From the Guidelines
Pityriasis rosea recurrence after aciclovir treatment is not significantly prevented by the treatment, and it is not generally recommended for recurrent disease. The use of aciclovir in treating pityriasis rosea, especially in cases of recurrence, has been debated, and evidence suggests that early treatment may have limited benefits for some patients with recurrent disease 1. When considering the management of pityriasis rosea recurrence after aciclovir treatment, it's essential to focus on symptomatic relief, as the condition is often self-limiting. Some key considerations include:
- Symptomatic management with antihistamines for itching
- Topical corticosteroids for inflammation
- Moisturizers for skin dryness Given the potential for viral reactivation and the association of pityriasis rosea with human herpesvirus 6 and 7, the effectiveness of antiviral treatment for recurrent cases may vary. For persistent or frequently recurring cases, consultation with a dermatologist is recommended to confirm the diagnosis and consider alternative treatments. It's also important to note that most recurrences are self-limiting and resolve within a certain period even without specific treatment. The approach to managing recurrence should prioritize improving the patient's quality of life by alleviating symptoms, rather than solely focusing on preventing recurrence with antiviral therapy.
From the Research
Pityriasis Rosea Recurrence after Aciclovir Treatment
- Pityriasis rosea is a common acute, self-limited papulosquamous dermatosis that primarily affects children and young adults 2.
- The condition is characterized by a "herald patch" after which oval erythematous squamous lesions appear along Langer's lines of cleavage on the trunk and proximal extremities, giving it a "Christmas tree" appearance 2.
- Treatment options for pityriasis rosea include acyclovir, macrolides, and ultraviolet phototherapy 2.
- Acyclovir has been shown to be effective in reducing the duration of illness and improving symptoms in patients with pityriasis rosea 3, 4, 5.
- A systematic review and meta-analysis found that acyclovir was superior to placebo for complete regression of lesions at week 1, and individual studies showed the superiority of acyclovir for the control of symptoms and pruritus 3.
- Another study found that acyclovir offered rapid resolution of clinical severity of pityriasis rosea from second week onwards without significantly increased adverse events as compared to supportive therapy alone 4.
- A randomized, investigator-blind, prospective study found that acyclovir was more effective than follow-up in reducing erythema at the end of the first, second, third, and fourth week of treatment 5.
- A Cochrane review found that oral acyclovir probably leads to increased good or excellent, medical practitioner-rated rash improvement, but evidence for the effect of acyclovir on itch was inconclusive 6.
- The review also found that erythromycin probably reduces itch more than placebo, but small study sizes, heterogeneity, and bias in blinding and selective reporting limited the conclusions 6.
- Further research is needed to investigate different dose regimens of acyclovir and the effect of antivirals on pityriasis rosea 6.
Recurrence of Pityriasis Rosea after Aciclovir Treatment
- There is limited evidence on the recurrence of pityriasis rosea after aciclovir treatment.
- A study found that acyclovir may be effective in reducing the recurrence of pityriasis rosea, but more research is needed to confirm this finding 5.
- Another study found that the addition of acyclovir to standard care may lead to increased itch resolution and reduction in itch score compared to standard care alone, but the effect on recurrence was not reported 6.