miércoles, 31 de mayo de 2017

THE PITYRIASIS ALBA, A REVIEW ./ LA PITIRIASIS ALBA REVISION


The Pityriasis Alba, a Review. 

La Pitiriasis Alba, Revision













EDITORIAL ENGLISH
=================== Hello friends of the network. DERMAGIC EXPRESS, brings you a very interesting topic because this disease: PITYRIASIS ALBA (PA), is very common among children and adolescents of both sexes and quite frequent in the dermatological consultation.

The first thing I am going to tell you is that the majority of the patients who go to the dermatological consultation with this disease think or believe that it is a "FUNGUS", because its clinical characteristics are similar to PITYRIASIS VERSICOLOR, which if it is produced By yeast MALASSEZIA FURFUR as I explained in a previous review.

The history of this disease in its characterization began in 1.853 when GUDDEN described a hypopigmentation (loss of skin color) RESIDUAL after healed PITYRIASIS VERSICOLOR, which was known and described its causal agent in 1.848 by Eichstedt being this as I told you the fungus Malassesia Furfur.

This fact provoked confusion for a long time, being nowadays still misdiagnosed as a SUPERFICIAL MICOSIS of the skin, when in fact it is not.

The main cause of the PITYRIASIS ALBA recognized today is the PROLONGED EXPOSURE TO THE SUN without proper use of sunscreen. The most commonly affected areas are in children the FACE and in adolescents the ARMS. The lesions are oval, hypopigmented and diffuse from small to medium size, usually asymptomatic, but there may be slight desquamation.

There is a more severe variant of PITYRIASIS ALBA called EXTENSIVE PITYRIASIS ALBA which is presented in addition to the face and arms in TRUNK AND EXTREMITIES, the lesions are more numerous and it is more difficult to treat.

It is also interesting that you know that talking about diffuse hypochromic maculae EXISTS ANOTHER ENTITY, called PROGRESSIVE MACULAR HYPOMELANOSIS, very similar to PITYRIASIS ALBA, in fact some authors consider it to be the same disease. In the year 1.992, Dr. Dante Borelli, a Venezuelan mycologist, called it CUTIS TRUNCI VARIATA, also known as PROGRESSIVE HIPMELANOSIS OF THE TRUNK.

In this the hypochromic maculae mainly affect the back and anterior thorax, are more rounded and there is no antecedent of prolonged sun exposure, in many cases they appear spontaneously.

DIFFERENTIAL DIAGNOSIS OF PITYRIASIS ALBA:

1.) PITYRIASIS VERSICOLOR
2.) PROGRESSIVE MACULAR HYPOMELANOSIS.
3.) LEPROSY
4.) POSTINFLAMATORY HIPOPGMENTARY DERMATITIS.
5.) VITILIGO.
6.) HIPOMELANOSIS GUTTATA.

MORE USED TREATMENTS.

1.) SUNSCREENS.
2.) MOISTURIZERS.
3.) TACROLIMUS.
4.) PIMECROLIMUS.
5.) UREA.
6.) SALICYLIC ACID.
7.) TOPICAL STEROIDS.
8.) PUVA (PSORALENES + UVA)
9.) LASER.
10.) CALCITRIOL.
11.) TOPICAL TRETINOIN.

The word PITYRIASIS means, desquamation in fine crusts, and the word ALBA means WHITE. Hypopigmentation occurs because the production of MELANINE, is inhibited, several theories about it: sun rays, use of cosmetics on the skin, type of skin coloration, and others. This enigmatic and common disease disappears completely with a good treatment, which can sometimes be long because it is necessary to stimulate the production of the pigment in the superficial layer of the skin.
 
The fundamental treatment of PITIRYIASIS ALBA is based on the use of a GOOD SUNSCREEN in areas exposed to the sun during the day and a GOOD HYDRATION of the skin, in addition, paradoxically taking moderate "SUN" baths are necessary to stimulate the production of the pigment in the skin or MELANOGENESIS that is inhibited in this pathology.

And always remember, NOT ALL WHITE SPOT on the skin it’s always a "FUNGUS"

In the references the facts, in the attached THE PITYRIASIS ALBA IN FACE, ARM AND EXTENSIVE.

Greetings to all.

Dr. José Lapenta R
  





 EDITORIAL ESPAÑOL
=================
Hola amigos de la red. DERMAGIC EXPRESS, les trae un tema bastante interesante pues esta enfermedad: LA PITIRIASIS ALBA (PA), es muy comun entre niños y adolescentes de ambos sexos y bastante frecuente en la consulta dermatologica.

Lo primero que voy a decirte es que la mayoria de los pacientes que van a la consulta dermatologica con esta enfermedad piensan o creen que se trata de un "HONGO", porque sus caractteristicas clinicas son similares a la PITIRIASIS VERSICOLOR, la cual si es producida por la levadura MALASSEZIA FURFUR como ya les explique en una revision previa.

La historia de esta enfermedad en su caracterizacion comenzo en el año 1.853 cuando GUDDEN, describio una hipopigmentacion (perdida del color de la piel) RESIDUAL despues de cicatrizada la PITIRIASIS VERSICOLOR, a la cual se le conocio y describio su agente causal en 1.848 por Eichstedt siendo este como les dije el hongo Malassesia Furfur.

Este dato se presto a confusion durante mucho tiempo, siendo hoy en dia todavia mal diagnosticada como una MICOSIS SUPERFICIAL de la piel, cuando en realidad no es.

La principal causa de la PITIRIASIS ALBA reconocida hoy en dia es LA EXPOSICION PROLONGADA AL SOL sin uso adecuado de protector solar. Las areas mas comunmente afectadas son en los niños la CARA y en los adolescentes los BRAZOS. Las lesiones son ovales, hipopigmentadas y difusas de pequeño a mediano tamaño, por lo general asintomaticas, pero puede haber leve descamacion.

Existe una variante mas severa de la PITIRIASIS ALBA denominada PITIRIASIS ALBA EXTENSA O EXTENSIVA la cual se presenta ademas de la cara y brazos en TRONCO Y EXTREMIDADES, las lesiones son mas numerosas y es mas dificil de tratar.

Tambien es interesante que conozcas que hablando de maculas hipocromicas difusas EXISTE OTRA ENTIDAD, denominada HIPOMELANOSIS MACULAR PROGRESIVA, muy similar a la PITIRIASIS ALBA, de hecho algunos autores consideran que es la misma enfermedad. En el año 1.992 el Dr, Dante Borelli Micologo venezolano la denomino CUTIS TRUNCI VARIATA, tambien conocida como HIPOMELANOSIS PROGRESIVA DEL TRONCO.

En esta ultima las maculas hipocromicas afectan fundamentalmente la espalda y torax anterior son mas redondeadas y no existe el antecedente de exposicion solar prolongada, en muchos casos, aparecen espontaneamente.

DIAGNOSTICO DIFERENCIAL DE LA PITIRIASIS ALBA:

1.) PITIRIASIS VERSICOLOR
2.) HIPOMELANOSIS MACULAR PROGRESIVA.
3.) LEPRA.
4.) DERMATITIS HIPOPIGMENTARIA POSTINFLAMATORIA.
5.) VITILIGO.
6.) HIPOMELANOSIS GUTTATA.

TRATAMIENTOS MAS UTILIZADOS.

1.) PROTECTOR SOLAR.
2.) HIDRATANTES.
3.) TACROLIMUS.
4.) PIMECROLIMUS.
5.) UREA.
6.) ACIDO SALICILICO.
7.) ESTEROIDES TOPICOS.
8.) PUVA (PSORALENOS + UVA
9.) LASER.
10.) CALCITRIOL.
11.) TRETINOINA TOPICA.


LA palabra PITIRIASIS significa, DESCAMACION en costras finas, y la palabra ALBA significa BLANCA. La hipopigmentacion se produce porque la produccion de MELANINA, queda inhibida, varias son las teorias al respecto: rayos solares, uso de cosmeticos en la piel, tipo de coloracion de la piel, y otras.  Esta enigmatica y comun enfermedad desaparece totalmente con un buen tratamiento, el cual a veces puede ser largo porque hay que estimular la produccion  del pigmento en la capa superficial de la piel.

El tratamiento fundamental de la PITIRIASIS ALBA esta basado en la utilizacion DE UN BUEN PROTECTOR SOLAR en areas expuestas al sol, durante el dia, y una BUENA HIDRATACION de la piel, ademas de ello, paradojicamente tomar baños de "SOL" moderados,son necesarios para estimular la producccion del pigmento en la piel o MELANOGENESIS que se encuentra inhibida en esta patologia.

Y recordar siempre, NO TODA MANCHA BLANCA en la piel siempre es un "HONGO"

En las referencias los Hechos, en el adjunto LA PITIRIASIS ALBA EN CARA, BRAZO Y EXTENSIVA.

Saludos a Todos.

Dr. Jose Lapenta R

===========================================================================
REFERENCIAS BIBLIOGRAFICAS / BIBLIOGRAPHICAL REFERENCES
============================================================================ ============================================================================
1.) Pityriasis Alba--Common Disease, Enigmatic Entity: Up-to-Date Review of the Literature.
2.) Pityriasis alba revisited: perspectives on an enigmatic disorder of childhood.
3.) Tacrolimus ointment 0.1% in pityriasis alba: an open-label, randomized, placebo-controlled study.
4.) Clinicopathologic study on pityriasis alba.
5.) Pityriasis alba: a study of pathogenic factors.
6.) An exploratory study to evaluate the efficacy of pimecrolimus cream 1% for the treatment of
pityriasis alba.
7.) A Case of Extensive Pityriasis Alba.
8.) Pityriasis alba.
9.) Progressive and extensive hypomelanosis and extensive pityriasis alba: same disease,
10.) Extensive pityriasis alba: a histological histochemical and ultrastructural study.
11.) Tacrolimus ointment 0.1% in pityriasis alba: an open-label, randomized, placebo-controlled
study.
12.) Progressive macular hypomelanosis.
13.) Progressive macular hypomelanosis in a 16-year old.
14.) Oral methoxsalen photochemotherapy of extensive pityriasis alba. Preliminary report.
15,) Ultrastructural findings in progressive macular hypomelanosis indicate decreased melanin production.
16.) Hypopigmented macules of photodamaged skin and their treatment with topical tretinoin.
17.) Efficacy and tolerability of a cream containing AR-GG27® (sorbityl furfural palmitate) in the treatment of mild/moderate childhood atopic dermatitis associated with pityriasis alba. A double-blind, placebo-controlled clinical trial.
18.) Double-blind, placebo-controlled, randomized study comparing 0.0003% calcitriol with 0.1% tacrolimus ointments for the treatment of endemic pityriasis alba.
19.) Efficacy of 308-nm xenon chloride excimer laser in pityriasis alba.
20.) Hypopigmented macules: leprosy, atopy or pityriasis versicolor?
21.) Pityriasis versicolor alba.
==========================================================  ==========================================================
1.) Pityriasis Alba--Common Disease, Enigmatic Entity: Up-to-Date Review of the Literature.
==========================================================
Pediatr Dermatol. 2015 Nov-Dec;32(6):786-91. doi: 10.1111/pde.12683. Epub 2015 Oct 19.

Miazek N1, Michalek I1, Pawlowska-Kisiel M1, Olszewska M1, Rudnicka L1.
Author information

1
Department of Dermatology, Medical University of Warsaw, Warsaw, Poland.

Abstract

Pityriasis alba (PA) is a skin disorder that affects children and adolescents. Although it is common worldwide, its incidence is markedly higher in darker skin phototypes. Its characteristic features include an extended, multistage course and spontaneous remissions and recurrences. Preceded by erythematous changes, patches of hypopigmented skin of up to a few centimeters in diameter appear on the upper body. Pruritus may accompany it. Even though its etiology is unknown, possible reported triggering factors include sunlight, beauty treatments, and microorganisms, among others. Calcineurin inhibitors play the most crucial role in PA pharmacotherapy. PA often coexists with atopic dermatitis and is considered one of its milder forms.
==========================================================
2.) Pityriasis alba revisited: perspectives on an enigmatic disorder of childhood.
==========================================================
Cutis. 2011 Feb;87(2):66-72.

Jadotte YT1, Janniger CK.
Author information

1
New Jersey Medical School, Newark , NJ 07103 USA.

Abstract

Pityriasis alba (PA) is a localized hypopigmented disorder of childhood with many existing clinical variants. It is more often detected in individuals with a darker complexion but may occur in individuals of all skin types. Atopy, xerosis, and mineral deficiencies are potential risk factors. Sun exposure exacerbates the contrast between normal and lesional skin, making lesions more visible and patients more likely to seek medical attention. Poor cutaneous hydration appears to be a common theme for most risk factors and may help elucidate the pathogenesis of this disorder. The end result of this mechanism is inappropriate melanosis manifesting as hypopigmentation. It must be differentiated from other disorders of hypopigmentation, such as pityriasis versicolor alba, vitiligo, nevus depigmentosus, and nevus anemicus. Alleviation of the various risk factors via patient education on proper skin care and hygiene, use of lubricants and emollients, topical corticosteroid therapy in the presence of inflammation, and the novel administration of topical anti-inflammatory drugs such as calcineurin inhibitors can play a crucial role in promoting remission or resolution.
=========================================================
3.) Tacrolimus ointment 0.1% in pityriasis alba: an open-label, randomized, placebo-controlled study.
=========================================================
Br J Dermatol. 2006 Jul;155(1):152-5.

Rigopoulos D1, Gregoriou S, Charissi C, Kontochristopoulos G, Kalogeromitros D, Georgala S.
Author information

1
Department of Dermatology, Andreas Sygros Hospital, University of Athens, 5 Ionos Dragoumi Str, 16121 Athens, Greece. drigop@hol.gr

Abstract
BACKGROUND:

Pityriasis alba (PA) is a frequent reason for dermatological consultation because of its chronic course, tendency to relapse and aesthetic impact.
OBJECTIVES:

In view of its strong association with atopic dermatitis, the objective of this open-label study was to assess the efficacy and safety of tacrolimus ointment in the treatment of PA compared with the efficacy of moisturizers.
PATIENTS/METHODS:

The study population consisted of 60 individuals of phototype III or IV according to Fitzpatrick's classification, aged 6-21 years. Patients were randomly assigned to one of two groups. Subjects in group A were instructed to apply tacrolimus ointment 0.1% twice daily, 12 h apart, on all hypopigmented macules. Standard moisturizers with SPF 20 sunscreen were used on all lesions applied at least 30 min apart from the tacrolimus ointment. Subjects in group B used solely the same moisturizers with sunscreen. Hypopigmented areas were evaluated at baseline and weeks 0, 3, 6 and 9 by investigators for scaling, hypopigmentation and pruritus on a scale of 0-3. Patient satisfaction was also recorded on a scale of 0-3. All adverse effects were recorded.
RESULTS:

A statistically significant improvement through time, in hypopigmentation, pruritus and scaling was observed in both groups during the course of 9 weeks. Hypopigmentation resolved from a baseline score of 2.38+/-0.64 to 1.15+/-0.54 at week 3, 0.46+/-0.51 at week 6 and 0.00+/-0.00 at week 9 for the group applying tacrolimus ointment 0.1%. The difference in improvement between the two groups was statistically significant on all three assessments for hypopigmentation (P<0.001), and for pruritus on week 6 and 9 assessments (P<0.05). Three patients (11.5%) in the tacrolimus group reported a mild transient sensation of burning. All patients in the tacrolimus group reported they were completely satisfied or just satisfied with the treatment compared with only 50% of patients using the placebo.
CONCLUSIONS:

Tacrolimus ointment 0.1% appears to be an effective and safe treatment for PA.
=========================================================
4.) Clinicopathologic study on pityriasis alba.
=========================================================
Martín RF1, Lugo-Somolinos A, Sánchez JL.
Author information

1
Department of Dermatology, University of Puerto Rico, School of Medicine, San Juan 00936-5067.

Abstract

Pityriasis alba (PA) is a relatively common skin disorder usually seen in children and young adults characterized by the presence of superficial hypopigmented macules. A clinicopathologic study on pityriasis alba was undertaken which showed an increased occurrence of the disease in preadolescent children with an equal incidence in boys and girls, and a predominance of white over black patients. There was an increased personal history of atopy and the skin lesions were found to occur most frequently in the arms and face followed by the legs and the trunk. Histologic evaluation of biopsy specimens of PA showed consistent spongiosis, follicular spongiosis, focal parakeratosis and acanthosis in the epidermis together with a superficial perivascular lymphocytic infiltrate.
=========================================================
5.) Pityriasis alba: a study of pathogenic factors.
=========================================================
J Eur Acad Dermatol Venereol. 2002 Sep;16(5):463-8.

Blessmann Weber M1, Sponchiado de Avila LG, Albaneze R, Magalhães de Oliveira OL, Sudhaus BD, Cestari TF.
Author information

1
School of Medicine, Lutheran University of Brazil (ULBRA), Canoas, RS. mbw@zaz.com.br

Abstract
BACKGROUND:

The aetiology of pityriasis alba (PA), a common dermatosis in childhood, is still controversial. The objective of this study was to assess the possible aetiopathogenic factors of this disease in infants.
METHODS:

Forty-four patients with PA and 31 healthy children were examined and compared. Personal hygiene habits, sun exposure, presence of Staphylococcus aureus in nasal fossae and presence of major or minor signs of atopy were assessed during anamnesis and physical examination. Susceptibility to ultraviolet (UV) B radiation was measured by the onset of a contact hypersensitivity reaction to diphenylcyclopropenone in individuals sensitized in previously irradiated areas.
RESULTS:

The prevalence of PA was higher in individuals with darker skin, in high phototype categories, as well as in males. The number of daily baths and sun exposure between 10.00 h and 15.00 h were significantly higher in the PA group when compared with controls (P = 0.03 and P = 0.0015, respectively). The presence of atopy signs was more common in pityriasis patients (P = 0.002). Susceptibility to UVB radiation was 29.6% in the PA group vs. 29.0% in the control group; nevertheless, important differences were found after stratification in order to control possible confounding factors. The presence of S. aureus in the nostrils was equal in both groups.
CONCLUSIONS:

Our results confirm that PA, in our population, is more prevalent in males and in individuals in higher phototype categories. In those with inadequate personal hygiene and sun exposure habits the disease is more accentuated, demonstrating that the xerosis presenting in individuals with atopic diathesis is an important element in the development of the disease. S. aureus is not an important aetiopathogenic factor in PA. Susceptibility to UVB becomes important when related to the patient's phototype.
=========================================================
6.) An exploratory study to evaluate the efficacy of pimecrolimus cream 1% for the treatment of
pityriasis alba.
=========================================================
Int J Dermatol. 2007 Jul;46(7):700-5.

Fujita WH1, McCormick CL, Parneix-Spake A.
Author information
1
HI 96701, USA. daddy-and-mommy@yahoo.com
Abstract
BACKGROUND:
Use of topical corticosteroids for the treatment of pityriasis alba is limited by their potential side-effects, such as skin atrophy especially with long-term use on the face. Pimecrolimus cream 1% is a topical calcineurin inhibitor that has anti-inflammatory properties, lacks the cutaneous side-effects associated with steroids, and provide a potential benefit for the treatment of pityriasis alba.
METHODS:
This 10-patient, prospective, single-arm, open-label, single-center, 12-week, investigator-initiated proof of concept study assessed the efficacy, safety, and patient acceptance of pimecrolimus cream 1% twice daily. In addition to pimecrolimus cream, patients used facial emollient containing SPF 15 sunscreen and mild soap-free cleanser. Efficacy assessments were Investigator Global Assessment (IGA) of disease severity and evaluation of uneven skin color, scaling, eczema, follicular keratosis, and pruritus. All efficacy assessments were reported on a 4-point scale (0 = none to 3 = severe).
RESULTS:
Of the 10 patients enrolled (aged: 12-35 years), all had intensive sun-exposure, 90% had skin type IV-V, and 80% completed the 12-week treatment. At baseline, mean IGA was 1.20 (mild-moderate), uneven skin color was 2.3 (moderate-severe) and scaling was 1.2 (mild). IGA decreased to 0.25 by week 12, uneven skin color improved by week 3 with near complete resolution by week 12 (mean = 0.38) and scaling resolved at week 3. Pruritus, eczema, and follicular keratosis remained at low levels from baseline throughout the course of the study. Patients consistently reported satisfaction with the treatment ("satisfied" or "very satisfied"). No adverse events were reported.
CONCLUSIONS:
Pimecrolimus cream 1% may represent an alternative for the treatment of pityriasis alba.
=========================================================
7.) A Case of Extensive Pityriasis Alba.
========================================================
Ann Dermatol. 2008 Sep;20(3):146-8. doi: 10.5021/ad.2008.20.3.146. Epub 2008 Sep 30.

Lee D1, Kang JH1, Kim SH1, Seo JK1, Sung HS1, Hwang SW1.
Author information
1
Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea.
Abstract
Pityriasis alba (PA) is a common benign disease, characterized by hypopigmented macules or patches on the face, usually seen in children. However, two uncommon variants exist, a pigmenting type and an extensive type. Extensive PA is rare. The lesions tend to be less scaly, more persistent, more generalized, more symmetrical, and more frequently seen over the trunk and less so over the face. We report a child who had extensive PA lesions.
KEYWORDS:
Extensive; Hypopigmented; Pityriasis alba
=========================================================
8.) Pityriasis alba.
========================================================
Cutis. 2005 Jul;76(1):21-4.

Lin RL1, Janniger CK.
Author information
1
Dermatology and Pediatrics, UMDNJ-New Jersey Medical School, Newark, USA.
Abstract
Pityriasis alba (PA) is a common benign condition in children that has no definitive treatment. Its etiology and pathogenesis are still poorly understood. Recent studies have found direct correlations between the incidence of PA and atopy, amount of sun exposure, lack of sunscreen use, and frequency of bathing. It is often an incidental finding on physical examination because it is usually asymptomatic. Although treatment with emollients and mild topical corticosteroids may accelerate the repigmentation, they have limited efficacy. Without intervention, the lesions normally resolve within months to years. Extensive PA and pigmenting PA are rarer variants.
PMID: 16144284
=========================================================
9.) Progressive and extensive hypomelanosis and extensive pityriasis alba: same disease,
=========================================================
J Eur Acad Dermatol Venereol. 2005 May;19(3):370-2.

different names?
Di Lernia V1, Ricci C.
Author information
1
Operative Unit of Dermatology, 1st Medical Department, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. vito.dilernia@asmn.re.it
Abstract
We report the cases of five female patients with high skin phototype affected by relapsing, hypochromic, non-scaling macules occurring after the summer on the back and spreading over large areas of skin. Histological features disclosed decreased epidermal melanin. Psoralen plus ultraviolet A (PUVA) treatment proved to be beneficial, but new relapses were noted after stopping treatment. Clinical and histological features were consistent with the diagnosis of 'progressive and extensive hypomelanosis' described by Guillet in persons of mixed racial background. We discuss the differential diagnosis of the latter entity with respect to the other idiopathic acquired primitive hypomelanosis and hypothesize an overlapping with the so-called extensive pityriasis alba (EPA).
=========================================================
10.) Extensive pityriasis alba: a histological histochemical and ultrastructural study.
=========================================================
Br J Dermatol. 1983 Jan;108(1):83-90.

Zaynoun ST, Aftimos BG, Tenekjian KK, Bahuth N, Kurban AK.
Abstract
Nine patients with extensive pityriasis alba were studied using histopathological and histochemical techniques and electron microscopy. There was a reduction in the density of functional melanocytes in the affected areas without any change in their 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. The histology was non-specific. Hyperkeratosis and parakeratosis were not consistently present, and it seems unlikely that they played a significant role in the pathogenesis of the hypomelanosis. A variable degree of intercellular oedema and intracytoplasmic lipid droplets were present. The hypopigmentation may thus be due primarily to the reduced numbers of active melanocytes and a decrease in number and size of melanosomes in the affected skin.
=========================================================
11.) Tacrolimus ointment 0.1% in pityriasis alba: an open-label, randomized, placebo-controlled
study.
=========================================================
Br J Dermatol. 2006 Jul;155(1):152-5.

Rigopoulos D1, Gregoriou S, Charissi C, Kontochristopoulos G, Kalogeromitros D, Georgala S.
Author information
1
Department of Dermatology, Andreas Sygros Hospital, University of Athens, 5 Ionos Dragoumi Str, 16121 Athens, Greece. drigop@hol.gr
Abstract
BACKGROUND:
Pityriasis alba (PA) is a frequent reason for dermatological consultation because of its chronic course, tendency to relapse and aesthetic impact.
OBJECTIVES:
In view of its strong association with atopic dermatitis, the objective of this open-label study was to assess the efficacy and safety of tacrolimus ointment in the treatment of PA compared with the efficacy of moisturizers.
PATIENTS/METHODS:
The study population consisted of 60 individuals of phototype III or IV according to Fitzpatrick's classification, aged 6-21 years. Patients were randomly assigned to one of two groups. Subjects in group A were instructed to apply tacrolimus ointment 0.1% twice daily, 12 h apart, on all hypopigmented macules. Standard moisturizers with SPF 20 sunscreen were used on all lesions applied at least 30 min apart from the tacrolimus ointment. Subjects in group B used solely the same moisturizers with sunscreen. Hypopigmented areas were evaluated at baseline and weeks 0, 3, 6 and 9 by investigators for scaling, hypopigmentation and pruritus on a scale of 0-3. Patient satisfaction was also recorded on a scale of 0-3. All adverse effects were recorded.
RESULTS:
A statistically significant improvement through time, in hypopigmentation, pruritus and scaling was observed in both groups during the course of 9 weeks. Hypopigmentation resolved from a baseline score of 2.38+/-0.64 to 1.15+/-0.54 at week 3, 0.46+/-0.51 at week 6 and 0.00+/-0.00 at week 9 for the group applying tacrolimus ointment 0.1%. The difference in improvement between the two groups was statistically significant on all three assessments for hypopigmentation (P<0.001), and for pruritus on week 6 and 9 assessments (P<0.05). Three patients (11.5%) in the tacrolimus group reported a mild transient sensation of burning. All patients in the tacrolimus group reported they were completely satisfied or just satisfied with the treatment compared with only 50% of patients using the placebo.
CONCLUSIONS:
Tacrolimus ointment 0.1% appears to be an effective and safe treatment for PA.
========================================================
12.) Progressive macular hypomelanosis.
========================================================
J Drugs Dermatol. 2011 May;10(5):502-6.

Elmariah SB1, Kundu RV.
Author information
1
Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.
Abstract
Progressive macular hypomelanosis is an under-recognized disorder characterized by the presence of numerous ill-defined hypopigmented macules and patches on the trunk of young adults. Although common, particularly in Fitzpatrick skin types IV-VI, this condition is frequently misdiagnosed and treated inadequately with antifungals or topical steroids resulting in patient frustration. The exact pathogenesis of progressive macular hypomelanosis is unknown; however, recent studies suggest hypopigmentation results from decreased melanin formation and altered melanosome distribution in response to Proprionibacterium. While there are no well-established or consistently effective therapies for progressive macular hypomelanosis, our growing understanding of its pathogenesis urges consideration of alternative treatment strategies. Here, we report five patients with progressive macular hypomelanosis who benefitted from topical and systemic antimicrobial therapy and summarize the current clinical, pathological and treatment paradigms of this disorder.
========================================================
13.) Progressive macular hypomelanosis in a 16-year old.
========================================================
Pediatr Dermatol. 2008 Jan-Feb;25(1):63-5. doi: 10.1111/j.1525-1470.2007.00585.x.

Perman M1, Sheth P, Lucky AW.
Author information
1
Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio 45229, USA.
Abstract
Progressive macular hypomelanosis of the trunk is a disease of unclear etiology that often goes unrecognized in the clinical setting. We present a Caucasian adolescent girl with hypopigmented macules coalescing into patches on her trunk, initially diagnosed as tinea versicolor. Upon further evaluation, the patient was found to have progressive macular hypomelanosis that demonstrated improvement with sunlight exposure and doxycycline. We report this patient to make physicians more aware of this entity and discuss the literature.
========================================================
14.) Oral methoxsalen photochemotherapy of extensive pityriasis alba. Preliminary report.
========================================================
J Am Acad Dermatol. 1986 Jul;15(1):61-5.

Zaynoun S, Jaber LA, Kurban AK.
Abstract
Six patients with extensive pityriasis alba were treated with oral methoxsalen, followed by exposure to midday summer sun or exposure to long-wave ultraviolet radiation in a psoralens plus ultraviolet A (PUVA) cabinet. Complete clearing or marked improvement was obtained in five patients in less than 4 weeks of treatment. The patient with the most extensive skin involvement and the longest duration of the disease achieved a marked degree of improvement after 15 weeks of therapy. A long-term follow-up is still required to define the maintenance treatment and its efficacy.
PMID: 3722511
========================================================
15,) Ultrastructural findings in progressive macular hypomelanosis indicate decreased melanin production.
========================================================
J Eur Acad Dermatol Venereol. 2008 May;22(5):568-74. doi: 10.1111/j.1468-3083.2007.02515.x. Epub 2008 Feb 4.

Relyveld GN1, Dingemans KP, Menke HE, Bos JD, Westerhof W.
Author information
1
Netherlands Institute for Pigment Disorders, and Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. g.n.relyveld@amc.uva.nl
Abstract
BACKGROUND:
The pathogenesis of progressive macular hypomelanosis (PMH) is unknown. Recently, Westerhof et al. (Arch Dermatol 2004; 140: 210-214) hypothesized that Propionibacterium acnes produces a depigmenting factor that interferes with melanogenesis in the skin, resulting in hypopigmented spots. The purpose of the study is to gain an insight into the pathogenesis of PMH.
MATERIALS AND METHODS:
We took a biopsy of 2-mm diameter from normal and lesional skin in eight PMH patients. Using electron microscopy, we compared melanization of melanosomes, melanosome transfer and amount of epidermal melanin in normal and lesional skin.
RESULT:
Compared to non-lesional skin, we observed a decrease of epidermal melanin and less melanized melanosomes in lesional skin of all patients. When comparing normal and lesional skin of patients with skin type V and VI, we observed a difference in melanosome size and maturation and a switch of transferred melanosomes from single stage IV transferred melanosomes to aggregated stage I, II and III transferred melanosomes, as seen in healthy skin of skin type I to IV.
CONCLUSION:
Hypopigmentation in PMH seems to be the result of an altered melanogenesis based on a decrease in melanin formation and a change in the distribution of melanosomes. In lesional skin of PMH patients with skin type V and VI less melanized, aggregated melanosomes in stead of single, mature melanosomes are transferred from melanocytes to keratinocytes. This results in a decrease of epidermal melanin. Further investigations are needed to determine the precise role of Propionibacterium acnes in this alteration of melanogenesis.
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16.) Hypopigmented macules of photodamaged skin and their treatment with topical tretinoin.
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Acta Derm Venereol. 1999 Jul;79(4):305-10.

Pagnoni A1, Kligman AM, Sadiq I, Stoudemayer T.
Author information
1
S.K.I.N. Incorporated, Conshohocken, PA 19428, USA.
Abstract
Hypopigmented macules are frequently observed in the photodamaged skin of elderly people. We undertook to study and treat 2 types of hypomelanosis of photoaged skin. These lesions were: 1) idiopathic guttate hypomelanosis; and 2) macular hypomelanosis. Comparative studies included: 1) high-resolution photography using parallel polarized light, ultra-violet (UVA) and epiluminescence; 2) Silflo replicas for microtopography; and 3) suction device (Cutometer) for elasticity. Macular hypomelanosis was distinguishable from idiopathic guttate hypomelanosis because the macules were less white and less well demarcated. Glyphic markings were essentially absent in macular hypomelanosis, but variably effaced in idiopathic guttate hypomelanosis. Distensibility of the macules was characteristically low in proportion to the loss of glyphic markings. The chief histologic finding was the absence of melanin in basal keratinocytes. Macular hypomelanosis and idiopathic guttate hypomelanosis are probably related disorders along a spectrum of depigmentation. Treatment with tretinoin for 4 months restored the elasticity, the glyphic markings, with a partial restoration of pigmentation.
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17.) Efficacy and tolerability of a cream containing AR-GG27® (sorbityl furfural palmitate) in the treatment of mild/moderate childhood atopic dermatitis associated with pityriasis alba. A double-blind, placebo-controlled clinical trial.
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G Ital Dermatol Venereol. 2012 Dec;147(6 Suppl 1):1-8.

Patrizi A1, Raone B, Raboni R, Neri I.
Author information
1
Department of Internal Medicine, Aging and Nephrology, Policlinico S. Orsola Malpighi, Bologna, Italy. annalisa.patrizi@unibo.it
Abstract
AIM:
Pityriasis alba (PA) is a skin disorder characterized by finely scaly, hypopigmented patches, typical of childhood, that also represents an atopic dermatitis (AD) minor sign according to Hanifin and Rajka criteria. It may be isolated or associated with AD representing, sometimes an atypical manifestation of AD during the long-term follow-up of the disease. Aim of the study was to evaluate of the efficacy and tolerability of AR-GG27® (sorbityl furfural palmitate) cream in the treatment of childhood mild or moderate AD associated with PA.

METHODS:
The trial is a single center, double-blind, randomized, placebo-controlled study. The study included patients of both sexes, aged between two months and 15 years, suffering from mild and moderate AD always associated with PA. Xerosis was present in all patients. The treatment with topical steroids or topical calcineurin inhibitors (TIMs) had to be suspended for at least 15 days. Any systemic therapy and phototherapy or sun exposure were withdrawn at least 30 days before. Emollients were stopped at least seven days before. During the trial, no other local or systemic treatments were allowed, as well as sun exposure. Patients affected by AD with viral, bacterial or fungal overinfection or patients with diabetes mellitus, severe systemic diseases or intolerance to one or more components of the product were excluded. The primary endpoint was the evaluation of the average change in the Investigator Global Assessment (IGA) after 15 and 30 days of treatment. The second endpoint was the evaluation of severity of three different clinical signs: erythema, excoriation desquamation, using a subjective five-point scale. Changes in pruritus severity was also considered during the entire period of treatment, through the use of a Visual Analogue Scale (VAS). A P<0.05, two tailed was considered as statistically significant.

RESULTS:
After 15 and 30 days there was a statistically significant difference in the group treated with AR-GG27®, compared to the placebo (respectively, P=0.0007 and P=0.005). After 15 days of treatment, itching was clearly reduced in AR-GG27® treated group compared with the placebo, both in the study population (P=0.01) and in patients where the symptom was present from the beginning (P=0.05).

CONCLUSION:
AR-GG27® showed a beneficial action associated with high compliance and tolerability in dermatological skin conditions characterized by inflammation and tissue oxidative stress in children, as PA with mild and moderate AD.
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18.) Double-blind, placebo-controlled, randomized study comparing 0.0003% calcitriol with 0.1% tacrolimus ointments for the treatment of endemic pityriasis alba.
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Dermatol Res Pract. 2012;2012:303275. doi: 10.1155/2012/303275. Epub 2012 Apr 22.

Moreno-Cruz B1, Torres-Álvarez B, Hernández-Blanco D, Castanedo-Cazares JP.
Author information
1
Dermatology Department, Hospital Central "Dr. Ignacio Morones Prieto", Universidad Autónoma de San Luis Potosí, Avenida Carranza No. 2395, CP 78210, San Luis Potosi, Mexico.
Abstract
Background. Pityriasis alba (PA) is a frequent cause of consultation in tropical areas due to its chronic course, frequent relapses, and notorious hypopigmented lesions in pediatric dark skin populations. Currently, no treatment is widely accepted. Objective. To assess the efficacy of 0.0003% calcitriol and 0.1% tacrolimus ointments compared with placebo in the treatment of endemic PA. Methods. Twenty-eight children aged 3-17 years with 56 symmetrical lesions and phototype IV-V, were randomly assigned to receive the treatments on target lesions on the face. Improvement was evaluated at baseline and 8 weeks later clinically and by digital quantification of the affected area, colorimetry, and transepidermal water loss (TEWL). Results. Tacrolimus and calcitriol ointments induced a mean improvement of 68%, compared to 44% of placebo. We found an elevated TEWL in PA lesions. In the treated plaques, the reduction of the affected area was associated with improvement of pigmentation and TEWL. Conclusions. Calcitriol and tacrolimus induced similar repigmentation in endemic PA lesions. Melanogenic, anti-inflammatory, and barrier defect restoration properties of these drugs may explain these findings.
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19.) Efficacy of 308-nm xenon chloride excimer laser in pityriasis alba.
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Dermatol Surg. 2012 Apr;38(4):604-9. doi: 10.1111/j.1524-4725.2011.02223.x. Epub 2011 Nov 28.

Al-Mutairi N1, Hadad AA.
Author information

1
Department of Dermatology, Farwaniya Hospital, Kuwait. nalmut@usa.net

Abstract
OBJECTIVE:

Pityriasis alba (PA) is the most common cause of facial hypopigmentation presenting to the dermatologist. The objective of the current study was to study the effect of the 308-nm excimer laser in the treatment of PA.
MATERIALS AND METHODS:

Twelve patients with 37 PA patches were enrolled in this study. The lesions were treated using the 308-nm excimer laser twice a week for 12 weeks. The hypopigmented areas were evaluated at baseline and at weeks 0, 3, 6, and 12 for scaling, hypopigmentation, and pruritus on a 4-point scale (0 = none to 3 = severe). All adverse effects were recorded.
RESULTS:

There were seven male and five female participants in (aged 5-21 years), with skin type III to V. After 1 month of laser therapy, the clinical scores were significantly lower than at baseline. Similar decreases were observed for the scaling and pruritus scores. Uneven skin color improved by the third week, and near-complete resolution was noticed by the end of 3 months. No serious or unpleasant side-effects were observed, and all patients completed the 12-week treatment. Patients were satisfied or very satisfied with the treatment.
CONCLUSION:

The 308-nm excimer laser is an effective therapeutic option for PA.
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20.) Hypopigmented macules: leprosy, atopy or pityriasis versicolor?
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Massone C1, Cavalchini A, Clapasson A, Nunzi E.
Author information

1
Department of Dermatology, Medical University of Graz, Graz, Austria. cesare.massone@klinikum-graz.at

Abstract

Lepromatous leprosy (LL) represents the highest infective and multibacillary form of leprosy. Clinical manifestations are consequent to the haematogenous spread of bacilli and include macules, plaques and nodules in a symmetric distribution or a diffuse infiltration of the skin. LL may mimic many different inflammatory and neoplastic skin diseases and in a small percentage of patients, skin manifestation may be atypical. This article reports the case of a South American child with LL presenting with symmetrically distributed hypopigmented macules previously misdiagnosed as pytiriasis alba, atopic dermatitis and pityriasis versicolor. Atopy and pityriasis versicolor are common skin conditions that can be also observed in leprosy patients and that can masquerade the diagnosis of LL, especially if occurring in dark skin. Dermatologists in Europe should be aware of this unusual form of presentation of leprosy and must take in mind Hansen disease in the differential diagnosis in patients coming from endemic areas.
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21.) Pityriasis versicolor alba.
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J Eur Acad Dermatol Venereol. 2005 Mar;19(2):147-52.

Thoma W1, Krämer HJ, Mayser P.
Author information

1
Center of Dermatology and Andrology, Gaffkystr. 14, D-35385 Giessen, Germany. wiebke.thoma@derma.md.uni-giessen.de

Abstract

Pityriasis versicolor alba is a hypopigmented or depigmented variant of pityriasis versicolor characterized by maculous, partly pityriasiform, scaly depigmented lesions occurring particularly in seborrhoeic areas. Long-persisting hypopigmentation after healing of the pityriasis versicolor was first described by Gudden in 1853. Hypopigmentation and depigmentation were later differentiated as an independent variant of the disease. In 1848, Eichstedt recognized the pathogen-related character of pityriasis versicolor in its hyperpigmented form. Today it is generally accepted that the disease is caused by yeasts of the genus Malassezia, of which nine species are differentiated. It is controversial whether a single species is responsible for the disease. The pathogenesis of depigmentation has not been established. A screening effect by the scale layer as well as toxic effects on pigment synthesis by fungal metabolites have been discussed. With regard to the second mechanism, the newly discovered tryptophan-derived metabolites of M. furfur might be significant. Evidence-based data concerning the therapy of pityriasis versicolor alba do not exist. According to current recommendations, pityriasis versicolor should be rapidly treated with antimycotics, followed by ultraviolet therapy to induce maturation of existent melanosomes and accelerate repigmentation. However, depigmented lesions are difficult to improve by ultraviolet therapy.
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22.) Título: Cutis trunci variata: datos sobre 50 casos / Cutis trunci variata: datas of 50 cases
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Autor: Borelli, Dante; Borelli, Kyria; Barros, Jorge.

Fonte: Dermatol. venez;30(2):67-70, 1992. ilus.
Idioma: Es.
Resumo: La cutis trunci variata ha sido reportada no solamente en Venezuela, sino también en las Antillas y en las islas de Reunión (Océano Indico, donde ha sido llamada hipomelanosis maculosa progresiva del tronco. En esta nota reportamos datos obtenidos por inspección e interrogatorio de 50 portadores. Son 41 mujeres y 9 hombres; 20 morenos, 19 trigueños, 7 blancos y 1 negro. La edad de aparición fue de 9-42 años (mediana 20). La edad actual es de 16-46 (mediana 26). La duración varía entre 2 días y 23 años (mediana 4). Las regiones más afectadas son: sacrococcigea 84%, lumbar 64%, dorsal 54%, epigástrica 56%, hombros 44%, parte superior de nalgas 28%, laterotorácicas 24%, intermamaria 18%, hipogástrica 20%, parte superior de muslos 12%, caderas 14%. La existencia de consaguíneos afectados fue reportada por el 32%. La regresión espontánea (observada en las Antillas) no se conoce en Venezuela. La helioterapia ha sido útil en 4 casos inútil en 12. La iatrogenia es complicación frecuente de esta condición asintomática, porque legos y médicos la confunden con la pitiriasis versicolor y la tratan con antifúngicos en dosis tiempos exagerados(AU)
Descritores: Tinha Versicolor
Limites: Criança
Adolescente
Adulto
Masculino
Feminino
Tipo de Publ: Revisão
Responsável: VE1.1 - Biblioteca Humberto Garcia Arocha
  
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