From the Guidelines
Antiviral therapy such as acyclovir is not routinely recommended for the treatment of pityriasis rosea as it is generally a self-limiting condition that resolves on its own within 6-8 weeks. There is no standard dosing regimen for acyclovir in pityriasis rosea because evidence supporting its use is limited and inconsistent. Some studies have suggested various dosing regimens for acyclovir, such as 400 mg orally three times a day for 7-10 days, or 200 mg orally five times a day for 7-10 days 1, but these approaches remain controversial and are not considered standard of care. Pityriasis rosea is believed to be possibly related to human herpesvirus 6 or 7 reactivation, which theoretically provides a rationale for trying antivirals, but most dermatologists focus on symptomatic treatment instead. For symptom management, the following options may be considered:
- Topical corticosteroids
- Antihistamines for itching
- UVB phototherapy Patients should be advised that even without specific treatment, the condition will typically resolve completely without scarring. It's worth noting that the provided evidence is not directly related to the treatment of pityriasis rosea, but rather to the treatment of sexually transmitted diseases, and therefore should not be used to guide treatment decisions for pityriasis rosea. In the absence of strong evidence supporting the use of antiviral therapy for pityriasis rosea, symptomatic treatment is the most appropriate approach.
From the Research
Dose of Antiviral Therapy for Pityriasis Rosea
- The dose of antiviral therapy, such as acyclovir, for the treatment of pityriasis rosea is not universally established, but several studies provide guidance on its use 2, 3, 4, 5, 6.
Recommended Dosage
- A position statement on the management of patients with pityriasis rosea suggests that oral acyclovir can be considered at a dose of 400 mg three times daily for 7 days 6.
- Other studies have used similar dosages, such as 400 mg tablets thrice daily for 7 days 4, or 400 mg five times daily for 7 days 6.
- High-dose regimens, such as 800 mg five times daily for 7 days, have also been studied, but have not demonstrated significant benefits over low-dose regimens 6.
Efficacy and Safety
- The efficacy of oral acyclovir in reducing erythema and limiting lesion formation has been demonstrated in several clinical trials 3, 4, 5.
- Acyclovir has been found to be relatively safe and effective in the early course of pityriasis rosea, with minor adverse effects observed in some studies 4, 6.
- However, attention should be given to adverse effects and contraindications of acyclovir, and its use in children and breastfeeding women is not well established 6.