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Pityriasis Rosea Medication

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Jun 02, 2016
 

Medication Summary

Pityriasis rosea (PR) is a self-limited disease; treatment is supportive. Drug therapy for PR primarily consists of symptomatic treatment of pruritus. Topical zinc oxide and calamine lotion may be helpful. Oral antihistamines and topical corticosteroids can be used as needed. For patients in whom superficial tinea infection is a concern or possibility, topical antifungal therapy can be used. There is no evidence-based medicine for pityriasis rosea, a self-limited disorder.[63]

Management of PR in patients with evidence of group A streptococcal infection may be warranted. The possible risk of scarlet fever and poststreptococcal sequelae should be considered. Acyclovir may hasten resolution, especially if given within 1 week of rash, but the data are not conclusive.

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Corticosteroids

Class Summary

Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, these agents modify the body’s immune response to diverse stimuli. Over-the-counter (OTC) steroid preparations of low-to-medium potency steroids may help relieve the itching associated with PR.

Hydrocortisone topical (Westcort, U-Cort, Ala-Cort, Caldecort)

 

Topical hydrocortisone is an adrenocorticosteroid derivative that is suitable for application to skin or external mucous membranes and is used to treat inflammatory dermatosis that is responsive to steroids. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes (PMNs) and reversing capillary permeability.

Betamethasone topical (Diprolene, Luxiq)

 

Topical betamethasone is used to treat inflammatory dermatoses responsive to steroids. It decreases inflammation by suppressing migration of PMNs and reversing capillary permeability. It affects production of lymphokines and has an inhibitory effect on Langerhans cells.

Clobetasol (Temovate, Temovate E, Olux, Olux-E)

 

Clobetasol is a class I superpotent topical steroid. It suppresses mitosis and increases synthesis of proteins that decrease inflammation and cause vasoconstriction.

Triamcinolone topical (Kenalog, Triderm)

 

Topical triamcinolone decreases inflammation by suppressing migration of PMNs and reversing capillary permeability.

Prednisone (Rayos)

 

Prednisone may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.

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Antihistamines

Class Summary

Antihistamines may control PR-related itching by blocking effects of endogenously released histamine.

Diphenhydramine (Benadryl, Aler-Cap, Altaryl)

 

Diphenhydramine, which is available as an OTC product, is a very safe oral antihistamine that can be used safely in pregnancy. It is highly effective for controlling pruritus symptoms caused by release of histamine in allergic reactions.

Hydroxyzine (Vistaril)

 

Hydroxyzine is a sedating agent that antagonizes H1 receptors in the periphery and may suppress histamine activity in the subcortical region of the central nervous system (CNS). It is effective against PR-related pruritus.

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Antibiotics, Other

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Erythromycin (E.E.S., Ery-Tab, Erythrocin, EryPed)

 

Erythromycin inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes and causing RNA-dependent protein synthesis to arrest. It may have anti-inflammatory and immunomodulatory effects. In children, age, weight, and severity of infection determine the proper dosage. When twice-daily dosing is desired, half of the total daily dose may be taken every 12 hours.

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Antiviral Agents

Class Summary

Antiviral agents may improve the rate of resolution if given within 1 week of the appearance of the rash.

Acyclovir (Zovirax)

 

Acyclovir is a prodrug activated through phosphorylation by a virus-specific thymidine kinase that inhibits viral replication. Herpesvirus thymidine kinase (TK), but not host-cell TK, converts acyclovir into acyclovir monophosphate, a nucleotide analogue. Guanylate kinase converts the monophosphate into diphosphate and triphosphate analogues that inhibit viral DNA replication. Once phosphorylated, the drug causes DNA chain termination when acted on by DNA polymerase. It interferes with DNA replication within the virions.

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Richard Lichenstein, MD Professor, Pediatric Emergency Department, University of Maryland School of Medicine

Richard Lichenstein, MD is a member of the following medical societies: American Medical Association, American Academy of Pediatrics

Disclosure: Nothing to disclose.

Camila K Janniger, MD Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, Rutgers New Jersey Medical School

Camila K Janniger, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Robert A Allen, MD Staff Physician, Department of Dermatology, Drexel University College of Medicine-Hahnemann Hospital

Robert A Allen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and American Medical Association

Disclosure: Nothing to disclose.

Jerry Balentine, DO Professor of Emergency Medicine, New York College of Osteopathic Medicine; Executive Vice President, Chief Medical Officer, Attending Physician in Department of Emergency Medicine, St Barnabas Hospital

Jerry Balentine, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American College of Physician Executives, American Osteopathic Association, and New York Academy of Medicine

Disclosure: Nothing to disclose.

Kevin P Connelly, DO Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University School of Medicine; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center

Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Burke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Pamela L Dyne, MD Professor of Clinical Medicine/Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Mark W Fourre, MD Program Director, Department of Emergency Medicine, Maine Medical Center; Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine

Disclosure: Nothing to disclose.

Rajendra Kapila, MD, MBBS Professor of Medicine, Department of Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Rajendra Kapila, MD, MBBS is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America, and Infectious Diseases Society of New Jersey

Disclosure: Nothing to disclose.

Thomas M Kerkering, MD Chief of Infectious Diseases, Virginia Tech Carilion School of Medicine

Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Mark G Lebwohl, MD Chairman, Department of Dermatology, Mount Sinai School of Medicine

Mark G Lebwohl, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Amgen/Pfizer Honoraria Consulting; GlaxoSmithKline None Investigator; Novartis Honoraria Consulting; Ranbaxy None Consulting; Pfizer None Consulting; BioLineRX, Ltd. Honoraria Consulting; Celgene Corporation Consulting; Clinuvel None Investigator; Eli Lilly & Co. Honoraria Consulting; Genentech None Consulting

Daniel R Lucey, MD, MPH Chief, Fellowship Program Director, Department of Internal Medicine, Division of Infectious Diseases, Washington Hospital Center; Professor, Department of Internal Medicine, Uniformed Services University of the Health Sciences

Daniel R Lucey, MD, MPH is a member of the following medical societies: Alpha Omega Alpha and American College of Physicians

Disclosure: Nothing to disclose.

Amal Mattu, MD, FACEP, FAAEM Professor and Vice Chair, Department of Emergency Medicine, University of Maryland School of Medicine

Amal Mattu, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Giuseppe Micali, MD Head, Professor, Department of Dermatology, University of Catania School of Medicine, Italy

Giuseppe Micali, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Maria R Nasca, MD, PhD Assistant Professor, Department of Dermatology, University of Catania School of Medicine, Italy

Disclosure: Nothing to disclose.

Robert L Rogers, MD Staff Physician, Departments of Internal Medicine and Surgery, Division of Emergency Medicine, University of Maryland

Robert L Rogers, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American College of Physicians-American Society of Internal Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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Herald patch. Image courtesy of Drexel Department of Dermatology slide collection.
Christmas tree distribution of lesions on trunk. Image courtesy of Drexel Department of Dermatology slide collection.
Histopathologic features of pityriasis rosea. Image courtesy of Gary R Kantor, MD, Department of Dermatology, Drexel University, Philadelphia, PA.
 
 
 
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