PITYRIASIS ROSEA

What is Pityriasis Rosea?

Pityriasis Rosea (P. Rosea) is a benign skin rash that typically disappears within 6-8 weeks. While it can occasionally persist or reappear, it is not contagious and usually presents with minimal symptoms aside from itching. Treatment is often unnecessary unless there is significant itching or a widespread rash, in which case interventions may be used to expedite resolution.

What is the cause of Pityriasis Rosea?

The exact cause of P. Rosea remains elusive, with no confirmed association with bacteria, fungus, or skin allergies. Some studies suggest a viral origin, as P. Rosea often follows symptoms like fever, sore throat, cough, and rhinitis (common in viral infections like the flu). Certain human herpes viruses, such as types 6, 7, and 8, have been linked to P. Rosea in some research. However, further studies are needed to definitively establish its cause.

What are symptoms of Pityriasis Rosea?

• P. Rosea is more prevalent among older children and young adults, with a slightly higher occurrence in females.
• It often follows symptoms resembling a viral flu, such as cough, rhinitis, body aches, headaches, or occasionally fever, appearing a few days before the rash.
• Initially, about 50 to 90% of cases start with a single large red patch known as the mother's patch or herald patch. Over the next few days, it enlarges and becomes scaly. Within 2-3 weeks, multiple smaller patches called daughter patches emerge. These typically appear on the chest, shoulders, neck, abdomen, sides, back, and arms. Sometimes, lesions can also occur on the face and lower body, forming an oval or "Christmas tree" pattern. However, the scalp, palms, and soles remain unaffected. The rash spreads from the center outward or from top to bottom within a few days.
• New patches appear in batches, with sudden eruptions of 10-15 lesions followed by a period without new lesions before another batch appears.
• As the rash resolves, the redness diminishes first, followed by scaling. Some pigmentary changes may remain, gradually blending into the skin over the ensuing months.
• In children, the rash may differ in distribution, often involving the face, scalp, and skin folds.
• Oral mucosal lesions may also occur in about 25-30% of cases.

How do dermatologists diagnose Pityriasis Rosea?

Dermatologists typically diagnose P. Rosea through clinical assessment, which involves gathering a medical history and examining the skin lesions. Skin scrapings may be taken to examine the skin under a microscope and rule out conditions like ringworm. In some cases, a skin biopsy may be necessary to eliminate uncertainties and rule out other skin conditions such as secondary syphilis.

Can Pityriasis Rosea resolve without treatment?

P. Rosea often resolves on its own without requiring treatment. The rash typically clears up within 6-8 weeks, although in some cases, it may take longer.

When does Pityriasis Rosea need treatment?

Moderate to severe persistent itching in the skin rash

Extensive skin rash covering visible areas, affecting daily activities.

What is the treatment for Pityriasis Rosea?

• Patient or parental education regarding the condition.
• Use of moisturizers.
• Application of moderately potent topical steroid creams to alleviate itching and promote quicker resolution of the skin rash.
• Antihistamines for managing itching.
• Short-term oral antibiotics for moderate to severe cases.
• Exposure to natural sunlight outdoors.Consideration of oral antiviral medications for severe cases, although outcomes may varyPhototherapy for extensive disease.
• Management of post-inflammatory pigmentary changes typically involves moisturization and regular sunlight exposure, with topical medications as needed, prescribed by a dermatologist.