From the Research
Management of recalcitrant pityriasis rosea typically involves a combination of oral antivirals, phototherapy, and symptomatic treatments, with oral acyclovir being a recommended option to shorten the duration of illness, as supported by recent studies 1, 2. The goal of treatment is to alleviate symptoms, reduce the duration of the disease, and improve quality of life.
- Oral antivirals, such as acyclovir, have been shown to be effective in reducing the duration of pityriasis rosea, especially when started within the first week of symptom onset 2.
- Phototherapy, including narrowband UVB, can also be beneficial in reducing inflammation and accelerating resolution of lesions.
- Symptomatic treatments, such as oral antihistamines (e.g., cetirizine 10 mg daily) and topical corticosteroids (e.g., triamcinolone 0.1% cream twice daily), can help alleviate pruritus and inflammation.
- In particularly resistant cases, a short course of oral corticosteroids (e.g., prednisone 20-30 mg daily for 5-7 days with taper) may be considered, though this is rarely necessary.
- Macrolide antibiotics, such as erythromycin, have shown benefit in some cases through their anti-inflammatory properties rather than antimicrobial effects 3. It is essential to note that the evidence for the effectiveness of these treatments is based on moderate-quality studies, and further research is needed to confirm their efficacy.
- Patients should be advised to wear soft cotton clothing, avoid hot showers, and use mild soaps to prevent exacerbation of symptoms while the condition resolves.
- A recent review of interventions for pityriasis rosea found that oral acyclovir probably leads to increased good or excellent, medical practitioner-rated rash improvement, and erythromycin probably reduces itch more than placebo 3. However, the evidence is limited by small study sizes, heterogeneity, and bias in blinding and selective reporting.
- Therefore, treatment decisions should be made on a case-by-case basis, taking into account the individual patient's symptoms, medical history, and preferences.