eMedicine Specialties > Emergency Medicine > Dermatology

Pityriasis Rosea: Treatment & Medication

Author: Richard Lichenstein, MD, Associate Professor, Pediatric Emergency Department, University of Maryland School of Medicine
Contributor Information and Disclosures

Updated: Dec 8, 2009

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

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

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

References

  1. Neoh CY, Tan AW, Mohamed K, Sun YJ, Tan SH. Characterization of the inflammatory cell infiltrate in herald patches and fully developed eruptions of pityriasis rosea. Clin Exp Dermatol. Jul 29 2009;[Medline].

  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].

  3. Drago F, Ranieri E, Malaguti F. 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].

  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, Rebora A. Treatments for pityriasis rosea. Skin Therapy Lett. Mar 2009;14(3):6-7. [Medline].

  6. Sharma PK, Yadav TP, Gautam RK. Erythromycin in pityriasis rosea: A double-blind, placebo-controlled clinical trial. J Am Acad Dermatol. Feb 2000;42(2 Pt 1):241-4. [Medline].

  7. [Best Evidence] Amer A, Fischer H. Azithromycin does not cure pityriasis rosea. Pediatrics. May 2006;117(5):1702-5. [Medline].

  8. Stulberg DL, Wolfrey J. Pityriasis rosea. Am Fam Physician. Jan 1 2004;69(1):87-91. [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. [Guideline] Finnish Medical Society Duodecim. Syphilis. In: EBM Guidelines. Evidence-Based Medicine [Internet]. Helsinki, Finland: Wiley Interscience. John Wiley & Sons; 2008 Jun 6. [Full Text].

  11. Chuh A, Chan H, Zawar V. Pityriasis rosea--evidence for and against an infectious aetiology. Epidemiol Infect. Jun 2004;132(3):381-90. [Medline].

  12. Chuh A, Lee A, Zawar V. Pityriasis rosea--an update. Indian J Dermatol Venereol Leprol. Sep-Oct 2005;71(5):311-5. [Medline].

  13. Coustou D, Leaute-Labreze C, Bioulac-Sage P, et al. Asymmetric periflexural exanthem of childhood: a clinical, pathologic, and epidemiologic prospective study. Arch Dermatol. Jul 1999;135(7):799-803. [Medline].

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

  15. Horio T. Skin disorders that improve by exposure to sunlight. Clin Dermatol. Jan-Feb 1998;16(1):59-65. [Medline].

  16. Kay MH, Rapini RP, Fritz KA. Oral lesions in pityriasis rosea. Arch Dermatol. Nov 1985;121(11):1449-51. [Medline].

  17. Kempf W, Burg G. Pityriasis rosea--a virus-induced skin disease? An update. Arch Virol. 2000;145(8):1509-20. [Medline].

  18. Nanda A, Al-Hasawi F, Alsaleh QA. A prospective survey of pediatric dermatology clinic patients in Kuwait: an analysis of 10,000 cases. Pediatr Dermatol. Jan-Feb 1999;16(1):6-11. [Medline].

  19. Pomeranz AJ, Fairley JA. The systematic evaluation of the skin in children. Pediatr Clin North Am. Feb 1998;45(1):49-63. [Medline].

  20. Scott LA, Stone MS. Viral exanthems. Dermatol Online J. Aug 9 2003;9(3):4. [Full Text].

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

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

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.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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.

CME Editor

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, David Geffen School of Medicine at UCLA; 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.

 
 
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