eMedicine Specialties > Infectious Diseases > Skin and Soft-Tissue Infections

Pityriasis: Treatment & Medication

Author: Camila K Janniger, MD, Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, New Jersey Medical School
Coauthor(s): Rajendra Kapila, MD, MBBS, Professor of Medicine, Department of Medicine, UMDNJ, New Jersey Medical School; Robert L Rogers, MD, Staff Physician, Departments of Internal Medicine and Surgery, Division of Emergency Medicine, University of Maryland; Amal Mattu, MD, FACEP, FAAEM, Program Director, Emergency Medicine Residency, Co-Director, Emergency Medicine/Internal Medicine Combined Residency Program, Department of Surgery, Division of Emergency Medicine, University of Maryland School of Medicine
Contributor Information and Disclosures

Updated: Mar 2, 2009

Treatment

Medical Care

  • In most cases, pityriasis rosea is a self-limited disorder, and treatment is not necessary in uncomplicated cases.
  • The rash usually disappears in a few weeks.
  • Patients should avoid irritants such as wool, certain irritant soaps, perfumes, and household products.
  • Pruritus is commonly associated with pityriasis rosea and can be treated conservatively with calamine lotion or oral antihistamine therapy.
  • If the rash is severe, topical steroids can be applied.
    • Remember that steroids alleviate the pruritus, but they do not modify the eruption.
    • Cases of severe exacerbations have been reported in association with oral steroid use.

Consultations

In some instances, obtaining a consultation with an infectious disease specialist or dermatologist is warranted, especially in patients with atypical pityriasis rosea, comorbid conditions, solid organ transplants, or hematopoietic stem cell transplants.

Medication

Drug therapy for pityriasis rosea primarily consists of symptomatic treatment of pruritus. 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.

Chuh et al (2007) recently assessed the efficacy of interventions for pityriasis rosea.6 They found that evidence for efficacy for most treatments for pityriasis rosea is inadequate. Erythromycin has been reported as effective in the treatment of pityriasis rosea. However, in a placebo-controlled study conducted by Rasi et al (2008), oral erythromycin was not found to confer a significant benefit in 184 patients with pityriasis rosea.7

Antihistamines

Consider oral antihistamine therapy in patients with pruritus. These agents may control itching by blocking effects of endogenously released histamine.


Hydroxyzine (Atarax, Vistaril)

Effective antipruritic in the treatment of pityriasis rosea. Antagonizes H1 receptors in periphery.

Adult

25-100 mg PO/IM qd/qid or prn

Pediatric

<6 years: 50 mg/d PO divided qid
>6 years: 50-100 mg/d PO divided qid

CNS depression may increase with alcohol or other CNS depressants

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

Caution in hepatic disease; not safe in lactating women; may cause sedation and adverse GI effects


Diphenhydramine (Benadryl, Benylin)

Very safe oral antihistamine. Can be used safely in pregnancy. For symptomatic relief of symptoms caused by release of histamine in allergic reactions. Very effective in controlling pruritus.

Adult

25-50 mg PO/IV/IM q4-6h; not to exceed 300-400 mg/d

Pediatric

<6 years: Not established
6-12 years: 12.5-25 mg PO q4-6h or 5 mg/kg/d PO/IV/IM divided qid; not to exceed 150 mg/d
>12 years: Administer as in adults

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

Documented hypersensitivity; MAOIs

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

May cause somnolence; avoid use with drugs that may have anticholinergic properties; may exacerbate angle-closure glaucoma, hyperthyroidism, peptic ulcer, and urinary tract obstruction

More on Pityriasis

Overview: Pityriasis
Differential Diagnoses & Workup: Pityriasis
Treatment & Medication: Pityriasis
Follow-up: Pityriasis
References
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References

  1. 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].

  2. Robati RM, Toossi P. Plantar herald patch in pityriasis rosea. Clin Exp Dermatol. Mar 2009;34(2):269-70. [Medline].

  3. Kempf W, Adams V, Kleinhans M, et al. Pityriasis rosea is not associated with human herpesvirus 7. Arch Dermatol. Sep 1999;135(9):1070-2. [Medline].

  4. González LM, Allen R, Janniger CK, et al. Pityriasis rosea: an important papulosquamous disorder. Int J Dermatol. Sep 2005;44(9):757-64. [Medline].

  5. Rajpara SN, Ormerod AD, Gallaway L. Adalimumab-induced pityriasis rosea. J Eur Acad Dermatol Venereol. Oct 2007;21(9):1294-6. [Medline].

  6. Chuh AA, Dofitas BL, Comisel GG, et al. Interventions for pityriasis rosea. Cochrane Database Syst Rev. Apr 18 2007;CD005068. [Medline].

  7. 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].

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

  9. Cohen EL. Pityriasis rosea. Br J Dermatol. Oct 1967;79(10):533-7. [Medline].

  10. Harman M, Aytekin S, Akdeniz S, et al. An epidemiological study of pityriasis rosea in the Eastern Anatolia. Eur J Epidemiol. Jul 1998;14(5):495-7. [Medline].

  11. Hartley AH. Pityriasis rosea. Pediatr Rev. Aug 1999;20(8):266-9, quiz 270. [Medline].

  12. Parsons JM. Management of toxic epidermal necrolysis. Cutis. Oct 1985;36(4):305-7, 310-1. [Medline].

  13. Tay YK, Goh CL. One-year review of pityriasis rosea at the National Skin Centre, Singapore. Ann Acad Med Singapore. Nov 1999;28(6):829-31. [Medline].

  14. Wyndham M. Pityriasis. Practitioner. Jun 1997;241(1575):358. [Medline].

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Further Reading

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Keywords

pityriasis, pityriasis rosea, pityriasis circinata et marginata of Vidal, papulosquamous skin eruption, pityriasis lichenoides, pityriasis rubra pilaris, pityriasis rosea perstans, papular pityriasis rosea, vesicular pityriasis rosea, purpuric pityriasis rosea, inverse pityriasis rosea, herald patch

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Contributor Information and Disclosures

Author

Camila K Janniger, MD, Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, New Jersey Medical School
Camila K Janniger, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Coauthor(s)

Rajendra Kapila, MD, MBBS, Professor of Medicine, Department of Medicine, UMDNJ, 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.

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.

Amal Mattu, MD, FACEP, FAAEM, Program Director, Emergency Medicine Residency, Co-Director, Emergency Medicine/Internal Medicine Combined Residency Program, Department of Surgery, Division 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.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

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.

 
 
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