Pityriasis Rosea Treatment & ManagementMar 13, Author: Water, sweat, and soap may cause irritation and should be avoided early in the disease. Topical zinc oxide and calamine lotion are useful for pruritus. If the disease is severe or widespread eg, vesicular pityriasis 20 week equipoise cycletopical gosea pityriasis rosea treatment steroids steroids may be used. Ultraviolet UV radiation therapy has been demonstrated to be effective for pityriasis rosea but may leave postinflammatory pigmentation at the site of pitgriasis pityriasis rosea lesion. For patients in whom superficial tinea infection is a pityriasis rosea treatment steroids or possibility, topical antifungal therapy can be used.
Pityriasis Rosea - American Family Physician
Pityriasis rosea is an acute self-limiting skin disorder of unknown aetiology. Recently human herpes virus 6 and 7 has been hypothesized to be the cause of pityriasis rosea. To determine the efficacy of acyclovir, an anti-viral drug, in the treatment of pityriasis rosea. A randomized, double-blind, placebo-controlled study of efficacy of oral acyclovir in the treatment of pityriasis rosea was conducted on 73 patients. Thirty eight randomly selected patients were started on oral acyclovir.
Thirty-five patients were prescribed placebo. The patients as well as the chief investigator were unaware of the therapeutic group to which patients belonged acyclovir or placebo. Patients in both the groups were evaluated clinically after 7 and 14 days following the first visit and the data were analysed. Follow up data of 60 patients was available and these were included in the statistical analysis. The findings were statistically significant.
The study showed that high dose acyclovir is effective in the treatment of pityriasis rosea. Pityriasis rosea is an acute self-limiting papulo-squamous skin disorder of unknown aetiology. Its occurrence is ubiquitous. In different studies the incidence of pityriasis rosea was recorded to be between 0. Though self-limiting by weeks, the clinical course in some patients may be prolonged over several months and recurrence is known to occur.
The presence of generalized skin lesions results in considerable anxiety among patients with pityriasis rosea and there is a significant psychological impact upon parents of affected young children [ 3 ].
Post-inflammatory hyperpigmentation may also result in significant cosmetic concern among young patients. Recent data suggest the possibility that pityriasis rosea may pose a risk for spontaneous abortion in pregnant women [ 4 ]. Thus an effective treatment for this condition is essential. The exact aetiology of pityriasis rosea is not known. Seasonal occurrence, clustering of cases and presence of occasional prodromal symptoms suggests the possibility of an infectious agent involved in its pathogenesis [ 5 — 7 ].
Use of new garments or old garments in storage for prolonged period have been suggested as precipitating factors for pityriasis rosea, indicative of a transmissible infectious agent [ 8 ]. A chance observation of improvement of skin lesions of pityriasis rosea in two patients who were given erythromycin for upper respiratory tract infections, also confirms this hypothesis [ 9 ]. It has already been established that drugs like allopurinol, arsenic, bismuth, barbiturate, gold, hydrochlorothiazide, organic mercurials, nimesulide, d-penicillamine, clonidine, isotretinoin and ketotifen can cause eruptions resembling pityriasis rosea [ 10 — 12 ].
Ampicillin and systemic corticosteroids have been found to exacerbate PR [ 11 ]. Isolated cases of pityriasis rosea like rashes have also been reported following administration of captopril, metronidazole and omeprazole [ 13 — 15 ].
Recently DNA of human herpes virus 6 and 7 HHV-6 and HHV-7 have been isolated from lesional and non-lesional skin, peripheral blood mononuclear cells, serum and saliva samples of patients with pityriasis rosea [ 16 ].
In view of probable involvement of HHV-6 in its pathogenesis, anti-viral drugs may be useful in the treatment of pityriasis rosea. Few trials of acyclovir in pityriasis rosea has shown faster clearance of skin lesions and shortened duration of the disease [ 17 — 19 ] Based on the hypothesis of infectious aetiology in pityriasis rosea, as well as several circumstantial evidences for this, a trial on efficacy of acyclovir in this disorder was conducted.
A randomized, double blind, placebo controlled trial was conducted to determine the efficacy of acyclovir, an anti-viral drug, in the treatment of pityriasis rosea. Clinically diagnosed cases of pityriasis rosea, irrespective of age and sex were included in the study. Patients who had taken some form of systemic therapy for pityriasis rosea e. Informed consents were taken from all the patients and the parents of children. Clearance from institutional ethical committee, in accordance with the revised Helsinki Declarartion was obtained.
Detailed history of the illness regarding onset, evolution, duration, symptoms, systemic features, recurrence, history of contact and associated factors like socioeconomic status, history of drug intake, use of new clothing, along with other epidemiological data were recorded in the scheduled proforma for comparison with available published data.
Complete hemogram and urine analysis were done for all patients. Venereal disease research laboratory VDRL test was done, whenever necessary, in young sexually active adult patients. Therapy of the patients was advised by a dermatologist other than the chief investigator.
Acyclovir was administered irrespective of the duration of the disease. Vitamin C was used as the placebo in this trial. It is essential for formation of hydroxyproline, an integral constituent of collagen.
So, it is needed for growth of collagen fibers in the dermis, subcutaneous tissue, cartilage, bone, teeth and blood vessel walls [ 20 ]. In pityriasis rosea, most of the histopathological changes are seen in the epidermis. Therefore administration of vitamin-C as placebo is unlikely to influence the rate of resolution of skin lesions of pityriasis rosea. The patients were kept unaware of the therapeutic group to which they belong to acyclovir or placebo.
The chief investigator and the dermatologist assigned to give treatment were also unaware of the drug prescribed to individual patients. Symptomatic treatment and antihistamines were administered whenever necessary.
Patients in both the groups were evaluated clinically after 7 and 14 days. Skin lesions were evaluated as follows [ 17 ]:. New lesions appearing during treatment, if any, were recorded at 7 th and 14 th days.
The type and severity of any systemic symptoms was evaluated during these visits. The time taken for clearance of lesions was recorded. Therapeutic effect on the course of the disease was assessed.
Effect of early treatment upon the total duration of the disease was evaluated. The collected data was analyzed by using standard statistical methods. Data on patients in the acyclovir and placebo group were compared using Student t-test. Efficacy of treatment in the acyclovir group and the placebo group was compared using Z-test.
Significance of the pretreatment duration of illness on disease outcome was measured by t-test. Follow up data of 60 patients 30 in each group were available and these were included in the statistical analysis. The difference between two groups was statistically significant both on the 7 th and 14 th day after the first visit. Patients in the acyclovir group were divided in to two sub-groups based on whether the patient received treatment within the first week of onset of lesions, or beyond this period.
Appearance of new lesions. The results are for 30 patients each in the acyclovir and placebo group. Pityriasis rosea is an acute papulo-squamous disorder of unknown aetiology. It is a self-limiting condition and usually treated symptomatically.
Seasonal occurrence and clustering of cases led to the presumption of an infectious aetiology in pityriasis rosea and some antimicrobials have been tried accordingly. The course of the disease resembles viral exanthema. In some patients, history of prodromal symptoms and recent upper respiratory tract infection is present [ 11 , 21 ]. Spontaneous resolution of the lesions is also consistent with a viral aetiology [ 11 ]. The pathogenetic mechanism for the majority of the viral exanthems is still unclear.
It has been proposed that the virions invade the extravascular dermal spaces from the blood vessels and damage the dermal or epidermal tissues either directly or by their interaction with the host immune system [ 22 ].
Presumably the productive infection arises from reactivation, since these patients most likely have been infected with both of these viruses previously during childhood. In-vitro experiments have demonstrated that HHV-7, but not HHV-6, may be reactivated from latently infected blood mononuclear cells by T-cell activation [ 24 ].
It has also been shown that reactivation of one virus may occur with primary infection of the other. So, pityriasis rosea is not caused by direct herpes virus infection of the skin, but probably by cutaneous infiltration of latently infected lymphocytes during systemic viral replication [ 11 ]. Electron microscopy of lesional skin has also shown large numbers of virions resembling human herpes viruses in collagen fibers and blood vessels of upper and mid dermis [ 22 ].
Various treatment modalities have been tried in pityriasis rosea. X 2 weeks and children 25 to 40 mg q. Total 33 patients in the treatment group achieved complete response within 2 weeks of treatment with erythromycin compared to none in the placebo group [ 9 ].
UVB phototherapy was found to have resulted in decreased severity of pityriasis rosea in a bilateral comparison study [ 25 ]. A case of severe vesicular pityriasis rosea had been treated successfully with dapsone [ 26 ].
In view of probable viral aetiology, anti-viral drugs may be effective in pityriasis rosea. Ganciclovir, foscarnet, and cidofovir are active against HHV-6, but these agents have serious side effects like myelosuppression and nephrotoxicity. Acyclovir, in high dosage, has been proved to be effective against HHV-6 [ 17 ].
HHV-7 is less sensitive to acyclovir as it lacks the thymidine kinase gene, upon which the action of acyclovir is dependent [ 27 ].
However acyclovir is an easily available drug with lower side effects. Lesions in the acyclovir treated group cleared in significantly shorter time compared with the placebo group. Alleviation of the systemic symptoms after 7 and 14 days was better in the acyclovir treated group than in the control group [ 17 ]. A similar study done by Rassai et al. They had a similar follow-up assessment methodology as by Drago et al. They obtained a statistically significant result only at the end of eight weeks.
The results of the present study showed that significantly higher number of patients had complete regression of skin lesions in the acyclovir group compared to the placebo group on 7 th and 14 th days after the first visit. The response achieved on the 7 th day is more important, because in the course of the disease, a spontaneous remission is unlikely at that point of time.
These observations suggest that administration of acyclovir resulted in faster resolution of skin lesions in pityriasis rosea. A comparison of results with the study conducted by Drago et al. The present study showed a higher rate of complete response compared to the above-quoted studies. There was no significant difference in the time taken for resolution of skin lesions in the acyclovir group, whether the treatment was started within or after 7 days of onset.
This finding is in concordance with the findings of Drago et al. This is in contrast to other herpes virus infections where early administration of the anti-viral agent is necessary to achieve beneficial effects.