eMedicine Specialties > Pediatrics: General Medicine > Dermatology

Pityriasis Rosea: Treatment & Medication

Author: Maria R Nasca, MD, PhD, Assistant Professor, Department of Dermatology, University of Catania School of Medicine, Italy
Coauthor(s): Giuseppe Micali, MD, Head, Professor, Department of Dermatology, University of Catania School of Medicine, Italy
Contributor Information and Disclosures

Updated: Sep 24, 2009

Treatment

Medical Care

  • Treatment is unnecessary in most cases because pityriasis rosea (PR) is usually a self-limiting disease with no sequelae. Patient education and reassurance is all that is needed. Nonetheless, the efficacy of most attempted treatments has not been definitively proven.18
  • In cases of severe pruritus, various measures may be taken to provide symptomatic relief:
    • Instruct patients to avoid exposure to irritant agents, such as harsh soaps, fragrances, hot water, wool and synthetic fabrics, tight clothing, and scratching.
    • Bland emollients may be helpful. Topical preparations with calamine, menthol, pramoxine, colloidal starch, and oatmeal may also be beneficial.
    • Topical steroids may help alleviate the pruritus. The sedative effect of the antihistamines may help the patient to sleep better at night. Systemic steroids are not recommended because they may exacerbate the disease. However, some dermatologists use prednisone (0.5-1 mg/kg/d for 7 d) in selected patients with severe pruritus, vesicular lesions, or concern for significant postinflammatory hyperpigmentation to suppress both pruritus and the exanthem.
    • In a small clinical trial, 1 g of erythromycin taken orally 4 times daily in adults or 25-40 mg/kg divided 4 times daily in children for 2 weeks has led to early resolution of symptoms.19 However, antibiotic treatments have mostly been tried without success, and their efficacy is still controversial.20,21 Treatment in the first week of symptom onset with 1 g of acyclovir taken orally 5 times a day for 7 days in adults has been shown to shorten the duration of disease in one clinical trial and may be of benefit.22
    • Improvement with dapsone 20 mg/d has been reported in an atypical case of vesicular pityriasis rosea.15
    • UV-B (5 daily erythemogenic doses) may relieve pruritus in as little as 24 hours but may increase the incidence of postinflammatory hyperpigmentation.23,24

Consultations

  • Patients with severe pruritus or disease that requires systemic steroids or patients who desire UV-B therapy should be referred to a dermatologist. 
  • Consider evaluation by an infective disease specialist in immune suppressed individuals.

Activity

  • No restriction of activity or isolation is necessary.

Medication

Treatment is not necessary because pityriasis rosea (PR) is usually a self-limiting disease with no sequelae. Topical agents may be beneficial to soothe and moisturize the skin (eg, calamine lotion, zinc oxide, menthol-phenol preparations, colloidal starch, oatmeal). In cases of severe pruritus, oral antihistamines can be used for their sedating effect in attempt to prevent scratching at night.

Antihistamines

These agents are used for the sedating effect to decrease scratching at night. Act by competitive inhibition of histamine at the H1 receptor.


Hydroxyzine (Vistaril)

Antagonizes H1 receptors in periphery. May suppress histamine activity in subcortical region of CNS. Sedating antihistamine.

Adult

25-100 mg PO q4-6h prn; not to exceed 600 mg/d

Pediatric

2 mg/kg/d PO divided q6-8h

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

Associated with clinical exacerbations of porphyria (may not be safe for porphyric patients); ECG abnormalities (alterations in T waves) may occur; may cause drowsiness; adverse effects include dry mouth, drowsiness, tremor, convulsions, blurred vision, and hypotension


Diphenhydramine (Benadryl, Benylin)

For symptomatic relief of symptoms caused by release of histamine. Available as an over-the-counter product.

Adult

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

Pediatric

5 mg/kg/d PO divided q6h; not to exceed 37.5 mg/d if age <6 y or 150 mg/d for children aged 6-12 y

Potentiates effect of CNS depressants; because of alcohol content, do not administer syr dosage form to patients 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; infants and young children more likely to experience significant CNS effects; may cause sedation, nausea, vomiting, xerostomia, and blurred vision; paradoxical stimulation observed in children; adjust dose in renal failure

Corticosteroids, topical

Over-the-counter low-to-medium potency steroids may help relieve itching. Effectiveness is due to anti-inflammatory and immunosuppressive properties.


Triamcinolone 0.025-0.1% cream

Decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability.

Adult

Apply sparingly to affected area qd/bid for 5-10 d

Pediatric

Administer as in adults

Documented hypersensitivity; fungal, viral, 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

Do not use in decreased skin circulation; prolonged use, applications over large areas, and use of potent steroids and occlusive dressings may result in systemic absorption; systemic absorption may cause Cushing syndrome, reversible HPA axis suppression, hyperglycemia, and glycosuria

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. Allen RA, Janniger CK, Schwartz RA. Pityriasis rosea. Cutis. Oct 1995;56(4):198-202. [Medline].

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

  3. [Guideline] Finnish Medical Society Duodecim. Syphilis. EBM Guidelines. Jun 6 2008.

  4. Blauvelt A. Skin diseases associated with human herpesvirus 6, 7, and 8 infection. J Investig Dermatol Symp Proc. Dec 2001;6(3):197-202. [Medline].

  5. Broccolo F, Drago F, Careddu AM, Foglieni C, Turbino L, Cocuzza CE, 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].

  6. Canpolat Kirac B, Adisen E, Bozdayi G, et al. The role of human herpesvirus 6, human herpesvirus 7, Epstein-Barr virus and cytomegalovirus in the aetiology of pityriasis rosea. J Eur Acad Dermatol Venereol. Jan 2009;23(1):16-21. [Medline].

  7. 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].

  8. Drago F, Malaguti F, Ranieri E, Losi E, Rebora A. Human herpes virus-like particles in pityriasis rosea lesions: an electron microscopy study. J Cutan Pathol. Jul 2002;29(6):359-61. [Medline].

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

  10. Watanabe T, Kawamura T, Jacob SE, Aquilino EA, Orenstein JM, Black JB, et al. Pityriasis rosea is associated with systemic active infection with both human herpesvirus-7 and human herpesvirus-6. J Invest Dermatol. Oct 2002;119(4):793-7. [Medline].

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

  13. 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].

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

  15. Anderson CR. Dapsone treatment in a case of vesicular pityriasis rosea. Lancet. Aug 28 1971;2(7722):493. [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. 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].

  18. Chuh AA, Dofitas BL, Comisel GG, Reveiz L, Sharma V, Garner SE. Interventions for pityriasis rosea. Cochrane Database Syst Rev. 2007;(2):CD005068. [Medline].

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

  20. 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].

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

  22. 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].

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

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

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Further Reading

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Keywords

pityriasis rosea, PR, fine pink scale, inverse pityriasis rosea, inverse PR, vesicular pityriasis rosea, vesicular PR, bullous pityriasis rosea, bullous PR, papular pityriasis rosea, papular PR, syphilis, roseola, bone marrow transplantation, mononucleosis, influenza, parainfluenza, Epstein-Barr virus, parvovirus B19, cytomegalovirus, herpesvirus, infection, acetylsalicylic acid, barbiturates, bismuth, captopril, clonidine, gold, imatinib, isotretinoin, ketotifen, levamisole, metronidazole, omeprazole, D-penicillamine, terbinafine, Bacillus Calmette-Guérin vaccine, diphtheria vaccine, miscarriage, prematurity, neonatal hypotonia, hyporeactivity, lymphadenopathy, herald patch, tinea corporis, treatment, diagnosis

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Contributor Information and Disclosures

Author

Maria R Nasca, MD, PhD, Assistant Professor, Department of Dermatology, University of Catania School of Medicine, Italy
Disclosure: Nothing to disclose.

Coauthor(s)

Giuseppe Micali, MD, Head, Professor, Department of Dermatology, University of Catania School of Medicine, Italy
Giuseppe Micali, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Kevin P Connelly, DO, Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center
Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

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.

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
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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