Pityriasis Rosea

  • Medical Author:
    Gary W. Cole, MD, FAAD

    Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Pityriasis rosea facts

  • Pityriasis rosea begins as a single, large pink patch found on the trunk of the body called the "herald patch."
  • The herald patch is followed one to two weeks later with a profusion of smaller scaling pink spots on the torso.
  • Pityriasis rosea is mildly itchy in 50% of cases and clears spontaneously in an average of six to nine weeks.
  • Pityriasis rosea is sometimes accompanied by mild, flu-like symptoms.
  • Pityriasis rosea has no long-lasting health effects and is not overtly contagious.
  • It is unusual for an individual to have a second episode of the disease.
  • Pityriasis rosea typically occurs in healthy young adults.

What is pityriasis rosea?

Pityriasis rosea is a common viral disease that usually affects individuals between 10-35 years of age. The rash typically lasts six to nine weeks, rarely extending longer than 12 weeks. Once a person has pityriasis rosea, it generally does not recur in their lifetime.

Pityriasis rosea characteristically begins as an asymptomatic single, large pink, scaly plaque called the "herald patch" or mother patch, measuring 2-10 centimeters. The herald patch is a slightly scaly dry pink to red plaque which appears on the back, chest, or neck and has a well-defined, scaly border.

One to two weeks following the initial appearance of the herald patch, those affected will then develop many smaller pink spots across their trunk, arms, and legs. The second stage of pityriasis rosea erupts with a large number of oval spots, ranging in diameter from 0.5 centimeter (size of a pencil eraser) to 1.5 centimeters (size of a peanut). The individual spots form a symmetrical "Christmas tree" pattern on the back with the long axis of the ovals oriented in the "Lines of Blaschko" (invisible skin lines of embryonic origin). This rash is usually limited to the trunk, arms, and legs. Pityriasis rosea usually spares the face, hands, and feet.

Picture of pityriasis rosea on the torso
Picture of pityriasis rosea on the torso; photo courtesy of Gary W. Cole, MD, FAAD

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Pityriasis Rosea Treatment

In those few patients in whom the itching is severe enough to require treatment, there are a number of alternatives. Weak to moderately potent topical steroids and oral antihistamines (many of which are available without a prescription) will suffice. Sometimes ultraviolet light administered in a doctor's office or by careful sunbathing can diminish the itching sufficiently to be tolerable.

Who gets pityriasis rosea?

Pityriasis rosea is, for the most part, equally common in men and women. It generally occurs in children and young adults between 10-35 years of age. Pityriasis rosea has no racial predominance. Most people only develop pityriasis rosea once in their lifetime.

What causes pityriasis rosea? Is pityriasis rosea contagious?

The exact cause of pityriasis rosea remains unknown. Most recently, pityriasis rosea has been associated most strongly with a virus from the human herpes family called human herpes virus types 6 and/or 7. Pityriasis rosea is not caused by or known to be associated with the common types of herpes virus that causes genital, oral herpes, or varicella (chickenpox). While the mode of transmission (how it gets passed between people) of pityriasis rosea is also unknown, respiratory contact has been postulated. Pityriasis rosea does not seem to be directly or immediately contagious to close contacts or health-care providers exposed to the rash. Most people with a known exposure to pityriasis rosea do not seem to contract the rash.

What are pityriasis rosea symptoms and signs?

Most people do not notice any symptoms with pityriasis rosea except for the appearance of the rash itself. Mild, intermittent itching is reported in about 50% of individuals affected, especially when people exercise or take hot showers. Itching seems to increase with stress. Rarely, it is accompanied by flu-like symptoms, such as sore throat, fatigue, nausea, aching, and decreased appetite. Most people are otherwise in very good health and don't exhibit any other symptoms.

How do health care professionals make a diagnosis of pityriasis rosea?

Usually, a doctor may make a diagnosis of pityriasis rosea solely on the basis of its appearance, particularly the onset of the distinct large herald patch and the symmetrical Christmas tree presentation. Also, the herald patch tends to have a fine scale with a definite border, the so-called "collarette." To rule out other types of skin disorders, a physician may scrape the skin and examine the scales under the microscope to detect fungus infection that could mimic pityriasis rosea. Also, blood tests including rapid plasma reagent (RPR) may be done to detect secondary syphilis, which also may mimic pityriasis rosea. In some cases, a skin biopsy may be required to rule out other skin conditions.

What are some common misdiagnoses of pityriasis rosea?

The first herald patch of pityriasis rosea may look very similar in appearance to ringworm (tinea corporis). Pityriasis rosea has also been mistaken with eczema and psoriasis, which can occur as similar scaly patches, but not in the same distribution as pityriasis rosea.

Pityriasis rosea may be misdiagnosed as

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What is the treatment for pityriasis rosea? How long does pityriasis rosea last?

Pityriasis rosea usually requires no treatment and resolves spontaneously. Treatment is not necessary if the rash does not cause significant symptoms. Typically, pityriasis rosea will usually clear on its own within six to nine weeks without medical intervention.

The most common symptom is itching, which can be treated with topical steroid creams (like hydrocortisone cream) and oral antihistamines (like diphenhydramine [Benadryl], cetirizine [Zyrtec]). These will not shorten the duration of the rash but will decrease the itching. Another treatment for itching is ultraviolet light (UVB) or sunlight. Generally, the best treatment is to avoid being overheated by reducing exercise and avoiding hot showers and baths.

There has been limited evidence of reduced duration of pityriasis rosea with the off-label use of the antibiotic erythromycin or off-label use of antiviral medications such as acyclovir (Zovirax) or famciclovir (Famvir). However, neither of these medications has been proven to be uniformly effective in the treatment of pityriasis rosea and they are not usually necessary or required.

What home remedies can I use for pityriasis rosea?

Home remedies of pityriasis rosea include taking lukewarm baths or showers, avoiding drying soaps, wearing cotton or silk clothing to reduce heat, and taking oatmeal baths. Calamine or menthol lotions can also be helpful for itching. The following are additional home remedies:

  • Lubricating with bland moisturizers
  • Steroid creams (hydrocortisone cream)
  • Diphenhydramine (Benadryl) oral pills or liquid for itching
  • Natural sunlight exposure to body parts, 10-15 minutes per day

Is pityriasis rosea dangerous during pregnancy?

If pityriasis rosea occurs early in pregnancy, within the first 15 weeks, there seems to be a greater chance of miscarriage. In addition, children of affected mothers may be prone to premature delivery. Since there little that can be done to prevent this disease or treat it, affected mothers are monitored closely for potential problems. Occasionally, health care professionals consider treatment with acyclovir.

Is it possible to prevent pityriasis rosea?

There is no definitive prevention for pityriasis rosea, as the cause is not yet fully known.

What is the prognosis for pityriasis rosea?

The prognosis for pityriasis rosea is excellent as the rash usually clears even without treatment within nine weeks.

It typically leaves no long-lasting scars, although some mild, temporary skin discoloration called post inflammatory hypopigmentation or hyperpigmentation can occur in people with darker skin. It has no known long-lasting side effects and has not been associated with any other diseases.

Symptoms may be reduced with topical treatment or taking extra precautions to prevent overheating. Once a person has pityriasis rosea, they generally have lifelong immunity.

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Where can I find more information and facts about pityriasis rosea?

A good source of information is the American Academy of Dermatology (http://www.aad.org) or a board-certified dermatologist.

REFERENCES:

Drago, Francesco, Francesco Broccolo, and Alfredo Rebora. "Pityriasis Rosea: An Update With a Critical Appraisal of Its Possible Herpesviral Etiology." J Am Acad Dermatol 61.2 Aug. 2009: 303-318.

Drago, Francesco, Francesco Broccolo, et al. "Pregnancy Outcome in Patients With Pityriasis Rosea." J Am Acad Dermatol 58.5 May 2008: S78-S83.

Drago, Francesco, Giulia Ciccarese, Alfredo Rebora, Francesco Broccolo, and Aurora Parodi. "Pityriasis Rosea: A Comprehensive Classification." Dermatology Apr. 21, 2016: 1-7.

Eisman, Samantha, and Rodney Sinclair. "Pityriasis Rosea." BMJ 351 (2015): 1-6.

"Pityriasis Rosea." American Academy of Dermatology. <https://www.aad.org/skin-conditions/dermatology-a-to-z/pityriasis-rosea/>.

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Reviewed on 7/18/2017
References
REFERENCES:

Drago, Francesco, Francesco Broccolo, and Alfredo Rebora. "Pityriasis Rosea: An Update With a Critical Appraisal of Its Possible Herpesviral Etiology." J Am Acad Dermatol 61.2 Aug. 2009: 303-318.

Drago, Francesco, Francesco Broccolo, et al. "Pregnancy Outcome in Patients With Pityriasis Rosea." J Am Acad Dermatol 58.5 May 2008: S78-S83.

Drago, Francesco, Giulia Ciccarese, Alfredo Rebora, Francesco Broccolo, and Aurora Parodi. "Pityriasis Rosea: A Comprehensive Classification." Dermatology Apr. 21, 2016: 1-7.

Eisman, Samantha, and Rodney Sinclair. "Pityriasis Rosea." BMJ 351 (2015): 1-6.

"Pityriasis Rosea." American Academy of Dermatology. <https://www.aad.org/skin-conditions/dermatology-a-to-z/pityriasis-rosea/>.

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