From the Guidelines
Salicylic acid is a safe choice for the control of localized skin conditions in pregnancy and can be considered for treating recalcitrant pityriasis rosea in pregnant women. When managing recalcitrant pityriasis rosea during pregnancy, it's crucial to prioritize both maternal and fetal safety. For persistent cases that don't respond to conservative measures, salicylic acid can be applied daily, as it appears to be safe for use in pregnancy, according to the guidelines of care for the management of psoriasis and psoriatic arthritis 1. Before pursuing treatment with salicylic acid, conservative measures should be tried first, including lukewarm baths, mild moisturizers, and avoiding harsh soaps or hot water that can worsen itching.
Some key considerations for using salicylic acid in pregnancy include:
- Do not combine salicylic acid with other salicylate drugs, as systemic absorption can occur, especially when applied to more than 20% of the body surface area or in patients with abnormal hepatic or renal function 1.
- Salicylic acid decreases the efficacy of UVB phototherapy because of a filtering effect and should not be used before UVB phototherapy 1.
- The efficacy of salicylic acid used alone is limited, but it can be effective when combined with other treatments, such as mometasone furoate 1.
In contrast, anthralin is categorized as pregnancy category C, and its use should be approached with caution 1. Coal tar, another potential treatment option, has been used for various skin diseases, but its composition can vary, and its safety in pregnancy is not well established. Therefore, salicylic acid is the preferred treatment option for recalcitrant pityriasis rosea in pregnancy due to its safety profile and potential efficacy. Close monitoring by both a dermatologist and obstetrician is essential throughout treatment to ensure the best possible outcomes for both mother and fetus.
From the Research
Treatment of Recalcitrant Pityriasis Rosea in Pregnancy
- The treatment of recalcitrant pityriasis rosea in pregnancy is challenging due to the limited availability of safe and effective treatment options 2, 3.
- Acyclovir or valacyclovir may be considered as treatment options, but their safety and efficacy in pregnant women are not well established 2, 4.
- Ultraviolet phototherapy can also be considered for severe cases, but its safety and efficacy in pregnant women are not well established 4, 3.
- Corticosteroids or antihistamines can be used to control symptoms, but they may not be effective in reducing the duration of the disease 3.
- It is essential to carefully assess the potential risks and benefits of any treatment option and to closely monitor the pregnant woman and the fetus 2, 5.
Risk Factors for Pregnancy Complications
- Early onset of pityriasis rosea (before week 15) and enanthem are major risk factors for pregnancy complications 5.
- Constitutional symptoms, involvement of > 50% of the body area, and high HHV-6 viral load are minor risk factors for pregnancy complications 5.
- Pregnant women with these risk factors should be closely monitored, and their treatment options should be carefully assessed 2, 5.
Diagnosis and Differential Diagnosis
- The diagnosis of pityriasis rosea is based on clinical and physical examination findings, including the presence of a herald patch and a generalized rash along the Langer lines 4, 3.
- The differential diagnosis includes secondary syphilis, seborrheic dermatitis, nummular eczema, pityriasis lichenoides chronica, tinea corporis, viral exanthems, lichen planus, and pityriasis rosea-like eruption associated with certain medications 4, 3.
- It is essential to exclude these conditions and to confirm the diagnosis of pityriasis rosea before initiating treatment 2, 3.