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Year : 2021  |  Volume : 66  |  Issue : 5  |  Page : 567-568
Association of pityriasis alba with atopic dermatitis: A cross-sectional study

1 Department of Dermatology and Venereology, Government Medical College, Kottayam, Kerala, India
2 Department of Dermatology and Venereology, Government Medical College, Thrissur, Kerala, India

Date of Web Publication9-Dec-2021

Correspondence Address:
Sonali Ramkrishna Gawai
Department of Dermatology and Venereology, Government Medical College, Kottayam, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijd.ijd_936_20

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How to cite this article:
Gawai SR, Asokan N, Narayanan B. Association of pityriasis alba with atopic dermatitis: A cross-sectional study. Indian J Dermatol 2021;66:567-8

How to cite this URL:
Gawai SR, Asokan N, Narayanan B. Association of pityriasis alba with atopic dermatitis: A cross-sectional study. Indian J Dermatol [serial online] 2021 [cited 2023 Dec 1];66:567-8. Available from:


Pityriasis alba is one of the minor factor of Hanifin and Rajka's[1] criteria of atopic dermatitis. There are only a few analytical studies on the association of pityriasis alba with atopic dermatitis.[2]

We selected one-hundred-and-twenty-two consecutive patients with pityriasis alba (confirmed by two faculty members with postgraduate qualification in dermatology) and an equal number of age group and sex-matched patients with common hypopigmented disorders other than pityriasis alba (hundred patients with pityriasis versicolor, fifteen patients with post-inflammatory hypopigmentation, four patients with early vitiligo, two patients with Hansen's disease, and one patient with hypomelanosis of Ito) attending the outpatient department of dermatology of a teaching hospital during a period of 18 months for this study. The sample size was determined based on two previous studies.[3],[4]

The clinical profile, history of associated diseases, and precipitating factors of the participants were explored. They were evaluated for atopic dermatitis using the UK Working Party's diagnostic criteria.[5] Ethical clearance was obtained from the institutional ethics committee.

The age of the patients with pityriasis alba ranged from 6 months to 20 years. One-hundred-and-twelve (92%) patients were aged less than 15 years. The gender distribution was almost equal (M:F = 1.03:1). Average daily direct sun exposure of more than two hours (P = 0.03), personal history of atopy (P = 0.004), family history of atopy (P = 0.000) were associated with pityriasis alba, whereas, washing of the affected areas more than three times a day (P = 0.12) and washing of affected areas with soap more than two times a day (P = 0.30) were not associated [Table 1]. At least one atopic feature (namely, xerosis, ichthyosis, hyperlinearity of palms, recurrent conjunctivitis; hand and foot dermatitis, nummular eczema, pompholyx or Dennie Morgan folds) was seen in one-hundred-and-fourteen (93.4%) cases compared to sixty-six (54.1%) controls (P = 0.000). Among the individual atopic features, hyperlinearity of the palms (P = 0.000), xerosis (P = 0.000), and ichthyosis vulgaris (P = 0.000) were associated with pityriasis alba. Five patients (4.1%) with pityriasis alba satisfied diagnostic criteria of atopic dermatitis, whereas none in the control group did so. (P = 0.03). On multivariate logistic regression, significant association was noted for family history of atopy (P = 0.00), presence of at least one atopic feature (P = 0.000), xerosis (P = 0.000), ichthyosis (P = 0.000), and hyperlinearity of palms (P = 0.000) [Table 2].
Table 1: Clinical features of patients with pityriasis alba compared to the control group

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Table 2: Multivariate logistic regression analysis of predictor variables

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We found an association between pityriasis alba with personal history and family history of atopy (especially in first-degree relatives) as reported by Vinod et al.[6] Some descriptive studies have reported a higher frequency of atopic dermatitis in patients with pityriasis alba.[3],[6],[7] Weber et al.[2] had reported an association between pityriasis alba and atopic dermatitis in a comparative analytical study. Our study confirms such an association using a larger sample size. The co-existence of at least one atopic feature, especially xerosis, ichthyosis, or hyperlinearity of the palms could support a diagnosis of pityriasis alba in a patient with compatible clinical features.

Limitations of our study include recall bias among patients and selection bias expected in a hospital-based study. Adequate sample size, analytical design, and multivariate analysis are some of the strengths of this study. Future studies with large population data may throw more light on the association of pityriasis alba with atopic dermatitis.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol Suppl 1980;92:44-7.  Back to cited text no. 1
Blessmann Weber M, Sponchiado de Avila LG, Albaneze R, MagalhAães de Oliveira OL, Sudhaus BD, Cestari TF. Pityriasis alba: A study of pathogenic factors. J Eur Acad Dermatol Venereol 2002;16:463-8.  Back to cited text no. 2
Elshafey WSR, Fiala LA, Mohamed RW, Ismael NA. The distribution and determinants of pityriasis alba among elementary school students in Ismailia city. J Am Sci 2012;8:444-9.  Back to cited text no. 3
Scaria S, James E, Dharmaratnam AD. Epidemiology and treatment pattern of atopic dermatitis in patients attending a tertiary care teaching hospital. Int J Pharm Sci Res 2011;2:38-44.  Back to cited text no. 4
Williams HC, Burney PG, Hay RJ, Archer CB, Shipley MJ, Hunter JJ, et al. The U.K. working party's diagnostic criteria for atopic dermatitis. I. Derivation of a minimum set of discriminators for atopic dermatitis. Br J Dermatol 1994;131:383-96.  Back to cited text no. 5
Vinod S, Singh G, Dash K, Grover S. Clinico epidemiological study of pityriasis alba. Indian J Dermatol Venereol Leprol 2002;68:338-40.  Back to cited text no. 6
[PUBMED]  [Full text]  
In SI, Yi SW, Kang HY, Lee ES, Sohn S, Kim YC. Clinical and histopathological characteristics of pityriasis alba. Clin Exp Dermatol 2009;34:591-7. Erratum in: Clin Exp Dermatol 2009;34:751.  Back to cited text no. 7


  [Table 1], [Table 2]


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