PREVALENCE AND AWARENESS OF PITYRIASIS ALBA IN HAIL ARABIA.

Background: hypomelanosis which is generally seen in young children. There is no specific known cause for this Objective: Determination of the prevalence and awareness of PA in Arabia Methods: a cross-sectional study was carried out on 668 people in Hail, Saudi Arabia. Result: The prevalence of PA was 33.7%, and for the awareness of people was only 47.8%. Conclusion: The prevalence of PA was high in comparison with other similar studies in many countries, and the awareness was poor about the disease and 40.6% couldn’t differentiate it from vitiligo.


ISSN: 2320-5407
Int. J. Adv. Res. 6(4), 1100-1108 Data Collection;-Self-administered designed structured questionnaires consisted of 23 questions included demographic data of participants and knowledge about PA. The questionnaire contained general information including age, sex, nationality, educational level and residents. It also had questions about their knowledge about PA for example: what its causes, how is it different from vitiligo, if they knew a PA case, the case age, the color of the patches, when it started and if it has been diagnosed or not, what was believed to be the cause and did it get treat or not. The questionnaire contained also picture case of PA as in Fig. 1

Results:-
The responded ages ranged from 20 to 49 years old, 99.4% were Saudis and 97.5% were females. Most of the participants were highly educated with a university degree (66.2%) as shown in table 1.  fig. 2 and 3, only about 47.8% knew the disease and 40.6% couldn't differentiate it from vitiligo. Table 2 demonstrated the participant's responses in related to the causes that may suggest it a reason of PA, where participants thought that genetic factors were the highest percentage in causes of it with 33.5%, then environmental factors with 21.9% and the third cause were an allergy to certain food with 16.2%. However, sun rays, after using some creams and drugs, and frequent showers had minor causes as participants answers. To find out if participants have an information about any case with PA (Fig 4) showed that only 34% of all participants knew ones with this condition. The highest percentage for patients age at the current time was ranged between 10 to 19 years (43.7%), while the highest percentage for old of the patient when he/she first get this condition was under one year (47.8%) as shown in table 3.

Fig.2 if the participants heard about Pityriasis Alba
Yes No 41% 59%  In fig 5 and fig 6, it showed that 41.2% from participants answered with yes that these patches disappear without going to the hospital or getting a treatment, however, 48.1% answered with yes that patient get diagnosed by a doctor.

Fig 4 Do you know anyone with PA condition? Yes No
Lastly, fig 7 showed that only 11.6% from participants answered with yes in regards if there another member of the patient's family had got the same condition, where 68.7% from participants said that only one got the same condition, while 20.9% said that two got it. the age of patient's family who had got the same condition was mostly ranged between 1 to 9 years old with 43.9%, while 27.3% ranged between 10 to 19 years old (table 5).   11 16.7% As shown in table 6 vitamin deficiency was the most common cause of PA according to doctors' investigation with 39.6%, then other minor causes, however, 12.1% from all participants did not know the cause.

Discussion:-
Although skin diseases are common among children worldwide, there are only a few population-based epidemiologic studies measuring the prevalence of skin diseases in children. [5][6][7][8][9][10][11][12][13][14][15] In Saudi Arabia, there are few reports of surveys conducted on the prevalence of skin disease, mainly in male school children. [16][17][18][19] . In this study, we found that the prevalence of PA was 33.7% which is higher than in Babol school children, Northern Iran 9.4% 20 , in rural areas of Assiut Governorate, Upper Egypt 13.49% 21 , and among primary school children in Diyarbakir 18.3% 22 . In comparing to the prevalence in different climates our study shows that the prevalence rate in Hail city is high.
In 1993, Du Toit et al. described a series of 20 patients from the cape colored population (non-caucasian) with an uncommon variant of PA, occurring in childhood. They called it -Pigmenting Pityriasis Alba (PPA). Later, an additional report followed from India describing a similar condition 23 . The commonest sites of lesions in this study were the face with 72.7%, followed by arms 13.5%, and neck and chest 4.9%. About 14% of target population reported that the patches started with red\pink color and then it turned white, while 78.7% did not have a color change of patches and 41.2% from participants reported that these patches disappear without going to the hospital or getting a treatment.
Another study about Hypopigmentary disorders in children in South India result showed that most common hypopigmentary disorder was PA 24.7% 24 . A clinico-epidemiological study of hypopigmented and depigmented lesions in children and adolescent age group in Hadoti region (South East Rajasthan) result showed the most common disorder was PA, seen in 27.33% 25 .
PA is a condition of unknown etiology 26 . It is best characterized as a form of dermatitis that results in the reduction of melanocytes and melanosomes with no detectable defect in melanosomal transfer to keratinocytes [27][28][29] . Bacterial, fungal, and parasitic infections are more frequent among PA patients but no definitive association has been found 30,31 . Other possible causes include copper deficiency (tyrosinase cofactor) 32 , physical factors that affect the state of hydration of stratum corneum like xerosis, wind, soap, and sunlight. 14,33,34 Our study shows that vitamin deficiency was the most common cause of PA according to doctor investigation with 39.6%, then other minor causes, however, 12.1% from all participants reported that the doctor did not know the cause. In relation to the causes of PA in the participant's opinion genetic factor was the highest percentage 33.5%, then environmental factors with 21.9% and allergy to certain food were the third with 16.2%.
We found that the participant's awareness about PA was poor with 52.2% of them as they did not hear about the condition and 40.6% think it is a condition of vitiligo.
In conclusion, the prevalence of PA in Hail city is high. With this high prevalence and the poor awareness about PA in Hail city, the current situation needs further studies and taking further explore into consideration. Steps toward addressing PA have to be undertaken through studying its causes and planning for effective management. Health education programs and campaigns to clarify and explain the condition and its possible causes and to explain the importance of early diagnosis and getting the right treatment should be provided to all Hail city residents.
Declarations:-Funding: None Conflict of interest: None declared