Pityriasis rosea

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Last reviewed: September 2018

Last updated: November 2017

Summary

An inflammatory skin disease with unclear aetiology, although an infectious cause has been suggested.

Can present in patients of any age but most often in people aged 10 to 35 years.

Manifests as an acute, self-limiting, inflammatory eruption characterised by a single larger lesion, the herald patch, followed by eruption of smaller papulosquamous oval lesions.

Spontaneous resolution, usually over several weeks, but can persist for up to 5 months.

Symptoms treated by topical corticosteroids and/or oral antihistamines, or UV therapy.

Definition

Pityriasis rosea (PR) is an inflammatory skin condition of uncertain aetiology, although an unknown infectious agent has been suggested. PR manifests as an acute, self-limiting, inflammatory eruption characterised by a single larger lesion, the herald patch, followed by eruption of smaller papulosquamous oval lesions. com.bmj.content.model.Caption@600a958e [Figure caption and citation for the preceding image starts]: Herald patch in classic distribution on the upper torso From the collection of Daniela Kroshinsky, MD, MPH; used with permission [Citation ends]. com.bmj.content.model.Caption@c1d333b [Figure caption and citation for the preceding image starts]: Close-up herald patch From the collection of Daniela Kroshinsky, MD, MPH; used with permission [Citation ends].

History and exam

Key diagnostic factors

herald patch
pruritus
age 10 to 35 years
2- to 12-week duration
scale
located on trunk and upper extremities
fir-tree pattern distribution
located on face, palms, soles, mucosa
acute to sub-acute recurrent skin eruption

Full details

Other diagnostic factors

2-week timing between herald patch and new lesions
female sex
prodromal symptoms
pigmentary alteration (severe cases/dark skin colour)

Full details

Risk factors

age 10 to 35 years
female sex

Full details

Diagnostic investigations

Investigations to consider

skin biopsy
antistreptolysin O titres
potassium hydroxide (KOH) preparation microscopy or fungal culture
RPR/VDRL

Full details

Treatment algorithm

ACUTE

mild-to-moderate symptoms

severe or refractory disease

refractory to all other treatments

Contributors

Authors VIEW ALL 

Daniela Kroshinsky, MD, MPH

Daniela Kroshinsky

Director of Inpatient Dermatology

Associate Professor of Dermatology

Massachusetts General Hospital

Harvard School of Medicine

Boston

MA

Disclosures

DK declares that she has no competing interests.

Peer reviewers VIEW ALL 

Eve Lowenstein, MD

Chief of Dermatology

Brookdale Hospital

Brooklyn

NY

Disclosures

EL declares that she has no competing interests.

Ladan Shahabi, MD

Fellow

Dermatology

University of Michigan

Ann Arbor

MI

Disclosures

LS declares that he has no competing interests.

John English, MBBS, FRCP

Consultant Dermatologist

Department of Dermatology

Queen's Medical Centre

Nottingham University Hospitals NHS Trust

Nottingham

UK

Disclosures

JE declares that he has no competing interests.

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