From the Guidelines
Pityriasis rosea in pediatric patients typically requires only symptomatic treatment as it is a self-limiting condition that resolves within 6-8 weeks. For mild cases, no treatment may be necessary beyond reassurance that the condition will resolve on its own. For symptomatic relief of itching, first-line options include:
- Lukewarm baths
- Moisturizers
- Over-the-counter antihistamines such as diphenhydramine (1 mg/kg/dose every 6 hours, maximum 50 mg/dose) or cetirizine (2.5-5 mg once daily for ages 2-5-10 mg once daily for ages 6+) 1. For moderate to severe cases with significant pruritus, topical corticosteroids of low to medium potency (such as hydrocortisone 1% or triamcinolone 0.1%) can be applied twice daily to affected areas for 7-10 days. In extensive or particularly uncomfortable cases, oral erythromycin (20-50 mg/kg/day divided into 2-4 doses for 7-14 days) or acyclovir (20 mg/kg 4 times daily for 7 days, maximum 800 mg per dose) may be considered, especially if started within the first week of symptom onset. Phototherapy with UVB may be an option for severe or persistent cases in older children, but is rarely necessary. Parents should be advised that the rash may temporarily worsen with heat, friction, or excessive bathing, and that the condition is minimally contagious, if at all, so isolation is not required. It's worth noting that the provided evidence does not directly address the treatment of pityriasis rosea, but rather the treatment of psoriasis and other conditions. However, the general principles of symptomatic treatment and the use of topical corticosteroids and antihistamines can be applied to the treatment of pityriasis rosea as well 1.
From the Research
Treatment Options for Pityriasis Rosea in Pediatric Patients
- The primary approach to treating pityriasis rosea in pediatric patients is reassurance and symptomatic treatment, as the condition is self-limiting and typically resolves on its own within 6 to 8 weeks 2, 3.
- For cases with severe or recurrent symptoms, or in pregnant women, active intervention may be considered, including the use of acyclovir, macrolides (such as erythromycin), and ultraviolet phototherapy 2.
- Evidence suggests that oral acyclovir can shorten the duration of illness in pityriasis rosea 2, 4.
- A network meta-analysis found that acyclovir was the best option for patients with extensive, persistent lesions or systemic symptoms, while oral steroids and antihistamines were effective for itch resolution 4.
- Other studies have investigated the efficacy of various treatments, including erythromycin, which was found to be effective in improving rash and decreasing itch in one small trial 5.
- However, not all antibiotics are effective, as azithromycin was found to have no significant effect on pityriasis rosea compared to a placebo 6.
Pharmacological Treatments
- Acyclovir: effective in shortening the duration of illness and improving symptoms 2, 4.
- Erythromycin: may be effective in improving rash and decreasing itch, but results are based on a small trial 5.
- Oral steroids and antihistamines: effective for itch resolution, particularly in combination 4.
- Azithromycin: not effective in treating pityriasis rosea 6.