Pityriasis rosea

Last reviewed: 5 May 2023
Last updated: 16 Aug 2022



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
More key diagnostic factors

Other diagnostic factors

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

Risk factors

  • age 10 to 35 years
  • female sex
More risk factors

Diagnostic investigations

Investigations to consider

  • skin biopsy
  • antistreptolysin O titres
  • potassium hydroxide (KOH) preparation microscopy or fungal culture
  • rapid plasma reagin/Venereal Disease Research Laboratory
More investigations to consider

Treatment algorithm


mild-to-moderate symptoms

severe or refractory disease

refractory to all other treatments



Daniela Kroshinsky, MD, MPH
Daniela Kroshinsky

Director of Inpatient Dermatology

Associate Professor of Dermatology

Massachusetts General Hospital

Harvard School of Medicine




DK declares that she has no competing interests.


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



DSM declares that he has no competing interests.

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