From the Guidelines
Treatment options for pityriasis vary depending on the specific type, with pityriasis rosea often resolving without treatment in 6-8 weeks. For symptomatic relief of itching, topical treatments like calamine lotion, zinc oxide, 1% menthol in aqueous cream, or over-the-counter hydrocortisone 1% cream can be used. For more severe cases, oral antihistamines such as diphenhydramine (25-50mg every 6 hours) or cetirizine (10mg daily) may help control itching. UVB phototherapy can be considered for widespread or persistent cases. For pityriasis versicolor (tinea versicolor), antifungal treatments are recommended, including topical options like ketoconazole 2% shampoo (applied to affected areas for 5 minutes daily for 3 days), selenium sulfide 2.5% shampoo (applied for 10 minutes daily for 7 days), or clotrimazole cream (applied twice daily for 2-4 weeks). For extensive cases, oral antifungals like fluconazole (400mg single dose or 150mg weekly for 2-4 weeks) or itraconazole (200mg daily for 5-7 days) may be prescribed. These treatments work by either reducing inflammation and itching or, in the case of antifungals, by eliminating the yeast (Malassezia) that causes pityriasis versicolor. Recurrence is common with pityriasis versicolor, so maintenance therapy may be needed, especially during warm months. Some studies, such as 1, have shown the efficacy of narrowband UVB phototherapy in treating various skin conditions, including pityriasis. However, the most recent and highest quality study, 1, provides guidance on the use of microencapsulated benzoyl peroxide for rosacea, but does not directly address pityriasis treatment. Therefore, the recommended treatment options are based on the available evidence and clinical guidelines, prioritizing the reduction of morbidity, mortality, and improvement of quality of life. Key considerations include:
- Symptomatic relief of itching and inflammation
- Antifungal treatment for pityriasis versicolor
- UVB phototherapy for widespread or persistent cases
- Maintenance therapy to prevent recurrence, especially during warm months.
From the FDA Drug Label
Ketoconazole Cream 2% is indicated for the topical treatment of ... tinea (pityriasis) versicolor caused by Malassezia furfur (Pityrosporum orbiculare); Cutaneous candidiasis, tinea corporis, tinea cruris, tinea pedis and tinea (pityriasis) versicolor: It is recommended that Ketoconazole Cream 2% be applied once daily to cover the affected and immediate surrounding area The treatment option for pityriasis (specifically tinea versicolor) is topical ketoconazole cream 2% applied once daily for two weeks 2 2.
- The recommended duration of treatment is two weeks for tinea versicolor.
- Ketoconazole cream 2% should be applied to cover the affected and immediate surrounding area.
From the Research
Treatment Options for Pityriasis
- The primary approach to treating pityriasis rosea is reassurance and symptomatic treatment, as the condition is self-limiting and typically resolves on its own within 6 to 8 weeks 3, 4, 5.
- For severe or recurrent cases, active intervention may be considered, including the use of:
- Acyclovir, which has been shown to shorten the duration of illness 3, 4, 6.
- Macrolides, such as erythromycin, which may be effective in reducing symptoms 3, 6.
- Ultraviolet phototherapy, which can be used for severe cases 3, 4.
- Corticosteroids or antihistamines, which can help control symptoms such as itch and inflammation 4, 6.
- A network meta-analysis found that acyclovir was the most effective treatment for rash improvement, while oral steroids and the combination of oral steroids and antihistamines were most effective for itch resolution 6.
- It is essential to note that pityriasis versicolor, a different condition, requires antifungal treatment, which is not applicable to pityriasis rosea 7.