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hypopigmented macules patches face cheek preauricular pityriasis alba tinea versicolor
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pityriasis alba face hypopigmented patches child
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The clinical picture is very clear. Here is the diagnosis:
Diagnosis: Pityriasis Alba
What the video shows
The video reveals multiple small, poorly demarcated hypopigmented macules and patches scattered across the lateral cheek, preauricular region, and along the jawline - flat lesions with subtle fine scale and otherwise normal surrounding skin. No erythema, nodules, or lymphadenopathy are present.
This distribution and morphology is classic for pityriasis alba.
Key Diagnostic Features (matching this case)
| Feature | This patient | Pityriasis Alba |
|---|---|---|
| Lesion type | Hypopigmented macules/patches | Hypopigmented macules/patches |
| Borders | Ill-defined, poorly demarcated | Characteristically ill-defined |
| Location | Cheek, preauricular, jawline | Face (especially malar region) is most common site |
| Scale | Subtle fine scale | Slight scale typical |
| Erythema | Absent | Usually absent (may precede early lesions) |
| Appearance | Flat, dry, whitish | "Whitish, dry, powdery" appearance |
What is Pityriasis Alba?
Pityriasis alba is a very common, benign hypopigmented dermatitis that affects up to one-third of school-age children in the United States. Key points:
- Pathophysiology: Reduced numbers of active melanocytes and decreased melanosomes in the affected skin (not complete absence, unlike vitiligo)
- Association: Strongly linked to atopic dermatitis (eczema) - considered part of the atopic spectrum
- Age: Primarily a disorder of childhood and adolescence
- Course: Lesions are more visible in summer (surrounding skin tans, lesions do not). Usually self-limiting and fade by adulthood
- Symptoms: Generally asymptomatic; occasionally mild itching or burning
Differential Diagnosis to Consider
| Condition | How to distinguish |
|---|---|
| Vitiligo | Complete absence of pigment (pure white); Wood's lamp shows total depigmentation |
| Tinea versicolor | KOH scraping shows "spaghetti and meatballs" hyphae; more common on trunk |
| Post-inflammatory hypopigmentation | History of preceding inflammation/trauma |
| Hypopigmented mycosis fungoides | Rare, more commonly on trunk/extremities; biopsy needed |
Wood's lamp examination would show a decrease but not absence of pigment - a key distinguishing feature from vitiligo.
Management
- Reassurance - condition is benign and self-resolving
- Emollients (moisturizers) - equally effective as steroids and first-line
- Topical hydrocortisone 1% - mild benefit; short courses only (max 2 weeks on face)
- Sun protection - reduces contrast between lesions and surrounding tanned skin
- Phototherapy - for extensive or persistent cases
Sources: Dermatology 2-Volume Set 5e, p. 1323-1324; Textbook of Family Medicine 9e, p. 923
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