazil, 5.1% in Romania, and only 1% with school children in Hong Kong.

root cause

The exact cause of pityriasis alba is not known. Atopic eczema that has healed sometimes also leaves the skin pale. This consequence can also be observed with excessive use of corticoid cream for the treatment of eczema . The hypopigmentation (reduced pigment formation in the skin) that occurs in pityriasis alba is a result of the reduced activity of the melanocytes , which release fewer and smaller melanosomes .

Clinical manifestations

In winter, the dry, scaly appearance of Pityriasis alba occurs most clearly as a result of dry indoor air. In summer, however, the pale color of the pityriasis alba spots is particularly visible due to the suntan of the surrounding skin.

The individual spots ( lesions ) develop in three stages and sometimes cause itching :

  1. Raised and reddened - the redness is often mild and goes unnoticed by parents.
  2. Elevated and pale
  3. Smooth and flat, pale spots

The spots are round or oval, between 0.5 and 2 cm in diameter. Spots on the body (as opposed to spots on the face) can be up to 4 cm. The number of spots on the whole body is usually 4 to 5, but it can also be more than 20. The spots are dry and finely flaky. They are most common on the face (especially the side cheeks), but 20% of patients also have spots on the upper arms, neck, or shoulders.

treatment

Treatment is not necessary as the stains will heal on their own after a while. Since the pityriasis alba spots are not subject to normal skin tanning when exposed to the sun and remain light, effective sun protection of the entire skin is the best method to minimize the aesthetically undesirable color difference between the spots and the surrounding skin. If necessary, the stains can be covered cosmetically .

If redness, flaking or itching occur, these can be treated with simple soothing agents. Sometimes the weak steroid hydrocortisone (trade name including: Fenistil Hydrocort ® ) is used. The use of tacrolimus (trade name Protopic ® ) can accelerate healing, but should only be used as a reserve drug due to the side effects and the suspicion of carcinogenicity . The treated patients should also be older than two years, and the treatment should only take place briefly or at intervals with small amounts of active ingredient. In particularly serious cases can PUVA therapy are employed, the long-wave UV light with as natural substances occurring psoralen combined.

Prospect of healing

The pigment shifts caused by Pityriasis alba can last between a month and ten years. Spots on the face usually last a year or more.

History and cultural aspects

Pityriasis alba was first described as a flaky skin disease in 1860 by the French doctor Camille-Melchior Gibert. Although it is not a clinically serious disease, pityriasis alba is important from an aesthetic point of view, as this skin disease usually affects the face and young children are the main patient group. Pityriasis alba has been investigated since the 19th century, but its aetiology is still not fully understood.

See also

  • Vitiligo , also known as white spot disease, causes completely pigment-free spots. When the face is affected, spots accumulate around the mouth and eyes.

Web links

Individual evidence

  1. ^ A b F. J. Pinto, JL Bolognia: Disorders of hypopigmentation in children. In: Pediatr. Clin. North Am. Vol. 38, No. 4, 1991, pp. 991-1017. PMID 1870914 .
  2. ↑ M. Blessmann Weber, LG Sponchiado de Avila, R. Albaneze, OL Magalhães de Oliveira, BD Sudhaus, TF Cestari: Pityriasis alba: a study of pathogenic factors. In: Journal of the European Academy of Dermatology and Venereology . Volume 16, No. 5, 2002, pp. 463-468. PMID 12428838 .
  3. ^ TA Laude: Approach to dermatologic disorders in black children. In: Seminars in Dermatology . Volume 14, No. 1, 1995, pp. 15-20. PMID 7742234 .
  4. ^ S. Dogra, B. Kumar: Epidemiology of skin diseases in school children: a study from northern India. In: Pediatric Dermatology . No. 6, 2003, pp. 470-473. PMID 14651562 .
  5. ↑ O. Faye, HT N'Diaye, S. Keita, AK Traoré, RJ Hay, A. Mahé: High prevalence of non-leprotic hypochromic patches among children in a rural area of ​​Mali, West Africa. In: Leprosy Review . Volume 76, No. 2, 2005, pp. 144-146. PMID 16038247 .
  6. ↑ K. Abdel-Hafez, MA Abdel-Aty, ER Hofny: Prevalence of skin diseases in rural areas of Assiut Governorate, Upper Egypt. In: International Journal of Dermatology . Volume 42, No. 11, 2003, pp. 887-892. PMID 14636205 .
  7. ↑ I. İnanır, MT Sahin, K. Gündüz, G. Dinç, A. Turel, p Oztürkcan: Prevalence of skin conditions in primary school children in Turkey: differences based on socioeconomic factors. In: Pediatric Dermatology . Volume 19, No. 4, 2002, pp. 307-311. PMID 12220273 .
  8. ↑ LM Bechelli, N. Haddad, WP Pimenta, PM Pagnano, E. Melchior, RC Fregnan, LC Zanin, A. Arenas: Epidemiological survey of skin diseases in schoolchildren living in the Purus Valley (Acre State, Amazonia, Brazil). In: Dermatologica . Volume 163, No. 1, 1981, pp. 78-93. PMID 7274519 .
  9. ^ R. Popescu, CM Popescu, HC Williams, D. Forsea: The prevalence of skin conditions in Romanian school children. In: British Journal of Dermatology . Volume 140, No. 5, 1999, pp. 891-896. PMID 10354028 .
  10. ^ WK Fung, KK Lo: Prevalence of skin disease among school children and adolescents in a Student Health Service Center in Hong Kong. In: Pediatric Dermatology. Volume 17, No. 6, 2000, pp. 440-446. PMID 11123774 .
  11. ^ F. Vargas-Ocampo: Pityriasis alba: a histologic study. In: International Journal of Dermatology. Volume 32, No. (12), 1993, pp. 870-873. doi: 10.1111 / j.1365-4362.1993.tb01401.x . PMID 8125687 .
  12. ^ RL Lin, CK Janniger: Pityriasis alba. In: Cutis . Volume 76, No. 1, 2005, pp. 21-24. PMID 16144284 .
  13. ↑ J. Harper: Topical corticosteroids for skin disorders in infants and children. In: Drugs . Volume 36, Suppl. 5, 1988, pp. 34-37. PMID 2978289 .
  14. ↑ D. Rigopoulos, S. Gregoriou, C. Charissi, G. Kontochristopoulos, D. Kalogeromitros, S. Georgala: Tacrolimus ointment 0.1% in pityriasis alba: an open-label, randomized, placebo-controlled study. In: British Journal of Dermatology. Volume 155, No. 1, 2006, pp. 152-155. doi: 10.1111 / j.1365-2133.2006.07181.x PMID 16792767 .
  15. ^ NH Cox, Catherine H. Smith, British Association of Dermatologists: Advice to dermatologists re topical tacrolimus. ( Memento of April 1, 2008 in the Internet Archive ) 2002.
  16. ↑ Di Lernia V, Ricci C: Progressive and extensive hypomelanosis and extensive pityriasis alba: same disease, different names? In: Journal of the European Academy of Dermatology and Venereology. Volume 19, No. 3, 2005, pp. 370-372. PMID 15857470 .
  17. Jump up ↑ Magda Blessmann Weber, Luiz Gustavo Sponchiado de Ávila, Tania Ferreira Cestari: Pityriasis alba: epidemiological, clinical, and therapeutic aspects. In: Anais Brasileiros de Dermatologia . ISSN  0365-0596 . (English edition.) Vol. 75, No. 3. Article available online ( Memento from July 1, 2007 in the web archive archive.today ) (Retrieved June 29, 2008.) There the first description is attributed to Gilbert (sic!).