Summary
Definition
Pityriasis rosea (PR) is an inflammatory skin condition of uncertain etiology, although an unknown infectious agent has been suggested. PR manifests as an acute, self-limited, inflammatory eruption characterized in the majority of patients by a single larger lesion, the herald patch, followed by eruption of smaller papulosquamous oval lesions. [Figure caption and citation for the preceding image starts]: Herald patch in classic distribution on the upper torsoFrom the collection of Daniela Kroshinsky, MD, MPH; used with permission [Citation ends].
[Figure caption and citation for the preceding image starts]: Close-up herald patchFrom 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 subacute recurrent skin eruption
Other diagnostic factors
- 2-week timing between herald patch and new lesions
- female sex
- prodromal symptoms
- pigmentary alteration (severe cases/dark skin color)
Risk factors
- age 10 to 35 years
- female sex
Diagnostic tests
Tests to consider
- skin biopsy
- antistreptolysin O titers
- potassium hydroxide (KOH) prep microscopy or fungal culture
- rapid plasma reagin/Venereal Disease Research Laboratory
Treatment algorithm
mild to moderate symptoms
severe or refractory disease
refractory to all other treatments
Contributors
Authors
Daniela Kroshinsky, MD, MPH
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.
Acknowledgements
Dr Dean S. Morrell would like to gratefully acknowledge Dr Eve Lowenstein, Dr Ladan Shahabi, and Dr John English, previous reviewers of this topic.
Peer reviewers
Dean S. Morrell, MD
Clinical Professor
Department of Dermatology
University of North Carolina
Chapel Hill
NC
Disclosures
DSM declares that he has no competing interests.
References
Key articles
Chuh A, Lee A, Zawar V, et al. Pityriasis rosea - an update. Indian J Dermatol Venereol Leprol. 2005 Sep-Oct;71(5):311-5.Full text Abstract
Chuh A, Zawar V, Lee A. Atypical presentations of pityriasis rosea: case presentations. J Eur Acad Dermatol Venereol. 2005 Jan;19(1):120-6. Abstract
Contreras-Ruiz J, Peternel S, Jiménez Gutiérrez C, et al. Interventions for pityriasis rosea. Cochrane Database Syst Rev. 2019 Oct 30;2019(10):CD005068.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
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