eMedicine Specialties > Emergency Medicine > Dermatology
Pityriasis Rosea: Treatment & Medication
Updated: Dec 8, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Emergency Department Care
- In most cases, treatment is not necessary for pityriasis rosea (PR).5
- In one study, the use of erythromycin in patients older than age 2 years with pityriasis rosea has been shown to be useful.6 A more recent study has shown that azithromycin is not effective for children with pityriasis rosea.7
- No evidence suggests that children with pityriasis rosea should be prevented from attending school.
Consultations
- Consultation with a pediatric dermatologist may be required for atypical presentations of pityriasis rosea.
Medication
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.8 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.9
Corticosteroids
These agents have anti-inflammatory properties and cause profound and varied metabolic effects. Modify the body's immune response to diverse stimuli.
Prednisone (Deltasone, Meticorten, Orasone)
May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.
Adult
5-60 mg/d PO qd or divided bid/qid; taper over 2 wk as symptoms resolve
Pediatric
4-5 mg/m2/d PO; alternatively, 0.05-2 mg/kg PO divided bid/qid; taper over 2 wk as symptoms resolve
Coadministration with estrogens may decrease prednisone clearance; concurrent use with digoxin may cause digitalis toxicity secondary to hypokalemia; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics
Documented hypersensitivity; fungal, tubercular skin, connective tissue, or viral infections; peptic ulcer disease; hepatic dysfunction; GI disease
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur with glucocorticoid use
Hydrocortisone (Cortaid, Cortef, Hycort)
Adrenocorticosteroid derivative suitable for application to skin or external mucous membranes. Mineralocorticoid and glucocorticoid effects resulting in anti-inflammatory activity.
Adult
Apply sparingly to affected areas bid/qid
Pediatric
Apply as in adults
None reported
Documented hypersensitivity; viral, fungal, and bacterial skin infections
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Prolonged use, applying over large surface areas, applying potent steroids, and using occlusive dressings may increase systemic absorption of corticosteroids and may cause Cushing syndrome, reversible HPA axis suppression, hyperglycemia, and glycosuria
Antibiotics
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.
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.
Adult
250 mg erythromycin stearate/base (or 400 mg ethylsuccinate) PO 1 h ac q6h, or 500 mg q12h
Alternatively, 333 mg PO q8h; increase to 4 g/d depending on severity of infection
Pediatric
30-50 mg/kg/d (15-25 mg/lb/d) PO divided q6-8h; double dose for severe infection
Coadministration may increase toxicity of theophylline, digoxin, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin and simvastatin, increases risk of rhabdomyolysis; decreases metabolism of repaglinide, thus increasing serum levels and effects
Documented hypersensitivity; hepatic impairment
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in liver disease; estolate formulation may cause cholestatic jaundice; GI side effects are common (give doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur
Antiviral agents
These agents may improve rate of resolution if given within 1 week of rash.
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.
Adult
800 mg PO 5 times daily for 5 d
Pediatric
10-20 mg/kg PO q6h for 5-10 d
Concomitant use of probenecid or zidovudine prolongs half-life and increases CNS toxicity of acyclovir
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in renal failure or when using nephrotoxic drugs
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
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Further Reading
Keywords
pityriasis rosea, PR, pityriasis rosea gigantica, pityriasis rosea urticata, papular PR, atypical PR, drug-induced PR, keratosis, vesicular PR, herald patch, rash, pruritus, exanthem, treatment, symptoms
