From the Guidelines
Management of persistent or recurrent pityriasis rosea typically involves a combination of topical and systemic treatments. For cases lasting several months, medium-potency topical corticosteroids (such as triamcinolone 0.1% cream or fluocinonide 0.05% cream) applied twice daily for 2-3 weeks can help reduce inflammation and itching. Oral antihistamines like cetirizine 10mg daily or hydroxyzine 25mg three times daily may also provide symptomatic relief. For more severe or persistent cases, narrow-band UVB phototherapy administered 2-3 times weekly for 6-8 weeks has shown good efficacy 1. In particularly resistant cases, a short course of oral corticosteroids (prednisone 20-30mg daily for 7-10 days with a taper) may be considered. Some dermatologists also prescribe oral acyclovir or other antivirals (800mg five times daily for 7 days) based on the theory that pityriasis rosea may have a viral etiology, though evidence for this approach is limited. Persistent cases should prompt consideration of alternative diagnoses such as secondary syphilis, drug eruption, or cutaneous T-cell lymphoma, so additional testing may be warranted. Patients should avoid hot showers, excessive sweating, and irritating soaps, as these can exacerbate symptoms. Moisturizing with fragrance-free emollients after bathing can help maintain skin barrier function and reduce irritation. It's worth noting that the provided evidence does not directly address the management of pityriasis rosea, but rather rosacea, and therefore the recommendations are based on general dermatological principles and may not be specific to pityriasis rosea. However, the general approach to managing persistent or recurrent skin conditions can be applied, and narrow-band UVB phototherapy has been shown to be effective in treating various skin conditions, including those with an inflammatory component 1.
From the Research
Management of Pityriasis Rosea
The management of pityriasis rosea that persists or recurs for several months involves several treatment options, including:
- Acyclovir: According to 2, acyclovir represents the best option for patients with PR that have extensive, persistent lesions or systemic symptoms.
- Oral steroids: 2 found that oral steroids resulted in the best treatment for itch resolution.
- Antihistamines: 2 also found that the combination of oral steroids and antihistamines seemed to be the best treatment for itch resolution.
- Erythromycin: 3 found that oral erythromycin was more effective than placebo in terms of rash improvement and decreasing the itch score.
- Ultraviolet phototherapy: 4 and 5 mentioned that ultraviolet phototherapy can be considered for severe cases.
Treatment Outcomes
The outcomes of these treatments vary, with some studies showing significant improvements in symptoms, while others show little to no difference. For example:
- 6 found that erythromycin may lead to increased rash improvement and reduction in itch score, but the evidence was of low quality.
- 6 also found that acyclovir probably leads to increased good or excellent, medical practitioner-rated rash improvement, but the evidence for its effect on itch was inconclusive.
Considerations
When managing pityriasis rosea, it is essential to consider the individual patient's symptoms and disease severity. Treatment should be aimed at controlling symptoms and improving quality of life. As stated in 5, treatment is aimed at controlling symptoms and consists of corticosteroids or antihistamines. In some cases, acyclovir can be used to treat symptoms and reduce the length of disease.