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In their practice, primary care doctors frequently encounter skin-manifesting symptoms caused by various conditions. One common skin condition is pityriasis rosea, a rash that usually affects young adults. In this article, we will go over what pityriasis rosea is, how to diagnose it, and the treatment options available.

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What is pityriasis rosea?

Pityriasis rosea is a skin condition that presents as a rash of oval-shaped, pink or red patches on the trunk, arms, and legs. The cause of pityriasis rosea is not fully understood, but it is thought to be caused by a viral infection. It is not contagious and is usually self-limiting, meaning it will go away on its own without treatment, but rare atypical manifestations can occur.

The rash can be itchy and uncomfortable, and some patients may seek treatment to alleviate their symptoms.

How to diagnose pityriasis rosea

The diagnosis of pityriasis rosea is usually based on the clinical presentation of the rash. The rash typically begins with a single patch, known as the herald patch, which is larger and more distinct than the other patches that follow. The other patches usually appear within one to two weeks and are smaller in size. The rash may be accompanied by mild flu-like symptoms, such as fever, headache, and fatigue.

If the diagnosis is unclear, you can perform a skin biopsy to confirm it. A skin biopsy involves taking a small sample of skin tissue and examining it under a microscope. However, this is rarely necessary for the diagnosis of pityriasis rosea.

How to manage pityriasis rosea

Most cases of pityriasis rosea will resolve on their own within four to eight weeks without treatment. However, you may want to provide symptomatic relief to your patients. Here are some options you may consider:

Topical steroids

These can help alleviate itching and inflammation. You can prescribe a mild topical steroid cream or ointment, such as hydrocortisone.

Antihistamines

These can help alleviate itching and improve sleep. You can prescribe an over-the-counter antihistamine, such as diphenhydramine or loratadine.

Moisturisers

These can help alleviate dryness and itchiness. You can recommend a fragrance-free moisturizer, such as Cetaphil or Eucerin.

UV light therapy

This can be an effective treatment for severe or persistent cases of pityriasis rosea. You may refer your patients to a dermatologist who can provide this treatment.

Oral steroids

Oral steroids may be prescribed for severe cases of pityriasis rosea that are causing significant discomfort. However, the risks and benefits of oral steroids should be carefully considered before prescribing.

Pityriasis rosea is a common skin condition that you may encounter in your primary care practice. While it is usually self-limiting, you may want to provide symptomatic relief to your patients. Topical steroids, antihistamines, moisturisers, UV light therapy, and oral steroids are some of the treatment options available.

– Dr Rosmy De Barros

Read another article like this one: How to manage pruritus

References:

1. Leung AKC, Lam JM, Leong KF, Hon KL. Pityriasis Rosea: An Updated Review. Curr Pediatr Rev. 2021;17(3):201-211. doi:10.2174/1573396316666200923161330
2. Mahajan K, Relhan V, Relhan AK, Garg VK. Pityriasis Rosea: An Update on Etiopathogenesis and Management of Difficult Aspects. Indian J Dermatol. 2016 Jul-Aug;61(4):375-84. doi: 10.4103/0019-5154.185699. PMID: 27512182; PMCID: PMC4966395.
3. Contreras-Ruiz J, Peternel S, Jiménez Gutiérrez C, Culav-Koscak I, Reveiz L, Silbermann-Reynoso ML. Interventions for pityriasis rosea. Cochrane Database Syst Rev. 2019 Oct 30;2019(10):CD005068. doi: 10.1002/14651858.CD005068.pub3. PMID: 31684696; PMCID: PMC6819167.
4. Sonthalia S, Kumar A, Zawar V, et al. Double-blind randomized placebo-controlled trial to evaluate the efficacy and safety of short-course low-dose oral prednisolone in pityriasis rosea. J Dermatolog Treat. 2018;29(6):617-622. doi:10.1080/09546634.2018.1430302