From the Guidelines
Recurrence of pityriasis rosea after aciclovir therapy is likely due to the limited benefit of antiviral treatment in preventing future episodes, as suggested by the 1993 CDC guidelines for sexually transmitted diseases treatment 1. When considering the management of recurrent pityriasis rosea, it's essential to prioritize symptomatic relief, as the condition is often self-limiting.
- Topical corticosteroids, such as 1% hydrocortisone cream, can be applied twice daily to itchy areas to reduce inflammation and discomfort.
- Oral antihistamines, like cetirizine 10mg daily, may help alleviate itching and improve quality of life.
- Lukewarm baths with colloidal oatmeal can also provide relief from itching and skin irritation. Most recurrences of pityriasis rosea resolve within 6-8 weeks without specific treatment, and repeating antiviral therapy with aciclovir is not generally recommended due to its limited benefit in preventing future episodes 1. The exact cause of pityriasis rosea remains unclear, which may explain why antiviral therapy is not universally effective in preventing recurrences. If recurrences are frequent or severe, consultation with a dermatologist is warranted to rule out other conditions that may mimic pityriasis rosea, such as secondary syphilis or drug eruptions.
From the Research
Recurrence of Pityriasis Rosea after Aciclovir Therapy
- The studies 2, 3, 4, 5, 6 suggest that acyclovir may be effective in reducing the symptoms and duration of pityriasis rosea.
- However, there is limited information available on the recurrence of pityriasis rosea after aciclovir therapy.
- A study 2 found that acyclovir offered rapid resolution of clinical severity of PR from second week onwards without significantly increased adverse events as compared to supportive therapy alone, but it does not provide information on the recurrence rate.
- Another study 5 found that 79% of treated patients fully regressed compared with 4% of the placebo group on the 14th day of treatment, but it does not provide long-term follow-up data on recurrence.
- A systematic review and meta-analysis 6 found that oral acyclovir significantly reduced erythema and limited lesion formation compared with nonacyclovir treatment on the 14th day, but it does not provide information on the recurrence rate after treatment.
Factors Influencing Recurrence
- The dosage and duration of acyclovir therapy may influence the recurrence rate of pityriasis rosea.
- A study 4 found that a low dose of acyclovir (400 mg five times a day for 1 week) was effective in reducing erythema and shortening the duration of PR.
- Another study 5 used a high dose of acyclovir (800 mg 5 times daily) and found that it was effective in treating PR, especially in patients treated in the first week from onset.