From the Research
Pityriasis rosea is a self-limiting skin condition that typically resolves on its own within 6-8 weeks, and the best approach for most patients is reassurance and symptomatic treatment, with acyclovir being the most effective option for patients with extensive, persistent lesions or systemic symptoms, as evidenced by a recent network meta-analysis 1. The condition often begins with a single, larger "herald patch" followed by smaller, oval-shaped, salmon-colored patches that may appear in a "Christmas tree" pattern on the trunk and upper extremities. For symptom relief, the following options can be considered:
- Mild to moderate topical corticosteroids like 1% hydrocortisone cream can be applied twice daily to itchy areas.
- Oral antihistamines such as cetirizine 10mg daily or diphenhydramine 25mg every 6 hours as needed may also help control itching.
- For severe cases, narrow-band UVB phototherapy administered 2-3 times weekly for 2-3 weeks might be beneficial, although its effectiveness is still a topic of debate 2.
- Keeping the skin moisturized with fragrance-free lotions and taking lukewarm (not hot) showers can provide additional comfort. The condition is believed to be associated with human herpesvirus 6 and 7 reactivation, though it is not highly contagious, as discussed in a review of the condition 3. Patients should be reassured about the benign nature of the condition and its eventual resolution, though post-inflammatory hyperpigmentation may persist for weeks to months after the rash clears. In terms of specific treatment options, acyclovir has been shown to be the most effective treatment for rash improvement, with a significant reduction in symptoms compared to placebo, as demonstrated in a recent study 1. Other treatment options, such as oral steroids and antihistamines, may also be effective for itch resolution, but the evidence is not as strong as it is for acyclovir 1. Overall, the management of pityriasis rosea should focus on symptomatic relief and reassurance, with acyclovir being a viable option for patients with more severe symptoms, as supported by the most recent and highest-quality evidence 1.