Answer to last month's Clinical Quiz

Question:

This 10 years old boy was brought by his mother for a consultation because of multiple hypopigmented lesions over the face for two years. The lesions were asymptomatic and worse during summer time. The trunk and limbs were spared. He had been treated with topical antifungal and topical steroid by a doctor without much response.

Answer:
C. Pityriasis alba

Pityriasis alba is a common non-specific dermatosis of unknown cause in children. Characteristically it presents as fine scaly hypopigmented macules with indistinctive borders on the face, especially over the cheeks. Occasionally, extra-facial involvement can occur over neck, shoulders and arms. It is more conspicuous in coloured patients and after sun exposure. Pityriasis alba has been regarded as a feature in atopic dermatitis, but it is definitely not confined to atopic patients. The natural course is variable, persisting from months to years. Very often it is misdiagnosed as pityriasis versicolor, in which facial involvement alone is very uncommon. Vitiligo presents as depigmented macules with well-demarcated borders, rather than as hypopigmented macules with fuzzy borders as in pityriasis alba. As the condition is usually asymptomatic and self-limiting, reassurance, avoidance of excessive sunlight and bland emollients are usually enough in the management. Topical 1% hydrocortisone-3% vioform cream has been commonly used empirically, but its real effect is doubtful.