Pityriasis Rosea Treatment & Management

  • Author: Robert A Allen, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 15, 2011
 

Medical Care

The most important part of treating patients with pityriasis rosea is reassurance that the rash will resolve.

  • Relief of pruritus is helpful and can be accomplished by using topical steroids, oral antihistamines, topical menthol-phenol lotions, and oatmeal baths. Systemic steroids are not recommended. Although they suppress pruritus, systemic steroids do not shorten the overall disease; in fact, they may prolong or exacerbate the disease.
  • Ultraviolet B (UV-B) light therapy, starting at 80% of the minimum erythrogenic dose, may rapidly relieve pruritus in resistant cases. If itching is not controlled, the dose of UV-B light should be increased by 20% until symptoms decrease. However, a recent study failed to find improvement in the pruritus but did note decreased lesion severity with UV-B light therapy. One must take into consideration the possibility of postinflammatory pigmentation with light therapy.[8, 9]
  • For vesicular pityriasis rosea, a single case was considerably improved with 20 mg of dapsone twice a day.
  • High-dose acyclovir (800 mg qid or 400 mg 5 times a day) may help shorten disease, especially if instituted early in the disease course.[10] Further trials are needed to help confirm this finding. A number of antibiotics have been tried without much success. Both azithromycin and erythromycin[11] have been shown to not shorten the disease course.
Proceed to Medication
 
 
Contributor Information and Disclosures
Author

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.

Coauthor(s)

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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; Centocor/Janssen Honoraria Consulting; DermiPsor Honoraria Consulting; GlaxoSmithKline Honoraria Consulting; HelixBioMedix Honoraria Consulting; Novartis Honoraria Consulting; Ranbaxy Lectures; Can-Fite Biopharma Honoraria Consulting; DermaGenoma Honoraria Consulting; Biosynexus Honoraria Consulting

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.

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.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

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

Disclosure: Nothing to disclose.

References

  1. Chuh AA, Chan PK, Lee A. The detection of human herpesvirus-8 DNA in plasma and peripheral blood mononuclear cells in adult patients with pityriasis rosea by polymerase chain reaction. J Eur Acad Dermatol Venereol. Jul 2006;20(6):667-71. [Medline].

  2. Drago F, Ranieri E, Malaguti F, Battifoglio ML, Losi E, Rebora A. Human herpesvirus 7 in patients with pityriasis rosea. Electron microscopy investigations and polymerase chain reaction in mononuclear cells, plasma and skin. Dermatology. 1997;195(4):374-8. [Medline].

  3. Broccolo F, Drago F, Careddu AM, et al. Additional evidence that pityriasis rosea is associated with reactivation of human herpesvirus-6 and -7. J Invest Dermatol. Jun 2005;124(6):1234-40. [Medline].

  4. Drago F, Broccolo F, Rebora A. Pityriasis rosea: an update with a critical appraisal of its possible herpesviral etiology. J Am Acad Dermatol. Aug 2009;61(2):303-18. [Medline].

  5. Drago F, Broccolo F, Zaccaria E, Malnati M, Cocuzza C, Lusso P, et al. Pregnancy outcome in patients with pityriasis rosea. J Am Acad Dermatol. May 2008;58(5 Suppl 1):S78-83. [Medline].

  6. Chuang TY, Ilstrup DM, Perry HO, Kurland LT. Pityriasis rosea in Rochester, Minnesota, 1969 to 1978. J Am Acad Dermatol. Jul 1982;7(1):80-9. [Medline].

  7. Amer A, Fischer H, Li X. The natural history of pityriasis rosea in black American children: how correct is the "classic" description?. Arch Pediatr Adolesc Med. May 2007;161(5):503-6. [Medline].

  8. Arndt KA, Paul BS, Stern RS, Parrish JA. Treatment of pityriasis rosea with UV radiation. Arch Dermatol. May 1983;119(5):381-2. [Medline].

  9. Leenutaphong V, Jiamton S. UVB phototherapy for pityriasis rosea: a bilateral comparison study. J Am Acad Dermatol. Dec 1995;33(6):996-9. [Medline].

  10. Drago F, Vecchio F, Rebora A. Use of high-dose acyclovir in pityriasis rosea. J Am Acad Dermatol. Jan 2006;54(1):82-5. [Medline].

  11. Rasi A, Tajziehchi L, Savabi-Nasab S. Oral erythromycin is ineffective in the treatment of pityriasis rosea. J Drugs Dermatol. Jan 2008;7(1):35-8. [Medline].

  12. Ackerman AB. Pityriasis rosea. In: Ackerman AB, ed. Histiologic Diagnosis of Inflammatory Skin Disease: A Method by Pattern Analysis. Philadelphia, Pa: Lea & Febiger; 1978.

  13. Bjornberg A, Hellgren L. Pityriasis rosea. A statistical, clinical, and laboratory investigation of 826 patients and matched healthy controls. Acta Derm Venereol Suppl (Stockh). 1962;42(Suppl 50):1-68. [Medline].

  14. Bjornberg A, Tegner E. Pityriasis rosea. In: Freedberg IM, Eisen AZ, Wolff K, et al, eds. Dermatology in General Medicine. 5th ed. New York, NY: McGraw-Hill; 1999:541-6.

  15. Miljkovic J, Bercic M, Belic M. Pityriasis rosea with unusual papulovesicular presentation. Acta Derm Venerol. 1996;5:61-3.

  16. Parsons JM. Pityriasis rosea update: 1986. J Am Acad Dermatol. Aug 1986;15(2 Pt 1):159-67. [Medline].

  17. Sezer E, Saracoglu ZN, Urer SM, Bildirici K, Sabuncu I. Purpuric pityriasis rosea. Int J Dermatol. Feb 2003;42(2):138-40. [Medline].

  18. Toussant S, Kareino H. Pityriasis rosea. In: Elder D, Elenitsas R, Jaworsky C, et al, eds. Lever's Histopathology of the Skin. 8th ed. Philadelphia, Pa: Lippincott-Raven; 1997:164-5.

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