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For further information, see CMDT Part 6-12: Pityriasis Rosea

Key Features

Essentials of Diagnosis

  • Oval, fawn-colored, scaly eruption following cleavage lines of trunk

  • Herald patch precedes eruption by 1–2 weeks

  • Occasional pruritus

General Considerations

  • Common mild, acute inflammatory disease that is 50% more common in women

  • The eruption usually lasts 6–8 weeks and heals without scarring

Demographics

  • Young adults are principally affected, mostly in the spring or fall

Clinical Findings

Symptoms and Signs

  • Diagnosis is made by finding one or more classic lesions

  • The lesions consist of oval, fawn-colored plaques up to 2 cm in diameter

  • The centers of the lesions have a crinkled or "cigarette paper" appearance and a collarette scale, ie, a thin bit of scale that is bound at the periphery and free in the center

  • Only a few lesions in the eruption may have this characteristic appearance, however

  • Lesions follow cleavage lines on the trunk (so-called Christmas tree pattern), and the proximal portions of the extremities are often involved

  • Herald patch precedes eruption by 1–2 weeks

  • Pruritus, if present, is usually mild

  • Variants that affect the flexures (axillae and groin), so-called inverse pityriasis rosea, and papular variants, especially in black patients, also occur

Differential Diagnosis

  • Secondary syphilis

  • Tinea corporis (body ringworm)

  • Seborrheic dermatitis

  • Tinea versicolor (pityriasis versicolor)

  • Lichen planus

  • Guttate or plaque psoriasis

  • Nummular eczema

  • Drug eruption

  • Viral exanthem

Diagnosis

  • Clinical

Treatment

Medications

  • See Table 6–2

  • Often requires no treatment

  • In darker-skinned individuals, in whom lesions may remain dyspigmented for some time, more aggressive management may be indicated

  • Oral acyclovir may improve the rash appearance

  • The most effective management consists of daily UVB treatments for a week, or a short course of prednisone

  • Topical corticosteroids of medium strength (triamcinolone 0.1%) and oral antihistamines may also be used if pruritus is bothersome

Outcome

Prognosis

  • Usually acute self-limiting illness that disappears in about 6 weeks

When to Refer

  • If there is a question about the diagnosis, if recommended therapy is ineffective, or if specialized treatment is necessary

References

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Contreras-Ruiz  J  et al. Interventions for pityriasis rosea. Cochrane Database Syst Rev. 2019 Oct 30;2019(10).
[PubMed: 31684696]
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Urbina  F  et al. Clinical variants of pityriasis rosea. World J Clin Cases. 2017 Jun 16;5(6):203–11.
[PubMed: 28685133]

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