Management

This condition usually spontaneously resolves after a month or two in most patients (1). An important part of management is to control pruritus. Topical antipruritic medication, for example 1 to 2% menthol in calamine or aqueous cream or oral antihistamines may be indicated. Rarely topical steroids may be used to control the itching (1)

According to a small number of controlled trials erythromycin therapy for 2 weeks was shown to clear the rash in 73% of the patients and might be beneficial (2).

Ultraviolet radiation may be used to decrease the duration of rash and intensity of itching but should be used with caution since this may result in post-inflammatory hyperpigmentation (3).

A systematic review concluded that "..When compared with placebo or no treatment, oral acyclovir probably leads to increased good or excellent, medical practitioner-rated rash improvement. However, evidence for the effect of acyclovir on itch was inconclusive. We found low- to moderate-quality evidence that erythromycin probably reduces itch more than placebo.." (4)

Reference:

• (1) Stulberg DL, Wolfrey J. Pityriasis Rosea. AFP 2004;69(1)
• (2) Sharma PK et al. Erythromycin in pityriasis rosea: a double blind, placebo-controlled clinical trial. J Am Acad Dermatol. 2000;42(2 Pt 1):241-4
• (3) Leenutaphong V, Jiamton S. UVB phototherapy for pityriasis rosea: A bilateral comparison study. J Am Acad Dermatol. 1995;33(6):996-9
• (4) Contreras-Ruiz J et al. Interventions for pityriasis rosea Cochrane Database Syst. Rev. 2019 Oct 30;2019(10):CD005068.