From the Research
Oral aciclovir may be considered for the treatment of pityriasis rosea, particularly in severe cases or when symptomatic treatment is necessary, as suggested by the most recent and highest quality study 1. Pityriasis rosea is a self-limiting skin condition that typically resolves on its own within 6-8 weeks without specific treatment. The exact cause of pityriasis rosea remains unclear, though it's suspected to have a viral etiology, possibly related to human herpesvirus 6 or 7, which explains why antivirals like aciclovir have been investigated. Some studies have suggested that aciclovir might help reduce the duration and severity of symptoms, with a systematic review and meta-analysis finding that oral acyclovir significantly reduced erythema and limited lesion formation compared to non-acyclovir treatment 1. However, it's essential to weigh the potential benefits against the possible side effects of oral aciclovir, including nausea, headache, and diarrhea. If symptomatic treatment is needed, options include topical corticosteroids for itching, oral antihistamines, and moisturizers. For severe cases with significant discomfort, a dermatology referral may be appropriate. The use of oral acyclovir for pityriasis rosea is considered off-label, and its use should be discussed with experienced colleagues and patients 2. Key points to consider when deciding on treatment include:
- The diagnosis of pityriasis rosea should be ascertained
- Patients should be assessed for rash severity and impacts on quality of life
- Pityriasis rosea is a self-limiting disease, and most patients do not necessitate any treatment
- For patients necessitating active treatment, oral acyclovir as 400 mg three times daily for 7 days can be considered 2
- Attention should be given to adverse effects and contraindications of acyclovir.