QWhat should I do to treat pityriasis rosea?

Pityriasis rosea is a benign, self-limited skin disease that causes discrete plaques on the trunk and proximal extremities.  It is usually found in young, health persons and is generally asymptomatic, with mild pruritus occasionally associated.  The eruption generally persists for no longer than 12 weeks.  When a patient presents to clinic with pityriasis rosea, the most important job is to get the right diagnosis.  This can be a clinical diagnosis or confirmed with a biopsy.  The differential includes guttate psoriasis and syphilis, so certain presentations may require testing.

Pityriasis rosea has been linked to human herpes virus 6 and 7, and as a result, antivirals have been examined for the treatment of the disease.¹ Acyclovir is the most commonly studied antiviral and studies have shown improved pruritus and rash over placebo treatment.² Oral erythromycin has also been shown to reduce pruritus in one study but failed to improve rash in other studies.² Overall, the evidence for these treatments is low to moderate. Dermatologists should treat patients’ symptoms with oral antihistamines, topical steroids, and other topical anti-pruritic agents before moving to other oral antivirals or antibiotics. 

References:

1. 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):303-318. doi:10.1016/j.jaad.2008.07.045
2. Contreras-Ruiz J, Peternel S, Jimenez Gutierrez C, Culav-Koscak I, Reveiz L, Silbermann-Reynoso ML. Interventions for pityriasis rosea. Cochrane Database Syst Rev. 2019;2019(10):CD005068. doi:10.1002/14651858.CD005068.pub3