Common treatments for symptom relief
Advanced treatment options
Preventing symptom worsening
References
Further reading
Pityriasis rosea is a skin condition characterized by widely distributed red, scaly, and often itchy skin lesions. It usually affects people between the ages of 10 and 35 and is slightly more common among women than men.
It is a common, acute skin illness that primarily affects children and young adults. Symptoms often begin with a single herald patch, followed by a rash spreading across the trunk and limbs. In most cases, the condition resolves on its own within 4 to 8 weeks, sometimes extending up to a couple of months.
A close-up of Pityriasis Rosea, a common skin condition characterized by a red, scaly, circular rash. This initial "herald patch" often appears before smaller lesions spread across the body. Image Credit: laksena/Shutterstock.com
Although the exact etiology is unknown, a history of upper respiratory symptoms, early onset, self-limited course, and low relapse rate all point to a viral infection. In some cases, the reactivation of human herpesvirus (HHV)-6 and HHV-7 infections has been linked to the development of pityriasis rosea. Specific treatments are generally not required, and the primary focus of management is reducing itchiness and addressing secondary bacterial infections or other complications.
Common treatments for symptom relief
The standard treatment regimen includes topical emollients and antipruritic lotions, corticosteroid creams, and oral antihistamines to control symptoms. Additionally, products like skin moisturizers and corticosteroid creams are used to alleviate discomfort caused by pityriasis rosea
1. Skin moisturizers or emollients
These are skin creams that are targeted to moisturize or soothe the skin, providing relief from itching and discomfort. They can come in various forms, such as lotions, creams, ointments, or gels. Emollients play a crucial role in managing conditions like eczema and other inflammatory skin diseases. They help improve the skin barrier function and reduce dryness, scaling, and pruritus.
Benefits - When applied to irritated skin, emollients relieve itching by moisturizing, softening, and soothing the skin. Emollients are a key part of skin care management for many inflammatory skin diseases, providing essential hydration and support to the skin barrier.
How and when to apply - For best results, emollients should be applied immediately after showering or bathing, as this helps lock in moisture. Reapply throughout the day if your skin feels uncomfortable or dry. It is important to apply emollients gently in the direction of hair growth to avoid irritating the skin. Patients should also avoid using harsh soaps, which can strip the skin of its natural oils and worsen dryness. Soaps with moisturizers or emollients may be recommended as alternatives.
2.Corticosteroid creams
Corticosteroid creams are primarily used to reduce inflammation in lesions. These synthetic hormones produced by the adrenal gland work by reducing itchiness and redness associated with inflammation. They are usually prescribed when emollients fail to provide adequate relief and are typically recommended by a physician.
Benefits and application—The creams should be applied lightly to the affected areas of the skin. They help calm inflammation and control symptoms that are not managed by other treatments. Apply these lotions in small amounts to the affected areas of the skin two or three times daily for the duration recommended by your dermatologist.
Precautions and side effects – They are usually prescribed for short durations, usually no more than a week, to avoid potential complications. A medium dosage is generally advised. to minimize side effects such as skin thinning or inflammation flare-ups when the treatment is discontinued abruptly. Some individuals may experience a slight burning or stinging sensation when they first apply the cream. However, this is usually temporary and subsides with continued usage.
Topical creams, such as moisturizers or steroid ointments, are often used to reduce itching and discomfort associated with Pityriasis Rosea. Image Credit: laksena/Shutterstock.com
3.Antihistamine pills
These are anti-allergy medications that may relieve itching. These medications are effective in alleviating symptoms caused by inflammation. Examples of antihistamines include chloropyramine, loratadine, desloratadine, cetirizine, levocetirizine, bilastine, and others.
Benefits - First generation antihistamines like chlorphenamine cause sedation and drowsiness, which can be beneficial for patients needing to sleep. In contrast, second-generation antihistamines like loratadine, and desloratadine are usually non-sedating, making them suitable for daytime use without causing drowsiness. If you need an antihistamine to help with sleep, choose one that does not say “non-drowsy” on the label. This type of medication can effectively relieve itching while promoting sleep. Sedate antihistamines may be particularly helpful for severe itching.
Usage - Your dermatologist will determine the correct antihistamine and dosage, depending on your individual symptoms and needs. It is important to follow their recommendations on how often to take the medication. Patients using sedating antihistamines are advised not to drive or operate heavy machinery due to potential drowsiness.
Advanced treatment options
1. UVB light therapy
If patients do not respond to the common therapy, they may be recommended for UV B light therapy. This involves controlled exposure of the affected skin for a few minutes at regular intervals to the UV B rays under the supervision of a dermatologist or a skin specialist. Exposure to natural sunlight can also be useful, but sunburns should be avoided, and exposure to sun’s rays may also lead to a higher risk of skin cancer.
According to a 2015 study, narrowband ultraviolet B (NBUVB) therapy is a widely available, cost-effective, and safe treatment option for managing pityriasis rosea. A 2018 study further supports the use of phototherapy, suggesting that it may alleviate itching (pruritus) by directly altering the sensitivity of cutaneous sensory nerves or by stimulating the release of natural antipruritic mediators in the skin.
2. Antiviral and antibiotic medications
Other medications that may be tried include acyclovir, which is an antiviral medication that may be used for herpes infections. There is limited evidence that acyclovir is useful in pityriasis rosea, and additionally, it is beneficial only if taken during the first week of the condition. Those who develop secondary bacterial infections over the lesions also need antibiotics to treat the infections.
Systemic treatments may include oral antibiotics, including azithromycin, clarithromycin, and erythromycin, as well as the antiviral medication acyclovir, according to a 2019 review that examined available treatment choices. None of the macrolide antibiotics that were reviewed—erythromycin, azithromycin, and clarithromycin—showed any discernible positive effects on the rash.
Preventing symptom worsening
Patients are advised to avoid anything that worsens their condition, such as hot baths, physical activity that leads to sweating, etc. Common recommendations include:
- Avoid overheating: Avoid hot weather, strenuous activities, and hot tubs, as these can worsen the rash and itching.
- Take lukewarm showers and baths: Opt for warm water instead of hot, as hot water can aggravate the rash and itching.
- Protect your skin from the sun: Avoid direct sun exposure to prevent the risk of sunburns.
- Use fragrance-free skincare: Apply fragrance-free emollients after bathing to soothe and hydrate your skin.
- Wear loose-fitting clothes: Choose loose, comfortable clothing to avoid irritating the rash.
- Avoid antifungal medications: Do not use antifungal treatments, as they may worsen pityriasis rosea.
References
- Jairath, V., Mohan, M., Jindal, N., Gogna, P., Syrty, C., Monnappa, P. M., Kaur, S., & Sehrawat, M. (2015). Narrowband UVB phototherapy in pityriasis rosea. Indian dermatology online journal, 6(5), 326–329. https://doi.org/10.4103/2229-5178.164480
- Villalon-Gomez, J. M. (2018). Pityriasis Rosea: Diagnosis and Treatment. American family physician, 97(1), 38–44.
- Legat, F. J. (2018). The Antipruritic Effect of Phototherapy. Frontiers in medicine, 5, 333. https://doi.org/10.3389/fmed.2018.00333
- Contreras-Ruiz, J., Peternel, S., Jiménez Gutiérrez, C., Culav-Koscak, I., Reveiz, L., & Silbermann-Reynoso, M. L. (2019). Interventions for pityriasis rosea. The Cochrane database of systematic reviews, 2019(10), CD005068. https://doi.org/10.1002/14651858.CD005068.pub3
- Tidy, C. (2021). Pityriasis rosea. Patient. Available at: http://www.patient.co.uk/doctor/Pityriasis-Rosea.htm
- NHS. (2023, September 7). Pityriasis rosea. National Health Service. Available at: https://www.nhs.uk/conditions/pityriasis-rosea/
- Ludmann, P. (2024, October 24). Pityriasis rosea: How to treat it at home. American Academy of Dermatology Association. Available at: https://www.aad.org/public/diseases/a-z/pityriasis-rosea-self-care.
- Ludmann, P. (2024, October 24). Pityriasis rosea: Diagnosis and treatment. American Academy of Dermatology Association. Available at: https://www.aad.org/public/diseases/a-z/pityriasis-rosea-treatment
- Litchman, G., Nair, P. A., Syed, H. A., et al. (2024, March 1). Pityriasis Rosea. [Updated 2024 Mar 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448091/
Further Reading