Pityriasis rosea in Child
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 4-8 weeks. Recurrence is rare.
Adolescents and young adults are most commonly affected. Pityriasis rosea is uncommon in children under 10 years of age. An atypical form of pityriasis rosea characterized by papular lesions and facial and scalp involvement is more prevalent in children of African descent. In individuals with darker skin phototypes, hyperpigmentation can result upon resolution.
While the exact cause remains unclear, pityriasis rosea in children is thought to be associated with primary infection or systemic reactivation of human herpesvirus 6 and 7 (HHV-6 and HHV-7).
Certain drugs 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; this is the most common complaint
- Guttate psoriasis – smaller size, thicker scale
- Erythema multiforme
- Secondary syphilis
- 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 Child
OverviewPityriasis rosea (PR) is a common rash that most commonly 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 due to infection with a virus.
Who’s At RiskPityriasis rosea can occur in people of any age, race / ethnicity, and sex, but it is most common in older children and young adults (aged 10-40 years). Pityriasis rosea is uncommon in children younger than 5 years.
Signs & SymptomsThe most common locations for pityriasis rosea include the:
- Upper back.
- Upper arms.
Some children report feeling mildly ill (headache, stuffy nose, muscle aches) for 1-2 weeks before the herald patch forms. Additionally, some children have 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 within 6-8 weeks, even 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 by:
- 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 your child develops a patch of pink, purplish, or brown, scaly skin that does not respond to over-the-counter antifungal cream or hydrocortisone cream, or if your child develops a widespread rash, see their medical professional or a dermatologist for an 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 child's medication history (making sure you know the names of any medications or supplements your child has taken within the last month)
TreatmentsIn most cases, a medical professional will be able to diagnose the rash by examining your child's 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 goes away on its own, no treatment is required. However, some children with pityriasis rosea have mild-to-severe itching, in which case the clinician may suggest:
- Moisturizing creams or lotions.
- Topical menthol-phenol lotions.
- Prescription topical corticosteroid (cortisone) creams or lotions.
- Oral antihistamine pills.
Pityriasis rosea in Child