Pityriasis rosea in Adult
Alerts and Notices
SynopsisPityriasis rosea is a common and typically self-limited cutaneous eruption. Classically, a solitary scaly, pink or skin-colored plaque – the "herald patch" – appears first, often on the trunk. The ensuing eruption appears days to weeks later and consists of multiple discrete oval, erythematous, and scaly plaques and patches oriented along skin cleavage lines, most commonly on the trunk and upper extremities. The face, palms, and soles are usually spared.
Pityriasis rosea is usually asymptomatic, although it occasionally may be pruritic. Constitutional symptoms may precede the eruption, including fever, headache, cough, and arthralgia. In a majority of patients, the rash typically resolves within 8 weeks. Recurrence is rare.
Adolescents and young adults are most commonly affected. Of note, pityriasis rosea occurring during pregnancy has been associated with increased risk of fetal demise and miscarriage, particularly if the lesions appear within the first 15 weeks of gestation. In pregnant individuals, the eruption may present in a more widespread distribution compared with classic pityriasis rosea and may be associated with systemic symptoms such as fatigue, headache, and loss of appetite. Close follow-up of pregnant patients with pityriasis rosea is recommended. Occasionally, pityriasis rosea can affect children under 10 years of age.
While the exact cause remains unclear, pityriasis rosea is thought to be associated with systemic reactivation of human herpesvirus 6 and 7 (HHV-6 and HHV-7).
Certain drugs, such as captopril, clonidine, omeprazole, nonsteroidal anti-inflammatory drugs (NSAIDs), metronidazole, terbinafine, and lamotrigine, among many others, can cause a pityriasiform eruption that resembles pityriasis rosea. Drug-related pityriasis rosea-like lesions may appear more red-violet in color, typically do not present with a herald patch, and may be associated with eosinophilia.
L42 – Pityriasis rosea
77252004 – Pityriasis rosea
Differential Diagnosis & Pitfalls
- Exanthematous drug eruption
- Tinea corporis
- Tinea versicolor
- Nummular dermatitis (nummular eczema) – very pruritic
- Guttate psoriasis – smaller size, thicker scale
- Small plaque parapsoriasis
- Secondary syphilis – Genital and palmoplantar lesions. Systemic symptoms are more pronounced, including lymphadenopathy, fevers, history of primary chancre, condyloma lata. If remotely suspicious, check syphilis serologies.
- Erythema multiforme
- Other conditions with a "Christmas tree" distribution, including pityriasis lichenoides, erythema dyschromicum perstans (ashy dermatosis), and, often, drug-induced lichen planus. Aggressive HIV-associated Kaposi sarcoma may show a pityriasis rosea-like pattern with oval violaceous papules and nodules.
Drug Reaction DataBelow is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
Patient Information for Pityriasis rosea in Adult
OverviewPityriasis rosea (PR) is a common rash that usually occurs on the back, chest, and abdomen. It starts fairly quickly, lasts about 6-8 weeks, and is usually not itchy.
The cause of pityriasis rosea is not known, but it may be caused by infection with a virus.
Who’s At RiskPityriasis rosea can occur in people of any age, race / ethnicity, or sex, but it is most common in older children and young adults (those aged 10-40 years).
Signs & SymptomsThe most common locations for pityriasis rosea include the:
- Upper back.
- Upper arms.
Some people report feeling mildly ill (headache, stuffy nose, muscle aches) for 1-2 weeks before the herald patch forms. Additionally, some people experience itching with pityriasis rosea. Becoming overheated by exercising or taking a hot shower may increase itching or make the rash more apparent.
Pityriasis rosea goes away on its own (is self-limited), typically within 6-8 weeks, without treatment. However, the rash often leaves behind patches of lighter (hypopigmented) or darker (hyperpigmented) skin; these patches are more obvious in darker skin colors and may take months to return to their normal color.
Self-Care GuidelinesThe herald patch of pityriasis rosea may be mistaken for ringworm (tinea corporis), but over-the-counter antifungal creams do not improve it. Similarly, the herald patch may look like eczema, but over-the-counter hydrocortisone creams also do not improve it.
Itching with pityriasis rosea can sometimes be reduced with:
- Oatmeal baths.
- Lukewarm (rather than hot) baths and showers.
- Antihistamine pills such as fexofenadine (Allegra), cetirizine (Zyrtec), or loratadine (Claritin) in the daytime and diphenhydramine (Benadryl) at bedtime.
When to Seek Medical CareIf you develop a patch of pink, purple, or brown scaly skin that does not respond to over-the-counter antifungal creams or hydrocortisone cream, or if you develop a widespread rash, see a dermatologist or another medical professional for evaluation.
Be prepared to discuss the following with the medical professional:
- The course of the rash (when it started, whether or not there was a herald patch, etc)
- What treatments, if any, you have tried
- Whether or not any friends or relatives have a similar rash
- Your recent sexual history
- Your medication history (including the names of any medications or supplements you have taken within the last month)
TreatmentsIn most cases, the medical professional will be able to diagnose the rash by examining your skin. If the rash is atypical, a skin biopsy may be required. These are usually performed by a dermatologist.
In addition, the medical professional may want to do blood tests for other medical conditions.
Because pityriasis rosea is benign and self-limited, no treatment is required. However, some people with pityriasis rosea have mild-to-severe itching, in which case your clinician may suggest:
- Moisturizing creams or lotions.
- Topical menthol-phenol lotions.
- Prescription topical corticosteroid (cortisone) creams or lotions.
- Oral antihistamine pills.
- Oral corticosteroid pills or an oral antibiotic or antiviral (if the pityriasis rosea is very severe).
Pityriasis rosea in Adult