Pediatric Pityriasis Rosea Treatment & Management

  • Author: Maria R Nasca, MD, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 3, 2011
 

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 diseaseand may be of benefit.[22, 28] Lower doses of 400 mg 5 times a day for 1 week may be equally effective.[32]
  • 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] Alternatively, low-dose (10 to 30 J/cm2) UV-A1 phototherapy (340-400 nm) given 2-3 times a week until resolution may be tried.[31]
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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.
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Activity

  • No restriction of activity or isolation is necessary.
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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.

Specialty Editor Board

Kevin P Connelly, DO  Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University School of Medicine; 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.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-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.

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 Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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Herald patch. Courtesy of the Drexel Department of Dermatology slide collection.
 
 
 
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