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Pityriasis Rosea

By Peter C. Schalock, MD, Harvard Medical School;Massachusetts General Hospital

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Patient Education

Pityriasis rosea is a self-limited, inflammatory disease characterized by diffuse, scaling papules or plaques. Treatment is usually unnecessary.

Pityriasis rosea (PR) most commonly occurs between ages 10 and 35. It affects women more often. The cause may be viral infection (some research has implicated human herpesviruses 6, 7, and 8). Drugs may cause a PR-like reaction.

Symptoms and Signs

The condition classically begins with a single, primary, 2- to 10-cm herald patch that appears on the trunk or proximal limbs. A general centripetal eruption of 0.5- to 2-cm rose- or fawn-colored oval papules and plaques follows within 7 to 14 days. The lesions have a scaly, slightly raised border (collarette) and resemble ringworm (tinea corporis). Most patients itch, occasionally severely. Papules may dominate with little or no scaling in children and pregnant women. The rose or fawn color is not as evident in patients with darker skin; children more commonly have inverse PR (lesions in the axillae or groin that spread centrifugally). Classically, lesions orient along skin lines, giving PR a Christmas tree–like distribution when multiple lesions appear on the back. A prodrome of malaise, headache, and sometimes arthralgia precedes the lesions in a minority of patients.


  • Clinical evaluation

Diagnosis is based on clinical appearance and distribution. Differential diagnosis includes tinea corporis, tinea versicolor, drug eruptions, psoriasis, parapsoriasis, pityriasis lichenoides chronica, lichen planus, and secondary syphilis. Serologic testing for syphilis is indicated when the palms or soles are affected, when a herald patch is not seen, or when lesions occur in an unusual sequence or distribution.


  • Antipruritic therapy

No specific treatment is necessary because the eruption usually remits within 5 wk and recurrence is rare; however, erythromycin, 250 mg po qid for 14 days may shorten symptom duration and decrease severity. Artificial or natural sunlight may hasten resolution. Antipruritic therapy such as topical corticosteroids, oral antihistamines, or topical measures may be used as needed.

Key Points

  • Pityriasis rosea is a self-limited, inflammatory disorder of the skin possibly caused by human herpesvirus types 6, 7, or 8 or drugs.

  • An initial 2- to 10-cm herald patch is followed by centripetal eruption of oval papules and plaques with a slightly raised and scaly border, typically appearing along skin lines.

  • Diagnose based on clinical appearance and distribution.

  • Treat with antipruritic drugs as needed and possibly erythromycin and/or sunlight.

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