Pityriasis Alba
Pityriasis alba is a low-grade type of eczema seen mainly in children. The name describes it: pityriasis for the fine scale and alba for the pale colour. It affects about 5% of children worldwide, mostly between 3 and 16 years, boys and girls equally, so it can begin in the toddler years (DermNet 2020). It often coexists with dry skin and Atopic Dermatitis, and it is listed as a minor feature of AD in the Hanifin-Rajka Criteria (Siegfried & Hebert 2015; Healio). Türe Avcı et al. (2026) list it with keratosis pilaris and Dennie–Morgan folds as typical findings alongside childhood AD. Its cause is unknown. Proposed factors include sun exposure, bathing habits, trace-element levels and Malassezia yeast metabolites, but none is proven (DermNet).
Pityriasis Alba [part-of] Atopic Dermatitis Pityriasis Alba [part-of] Hanifin-Rajka Criteria Malassezia [relates] Pityriasis Alba
What parents see. There are usually 1–20 round or oval patches, 0.5–5 cm across, mostly on the cheeks and chin and sometimes on the neck, shoulders and upper arms. Itch is minimal or absent, which is the main difference from ordinary AD patches. If both are present, though, the AD patches still itch (DermNet; National Eczema Society). A patch passes through stages: a slightly scaly pink patch, then a pale patch with fine scale, then a pale patch without scale, then normal skin. The paleness is most obvious in summer, because the surrounding skin tans and the patch does not. Dryness and scale are worse in winter. It is much more visible on darker skin.
Pityriasis Alba [relates] Eczema in Skin of Colour
Conflict: [National Eczema Society, n.d.] says pityriasis alba is more common in darker skin than white skin. [Siegfried & Hebert, J Clin Med 2015] say it is equally common in all skin types and only more apparent on darker skin; DermNet (2020) says “perhaps more common”. Unresolved — add to open_questions.
Diagnosis and look-alikes. Diagnosis is usually clinical. If doubt remains, a Wood lamp examination or fungal scrapings can exclude pityriasis versicolor and Tinea, and biopsy is rarely needed (DermNet). Hypopigmented mycosis fungoides, a rare childhood lymphoma, can look identical in severe cases. It favours areas covered by a swimsuit, so pale patches that persist or spread on the trunk deserve review (Siegfried & Hebert 2015; Türe Avcı 2026). Patchy paleness can also follow any resolving AD flare. Parents often blame Topical Corticosteroids, but the National Eczema Society states that the eczema, not the steroid, causes this paleness.
Pityriasis Alba [part-of] Differential Diagnosis of Toddler Eczema Tinea [relates] Pityriasis Alba
Management. No treatment is needed if the patches cause no symptoms. A moisturiser (Emollient Therapy) improves the dry look. Mild Hydrocortisone 0.5–1% or a topical calcineurin inhibitor helps if the patches are red or itchy, and calcineurin inhibitors may speed return of colour (DermNet). Steroids should not be continued long term just to correct colour, because that risks permanent lightening (NES). Sun protection makes the patches less noticeable. They clear after about a year on average, with a range from a few months to 2–3 years, and the colour returns fully (DermNet).
Emollient Therapy [treats] Pityriasis Alba Topical Calcineurin Inhibitors [treats] Pityriasis Alba
Connections
- Eczema in Skin of Colour — pale patches more common in darker skin, source: NES
- Atopic Dermatitis — minor feature / frequent coexisting condition, source: DermNet 2020; Siegfried & Hebert 2015
- Hanifin-Rajka Criteria — listed minor criterion, source: Healio; Siegfried & Hebert 2015
- Post-Inflammatory Hyperpigmentation — the opposite (darkening) pigment change after eczema, source: NES
- Differential Diagnosis of Toddler Eczema — pale-patch differential (tinea, versicolor, hypopigmented MF), source: DermNet; Türe Avcı 2026
- Topical Calcineurin Inhibitors — may speed repigmentation, source: DermNet 2020