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Therapeutic Approach

Pityriasis rosea (PR) is a benign, self-limiting skin disease characterized by the sudden appearance of multiple, discrete patches of skin in a distinctive pattern on trunk and limbs. A solitary larger lesion or “herald patch” usually precedes the widespread rash with lesions oriented along Langer’s cleavage lines in a “Christmas tree pattern.” The disease duration is typically 2 to 12 weeks but may last up to 7 months. Less common clinical variants include inverse, vesicular, purpuric, and pustular. A viral etiology has been postulated with attention focused on human herpesvirus-7 (HHV-7) and less so HHV-6, but this remains unproven. Patient education and reassurance is often a satisfactory treatment plan. However, several therapeutics (see treatment table) can be considered in severe or recurrent disease. See Table 11-1.

Table 11-1Pityriasis Rosea Treatment Table

Levels of evidence are based on the Journal of the American Academy of Dermatology guidelines: level IA evidence includes evidence from meta-analysis of randomized controlled trials; level IB evidence includes evidence from ≥1 randomized controlled trial; level IIA evidence includes evidence from ≥1 controlled study without randomization; level IIB evidence includes evidence from ≥1 other type of experimental study; level III evidence includes evidence from nonexperimental descriptive studies, including comparative studies, correlation studies, and case control studies; and level IV evidence includes evidence from expert committee reports or opinions or clinical experience of respected authorities, or both.


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Goldstein  A, Goldstein  B. Pityriasis rosea. In: UpToDate, Dellavalle  R (Ed.), Levy  M (Ed.), Ofori ...

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