Pityriasis Alba, Eczema in Children ?

Pityriasis Alba is a chronic skin disorder that affects some children usually between the ages of 6 to 12.  This rash is characterized by patches of lighter skin mainly on the face, although the neck, upper chest, and arms are sometimes involved.  The borders of the rash are not clearly visible.  The light colored patch seems to blend gradually into normal appearing skin.  Sometimes the rash is covered by very fine skin flakes resembling a light dust.

Pityriasis alba (PA) is a relatively common skin disorder in children and young adults. It is characterized by the presence of ill-defined, scaly, faintly erythematous patches that subside to leave areas of hypopigmentation. Lesions may progress through the following 3 clinical stages: Papular (scaling) erythematous, Papular (scaling) hypochromic and Smooth hypochromic

Lesions eventually subside, leaving areas of hypopigmentation that slowly repigment to normal. The duration of pityriasis alba varies from one month to 10 years, but most cases resolve over several months to one year. Diagnosis is made clinically, and treatment consists of skin care and education of the parents about the benign nature of the disorder. Hydrocortisone may decrease erythema, scale, and pruritus, if present. Pityriasis alba is a nonspecific finding that is commonly associated with atopic dermatitis. Xerosis that presents in individuals with atopic diathesis is an important element in the development of the disease.

Although the exact incidence has not been described, up to one third of school-aged children may have this disorder. Pityriasis alba is not seasonal, but the dry, slightly scaling appearance tends to worsen during cold months, when the air is relatively dry inside the home. In addition, sun exposure may make the lesions more obvious during spring and summer. The condition is more common in patients with a history of atopy.

In a large study of 9955 schoolchildren aged 6-16 years who lived in a tropical region, the prevalence of pityriasis alba was 9.9%. Pityriasis alba occurs in people of all races. One study found the incidence to be slightly higher in light-skinned people. The condition is frequently more apparent and cosmetically bothersome in patients with darker complexions. Pityriasis alba is more prevalent in males than in females. Pityriasis alba is most common in children aged 3-16 years. Ninety percent of cases occur in children younger than 12 years. Pityriasis alba occasionally occurs in adults.

Pityriasis alba is generally self-limited and asymptomatic. Cosmetic appearance may be an issue in some patients. Daycare facilities and schools may voice concern about the disorder and request the child be evaluated to rule out an infectious disease.

Pathophysiology

In a study of 9 patients with extensive pityriasis alba, the density of functional melanocytes was reduced in the affected areas without any change in cytoplasmic activity.The melanosomes tended to be fewer and smaller, but their distribution pattern in the keratinocytes was normal. Melanosomal transfer to keratinocytes was generally not disturbed. Histology was nonspecific. Hyperkeratosis and parakeratosis were not consistently present, and they are seemingly unlikely to play a significant role in the pathogenesis of the hypomelanosis. A variable degree of intercellular edema and intracytoplasmic lipid droplets were present. Hypopigmentation may be primarily due to the reduced numbers of active melanocytes and a decrease in number and size of melanosomes in the affected skin.

Sometimes pityriasis alba is confused with tinea versicolor, which is an autoimmune response to a fungus on the skin.  The diagnosis of tinea versicolor can be ruled out by a KOH examination of the flakes.  In this examination, a small amount of the surface flakes are scraped off the skin onto a glass slide.  KOH is added to the scraping and the slide is viewed under the microscope.  Fungal elements can be seen under the microscope with tinea versicolor but not with pityriasis alba.

Pityriasis alba can also be confused with vitiligo.  Pityriasis alba can be distinguished from vitiligo by the border of the rash.  The rash of vitiligo has a very distinct border with a sharp line between normal and lighter-colored skin.

Observation that the morphology of EPA lesions may not be different from that of classical PA is correct. The denomination of EPA is a misnomer that can create confusion. It is a condition not related to atopy, occurring in young adult females with chronic duration. To avoid misunderstanding, it should be regarded and identified possibly under the term progressive and extensive hypomelanosis, which is a different descriptive term defining the same disease.

The single skin lesions of EPA do not differ substantially from those of pityriasis alba, consistent differences are a widespread, symmetric involvement of the skin of the trunk by numerous, round, nonscaly, hypomelanotic patches without a preceding inflammatory phase and with long-lasting duration. Histologic examination shows a decrease of epidermal melanin; spongiosis is absent. Ultrastructural studies suggested that this hypopigmentation resulted primarily from a reduced number of active melanocytes and a decrease in the number and size of melanosomes.

Extensive pityriasis alba in a child with atopic (Children Allergy Clinic Jakarta Indonesia)

Reference

  • Sicherer SH, Sampson HA: Food allergy. J Allergy Clin Immunol 2006, (Suppl 2):470-475.
  • Hambly EM, Wilkinson DS. Some atypical forms of eczema in children. Ann Dermatol Venereol. 1978 Apr;105(4):369-71. French.
  • Blessmann Weber M, Sponchiado de Avila LG, Albaneze R, Magalhães de Oliveira OL, Sudhaus BD, Cestari TF. Pityriasis alba: a study of pathogenic factors. J Eur Acad Dermatol Venereol. 2002 Sep;16(5):463-8.
  • Mark A Crowe, MD; Dirk M Elston. Pediatric Pityriasis Alba. http://emedicine.medscape.com/article/910770-overview#showall
  • du Toit MJ, Jordaan HF. Pigmenting pityriasis alba. Pediatr Dermatol. 1993 Mar;10(1):1-5.
  • Brenninkmeijer EE, Spuls PI, Legierse CM, Lindeboom R, Smitt JH, Bos JD. Clinical differences between atopic and atopiform dermatitis. J Am Acad Dermatol. 2008 Mar;58(3):407-14.
  • Hiletework M. Evaluation of Hanifin and Rajka atopic eczema diagnostic guidelines for reduced minor criteria. Ethiop Med J. 2009 Jan;47(1):39-47.
  • Wahab MA, Rahman MH, Khondker L, Hawlader AR, Ali A, Hafiz MA, Ansari NP. Minor criteria for atopic dermatitis in children. Mymensingh Med J. 2011 Jul;20(3):419-24.
  • Di Lernia V, Ricci C. On atopic and idiopathic extensive pityriasis alba. Pediatr Dermatol. 2006 Nov-Dec;23(6):589-90.
  • Sandhu K, Handa S, Kanwar AJ. Extensive pityriasis alba in a child with atopic dermatitis. Pediatr Dermatol. 2004 May-Jun;21(3):275-6
  • Wolf R, Sandbank M, Krakowski A. Extensive pityriasis alba and atopic dermatitis. Br J Dermatol. 1985 Feb;112(2):247.
  • Blessmann Weber M, Sponchiado de Avila LG, Albaneze R, Magalhães de Oliveira OL, Sudhaus BD, Cestari TF. Pityriasis alba: a study of pathogenic factors. J Eur Acad Dermatol Venereol. 2002 Sep;16(5):463-8.
  • Massone C, Cavalchini A, Clapasson A, Nunzi E. Hypopigmented macules: leprosy, atopy or pityriasis versicolor? G Ital Dermatol Venereol. 2010 Dec;145(6):779-82.
  • Van Do T, Elsayed S, Florvaag E, Hordvik I, Endresen C: Allergy to fish parvalbumins: studies on the cross-reactivity of allergens from 9 commonly consumed fish. J Allergy Clin Immunol 2005, 116:1314-1320.
  • Zaynoun ST, Aftimos BG, Tenekjian KK et al. Extensive pityriasis alba: a histological histochemical and ultrastructural study. Br J Dermatol 1983;108:83–90.
  • GuilletG,Helenon R, GauthierYet al. Progressivemacular hypomelanosis of the trunk: primary acquired hypoppigmentation. J Cutan Pathol 1988;15:286–289.
  • Guillet G, He´le´non R, Guillet MH et al. Hypome´lanose maculeuse confluente et progressive du me´tis me´lanoderme. Ann Dermatol Venereol 1992;119:19–24.
  • Guillet G, Guillet MH. Dyschromie cre´ole ou hypome´lanose idiopathique du me´tis me´lanoderme de Guillet-He´le´- non. Bull Soc Path Ex 1997;90:333–334.
  • Helbling A, Haydel R, McCants ML, Musmand JJ, El Dahr J, Lehrer SB: Fish allergy: is cross-reactivity among fish species relevant? Double-blind placebo-controlled food challenge studies of fish allergic adults. Ann Allergy Asthma Immunol 1999, 83:517-523.
  • Sten E, Hansen TK, Stahl SP, Andersen SB, Torp A, Bindslev-Jensen U, et al.: Cross-reactivity to eel, eelpout and ocean pout in codfish-allergic patients. Allergy 2004, 59:1173-1180.
  • Leung PS, Chen YC, Chu KH: Seafood allergy: tropomyosins and beyond. J Microbiol Immunol Infect 1999, 32:143-154.
  • Reese G, Ayuso R, Lehrer SB: Tropomyosin: an invertebrate pan-allergen. Int Arch Allergy Immunol 1999, 119:247-258.
  • Halkier-Sorensen L, Thestrup-Pedersen K: Skin irritancy from fish is related to its postmortem age. Contact Dermatitis 1989, 21:172-178.
  • Ree-Kim L, Lehrer SB: Seafood allergy. Curr Opin Allergy Clin Immunol 2004, 4:231-234.
  • Jeebhay MF, Robins TG, Lehrer SB, Lopata AL: Occupational seafood allergy: a review. Occup Environ Med 2001, 58:553-562.
  • Aasmoe L, Bang B, Andorsen GS, Evans R, Gram IT, Lochen ML: Skin symptoms in the seafood-processing industry in north Norway. Contact Dermatitis 2005, 52:102-107.

Supported by

ALLERGY ONLINE CLINIC FOR CHILDREN, TEEN AND ADULT Yudhasmara Foundation htpp://www.allergyclinic.wordpress.com/ htpp://growupclinic.com GROW UP CLINIC I JL Taman Bendungan Asahan 5 Jakarta Pusat, Jakarta Indonesia 10210 Phone : (021)  5703646 – 44466102 GROW UP CLINIC II  MENTENG SQUARE Jl Matraman 30 Jakarta Pusat 10430 phone 44466103 – 97730777 http://growupclinic.com  http://www.facebook.com/GrowUpClinic Creating-hashtag-on-twitter@growupclinic WORKING TOGETHER SUPPORT TO THE HEALTH OF ALL BY CLINICAL, RESEARCH AND EDUCATIONS. Advancing of the future pediatric and future parenting to optimalized physical, mental and social health and well being for fetal, newborn, infant, children, adolescents and young adult

“GRoW UP CLINIC” Jakarta Focus and Interest on: *** Allergy Clinic Online *** Picky Eaters and Growup Clinic For Children, Teen and Adult (Klinik Khusus Gangguan Sulit Makan dan Gangguan Kenaikkan Berat Badan)*** Children Foot Clinic *** Physical Medicine and Rehabilitation Clinic *** Oral Motor Disorders and Speech Clinic *** Children Sleep Clinic *** Pain Management Clinic Jakarta *** Autism Clinic *** Children Behaviour Clinic *** Motoric & Sensory Processing Disorders Clinic *** NICU – Premature Follow up Clinic *** Lactation and Breastfeeding Clinic *** Swimming Spa Baby & Medicine Massage Therapy For Baby, Children and Teen ***

Professional Healthcare Provider “GRoW UP CLINIC” Dr Narulita Dewi SpKFR, Physical Medicine & Rehabilitation curriculum vitae HP 085777227790 PIN BB 235CF967   Clinical – Editor in Chief : Dr WIDODO JUDARWANTO, pediatrician email : judarwanto@gmail.com curriculum vitaeCreating-hashtag-on-twitter: @WidoJudarwanto  www.facebook.com/widodo.judarwanto Mobile Phone O8567805533 PIN BB 25AF7035
We are guilty of many errors and many faults. But our worst crime is abandoning the children, neglecting the fountain of life.
Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider

Copyright © 2013, Allergy Online Clinic Information Education Network. All rights reserved

One response to “Pityriasis Alba, Eczema in Children ?

Tinggalkan Balasan

Isikan data di bawah atau klik salah satu ikon untuk log in:

Logo WordPress.com

You are commenting using your WordPress.com account. Logout / Ubah )

Gambar Twitter

You are commenting using your Twitter account. Logout / Ubah )

Foto Facebook

You are commenting using your Facebook account. Logout / Ubah )

Foto Google+

You are commenting using your Google+ account. Logout / Ubah )

Connecting to %s