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For further information, see CMDT Part 6-39: 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

  • 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 patients with more darkly pigmented skin types, also occur

Differential Diagnosis

  • Secondary syphilis

  • Tinea corporis (body ringworm)

  • Seborrheic dermatitis

  • Tinea versicolor (pityriasis versicolor)

  • Lichen planus

  • Guttate or plaque psoriasis

  • Drug eruption

  • SARS-CoV-2 infection or COVID-19 vaccination

DIAGNOSIS

  • Clinical

TREATMENT

Medications

  • See Table 6–2

  • Often requires no treatment, unless patients are symptomatic

  • In darker-skinned individuals, more aggressive management may be indicated because there may be dyspigmentation of the lesions

  • For mild to moderate cases, topical corticosteroids of medium strength (triamcinolone 0.1%) and oral antihistamines may be used if pruritus is bothersome

  • For severe or severely symptomatic cases, ultraviolet B treatments or a short course of prednisone

Table 6–2.Useful topical dermatologic therapeutic agents.1

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