From the Research
The best treatment for pityriasis rosea is acyclovir, which has been shown to be effective in achieving rash improvement and reducing symptoms, particularly in patients with extensive, persistent lesions or systemic symptoms. According to a recent network meta-analysis 1, acyclovir resulted in the best treatment outcome for rash improvement, with a surface under the cumulative ranking (SUCRA) score of 0.92. This study found that acyclovir was significantly superior to placebo in terms of rash improvement, with a risk ratio (RR) of 2.55 and a 95% confidence interval (CI) of 1.81-3.58.
For patients with mild cases of pityriasis rosea, supportive care and symptomatic treatment may be sufficient, as the condition is self-limiting and usually resolves on its own within 6-8 weeks. Over-the-counter antihistamines like diphenhydramine (25-50mg every 4-6 hours) or cetirizine (10mg daily) can help reduce itching, while topical treatments such as calamine lotion, zinc oxide, or 1% hydrocortisone cream applied 2-3 times daily to affected areas can also provide relief.
However, for more severe or persistent cases, prescription-strength treatments like acyclovir may be necessary. The optimal dosage and duration of acyclovir treatment for pityriasis rosea are not well established, but a dose of 400mg three times daily for 7 days has been suggested 2. It is essential to note that acyclovir is not approved for the treatment of pityriasis rosea, and its use is considered off-label.
Other treatment options, such as erythromycin and UVB phototherapy, may also be effective in reducing symptoms and improving rash outcomes, but the evidence is less robust compared to acyclovir 3. In general, the treatment of pityriasis rosea should be individualized based on the severity of symptoms, the presence of systemic symptoms, and the patient's overall health status.
Some key points to consider when treating pityriasis rosea include:
- Avoiding hot showers, harsh soaps, and tight clothing, which can exacerbate symptoms
- Using lukewarm baths with colloidal oatmeal to soothe the skin
- Considering oral corticosteroids like prednisone (20-40mg daily for 5-7 days) in particularly uncomfortable cases, although this is uncommon
- Being aware of the potential for pityriasis rosea to be triggered by viral infection, particularly human herpesvirus 6 and 7, which may influence treatment decisions.