eMedicine Specialties > Dermatology > Papulosquamous Diseases

Pityriasis Rosea: Treatment & Medication

Author: Robert A Allen, MD, Staff Physician, Department of Dermatology, Drexel University College of Medicine-Hahnemann Hospital
Coauthor(s): Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Contributor Information and Disclosures

Updated: Feb 13, 2009

Treatment

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.7,8
  • For vesicular pityriasis rosea, a single case was considerably improved with 20 mg of dapsone twice a day.
  • High-dose acyclovir (800 mg qid) may help shorten disease, especially if instituted early in the disease course.9 Further trials are needed to help confirm this finding. A number of antibiotics have been tried without much success. Both azithromycin and erythromycin10  have been shown to not shorten the disease course.

Medication

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Corticosteroids

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli.


Hydrocortisone (Westcort)

Treats inflammatory dermatosis that is responsive to steroids. Decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability.

Adult

Apply a thin film to affected area tid/qid until favorable response achieved

Pediatric

Apply as in adults

Documented hypersensitivity; viral, fungal, and bacterial skin infections

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Products may contain either tartrazine or sodium bisulfite, which may cause allergic reactions in susceptible individuals; prolonged use, application over large surface areas, application of potent steroids, and use of occlusive dressings may increase systemic absorption of corticosteroids and may cause Cushing syndrome, reversible HPA-axis suppression, hyperglycemia, and glycosuria


Betamethasone (Diprolene, Betatrex)

For inflammatory dermatoses responsive to steroids. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability. Affects production of lymphokines and has an inhibitory effect on Langerhans cells.

Adult

Apply thin film bid/qid until response

Pediatric

Apply as in adults

Documented hypersensitivity; paronychia; cellulitis; impetigo; angular cheilitis; erythrasma; erysipelas; rosacea; perioral dermatitis; acne

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Do not use on skin with decreased circulation; can cause atrophy of groin, face, and axillae; if infection develops and is not responsive to antibiotic treatment, discontinue until infection is under control; do not use monotherapy to treat widespread plaque psoriasis


Clobetasol (Temovate)

Class I superpotent topical steroid. Suppresses mitosis and increases synthesis of proteins that decrease inflammation and cause vasoconstriction.

Adult

Apply bid for up to 2 wk; not to exceed 50 g/wk

Pediatric

Not established

Documented hypersensitivity; viral or fungal skin infections

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

May suppress adrenal function in prolonged therapy; may cause atrophy of skin with prolonged therapy; can cause atrophy of groin, face, and axillae; if infection develops and is not responsive to antibiotic treatment, discontinue until infection is under control

Antihistamines

These agents may control itching by blocking effects of endogenously released histamine.


Diphenhydramine (Benadryl, Belix)

For symptomatic relief of pruritus symptoms caused by release of histamine in allergic reactions.

Adult

25-50 mg PO q6-8h prn; not to exceed 400 mg/d; 10-50 mg IV/IM q6-8h prn; not to exceed 400 mg/d

Pediatric

12.5-25 mg PO tid/qid, or 5 mg/kg/d PO/IV/IM or 150 mg/m2/d PO/IV/IM divided tid/qid; not to exceed 300 mg/d

Potentiates effect of CNS depressants; because of alcohol content, do not give syrup form to patient taking medications that can cause disulfiramlike reactions

Documented hypersensitivity; MAOIs

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

May exacerbate angle-closure glaucoma, hyperthyroidism, peptic ulcer, and urinary tract obstruction

More on Pityriasis Rosea

Overview: Pityriasis Rosea
Differential Diagnoses & Workup: Pityriasis Rosea
Treatment & Medication: Pityriasis Rosea
Follow-up: Pityriasis Rosea
Multimedia: Pityriasis Rosea
References
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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, 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].

  5. 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].

  6. 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].

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

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

  9. 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].

  10. 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].

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

  12. 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].

  13. 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.

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

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

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

  17. 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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Further Reading

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Keywords

pityriasis rosea benign papulosquamous disease, herald spot, herald patch, picornavirus, human herpesvirus-6, HHV-6, human herpesvirus-7, HHV-7

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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, UMDNJ-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.

Medical Editor

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: Abbott Laboratories Honoraria Consulting; Actelion Honoraria Consulting; Amgen Honoraria Consulting; Astellas Honoraria Consulting; Basilea Honoraria Consulting; Briston-Myers Squibb Honoraria Consulting; Celtic Pharma  Other; Centocor Honoraria Consulting; Chattem Honoraria Other; DermiPsor Honoraria Consulting

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University 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.

Managing Editor

Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-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.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine 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, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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