Pityriasis Rosea in Emergency Medicine Medication

  • Author: Richard Lichenstein, MD; Chief Editor: Pamela L Dyne, MD   more...
 
Updated: Aug 24, 2011
 

Medication Summary

Pityriasis rosea (PR) is a self-limited disease, and treatment is supportive. Water, sweat, and soap may cause irritation and should be avoided early in the disease. Topical zinc oxide and calamine lotion are useful for pruritus. If the disease is severe or widespread (eg, vesicular pityriasis rosea), topical or oral steroids may be used. Ultraviolet radiation therapy has been demonstrated to be effective for pityriasis rosea but may leave postinflammatory pigmentation at the site of the pityriasis rosea lesion.[13] Acyclovir has been shown in one study to hasten resolution especially if given within 1 week of rash but this was a nonrandomized nonblinded trial.[14]

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Corticosteroids

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. Modify the body's immune response to diverse stimuli.

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Prednisone (Deltasone, Meticorten, Orasone)

 

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

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Hydrocortisone topical (Cortaid, Cortef, Hycort)

 

Adrenocorticosteroid derivative suitable for application to skin or external mucous membranes. Mineralocorticoid and glucocorticoid effects resulting in anti-inflammatory activity.

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Antibiotics

Class Summary

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

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Erythromycin (E.E.S., E-Mycin, Eryc, Ery-Tab)

 

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes and causing RNA-dependent protein synthesis to arrest.

In children, age, weight, and severity of infection determine proper dosage. When bid dosing is desired, half-total daily dose may be taken q12h. May have anti-inflammatory and immunomodulatory effects.

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Antiviral agents

Class Summary

These agents may improve rate of resolution if given within 1 week of rash.

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Acyclovir (Zovirax)

 

Prodrug activated by phosphorylation by virus-specific thymidine kinase that inhibits viral replication. Herpes virus thymidine kinase (TK), but not host cells TK, uses acyclovir as a purine nucleoside, converting it into acyclovir monophosphate, a nucleotide analogue. Guanylate kinase converts the monophosphate form into diphosphate and triphosphate analogues that inhibit viral DNA replication.

Has affinity for viral thymidine kinase and, once phosphorylated, causes DNA chain termination when acted on by DNA polymerase. Interferes with DNA replication within the virions.

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Contributor Information and Disclosures
Author

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

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

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

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.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

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.

References

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  2. 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].

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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.
 
 
 
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