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Copyright 2009, 2012
NORD is very grateful to John Browning, MD, FAAD, FAAP, Assistant Professor of Pediatrics & Dermatology, The University of Texas Health Science Center, for assistance in the preparation of this report.
Pityriasis rosea is a relatively mild skin disorder characterized by a salmon or pink colored, scaly rash. Pityriasis rosea most often affects children and young adults. In many individuals with pityriasis rosea, the characteristic rash develops after vague, nonspecific symptoms that resemble those associated with an upper respiratory infection. The rash is usually located on the back, chest and stomach and resolves on its own within one to three months. Certain treatments may reduce the duration of the rash. Researchers believe that pityriasis rosea is caused by an infectious pathogen, but they have been unable to isolate and identify such a pathogen.
In many cases, the characteristic rash associated with pityriasis rosea is preceded by vague, nonspecific symptoms similar to those seen with a viral upper respiratory infection. Such symptoms can include fever, headache, stuffy nose, sore throat and fatigue. Sometimes there is no history of preceding illness before the rash appears.
Eventually, affected individuals develop a herald patch, which is a single scaly red patch, usually on the back, chest or stomach. When located on the back the herald patch may go undetected before appearance of the generalized rash. A herald patch is a slightly raised plaque that is usually between 2 to 4 inches large. Often the herald patch is misdiagnosed as ring worm (tinea corporis). Over the next few days or weeks, multiple smaller scaly, pink or red spots will develop. In individuals with darker skin, the rash may be gray, dark brown or black. Although the back, chest and stomach are most commonly affected, the rash may spread to affect the arms, legs and neck. Less often, other areas of the body may become involved. In rare cases, the rash may be isolated (localized) to one specific area of the body. In some people, the rash does not itch; in other people, the rash may be extremely itchy (pruritic).
The rash usually lasts approximately one to three months in approximately 80 percent of cases. Pityriasis rosea eventually goes away on its own, even without treatment, and usually does not leave any scars or permanent marks. People with darker skin may have residual dark spots at sites of inflammation which can last for many months before resolution.
Researchers believe that pityriasis rosea is caused by a viral infection. However, even though the disorder was first described in the medical literature in 1860, no infectious pathogen has ever been identified.
Several factors support the theory that pityriasis rosea is caused by a viral infection - most individuals have vague, nonspecific symptoms before the development of the rash (prodromal illness); after the acute phase of infection the disorder does not recur, suggesting that the body builds up an immunity to the infection; and pityriasis rosea has occurred in clusters, suggesting that a viral illness is affecting a community. Although a virus is believed to cause pityriasis rosea, the disorder is not thought to be contagious.
Some researchers have theorized that autoimmune factors may play a role in the development of pityriasis rosea. Autoimmunity is when the body's immune system mistakenly attacks healthy tissue for unknown reasons.
Some reports in the medical literature state that pityriasis rosea affects females more often than males; others state that the disorder affects males and females in equal numbers. The disorder most commonly affects individuals between the ages of 10 and 35, but has been reported in all age groups including infants and the elderly. Pityriasis rosea occurs with greater frequency in the spring and autumn months.
Symptoms of the following disorders can be similar to those of pityriasis rosea. Comparisons may be useful for a differential diagnosis.
Psoriasis is a chronic, inflammatory skin disease characterized by dry, reddish (erythematous), thickened patches of skin that are covered with silvery-gray scales. These patches may be referred to as papules or plaques and most often affect the scalp, elbows, knees, hands, feet and/or lower back. The plaques may be intensely itchy (pruritic) or sore. In some cases, individuals with psoriasis may experience abnormalities affecting the fingernails, toenails, and the soft tissues inside the mouth. The severity of psoriasis varies from case to case. Psoriasis may be classified as mild, moderate or severe depending upon the amount of skin involved and the effect on an individual's quality of life. In approximately one-third of cases a family history of psoriasis is present. (For more information on this disorder, choose "psoriasis" as your search term in the Rare Disease Database.)
Syphilis is a chronic infectious disease caused by the bacterium (microorganism) treponema pallidum. It is transmitted by direct contact with an infected lesion, usually through sexual intercourse. When untreated, syphilis progresses through primary, secondary and latent stages. The early stages of syphilis may not have any detectable symptoms. In some cases, symptoms can remain dormant for years. Eventually any tissue or vascular organ in the body may be affected. Secondary syphilis usually presents itself within two weeks to six months after the appearance of the primary lesions. This stage of the disorder is characterized by lesions of the skin and mucous membranes that may be pink or coppery in color, widespread, symmetrical, and follow the lines of skin cleavage. Often the palms and soles are affected. The skin lesions of secondary syphilis are infectious. Symptoms such as loss of appetite, sore throat, headache, low-grade fever, muscle aches, nasal discharge, and swollen lymph nodes may occur. There is a relapse in 25 percent of the untreated cases, occurring most often in the first year. Secondary syphilis usually lasts two to six weeks and some of the lesions may leave scarring. (For more information on this disorder, choose "syphilis" as your search term in the Rare Disease Database.)
Certain drugs can potentially cause a rash extremely similar to pityriasis rosea as a side effect of their use. These drugs include barbiturates, bismuth, clonidine, captopril, gold, imatinib mesylate, interferon, arsenic compounds and gold.
A diagnosis of pityriasis rosea is made based upon identification of characteristic symptoms, a detailed patient history, and a thorough clinical evaluation. In the earlier stages of the disorder, additional tests such as blood tests or a biopsy may be necessary to distinguish pityriasis rosea from similar skin disorders.
The treatment is symptomatic and supportive. Many individuals may not require treatment and the rash usually clears up on its own within 1-3 months. Most treatment is geared to controlling or reducing itching. Such therapies include antihistamines, steroid creams or ointments,
A variety of therapies have been used to try to shorten the duration of the rash associated with pityriasis rosea. Such therapies include systemic corticosteroids, certain antiviral drugs such as acyclovir and famciclovir, and the antibiotic erythromycin. There is limited evidence to support any of these treatments.
Phototherapy is used for individuals with inflammatory skin disorders such as pityriasis rosea. Phototherapy may be administered by itself or in conjunction with topical treatments. Some affected individuals may be treated by greater exposure to sunlight.
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. Government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
Tollfree: (800) 411-1222
TTY: (866) 411-1010
For information about clinical trials sponsored by private sources, contact:
Please note that some of these organizations mat provide information concerning certain conditions potentially associated with this disorder.
James WD, Berger TG, Elston DM. Eds. Andrew's Diseases of the Skin: Clinical Dermatology. 10th ed. Saunders. 2005:208-209.
Champion RH, Burton JL, Ebling FJG. Eds. Textbook of Dermatology. 5th ed. Blackwell Scientific Publications. London, UK; 1992:948-951.
Drago F, Vecchio F, Rebora A. Use of high-dose acyclovir in pityriasis rosea. J Am Acad Dermatol. 2006;54:82-85.
Atzori L, Pinna AL, Ferreli C, Aste N. Pityriasis rosea-like adverse reaction: review of the literature and experience of an Italian drug-surveillance center. Dermatol Online J. 2006;12:1.
Stulberg DL, Wolfrey J. Pityriasis rosea. Am Fam Physician. 2004;69:87-91.
Chuh A, Chan H, Zawar V. Pityriasis rosea - evidence for and against an infectious etiology. Epidemiol Infect. 2004;132:381-390.
Mayo Clinic for Medical Education and Research. Pityriasis Rosea. April 3, 2010. Available at: http://www.mayoclinic.com/health/pityriasis-rosea/DS00720 Accessed on January 12, 2012.
DermNet NZ. Pityriasis Rosea.July 5, 2011. Available at: http://dermnetnz.org/viral/pityriasis-rosea.html Accessed on: January 12, 2012.
Report last updated: 2012/01/17 00:00:00 GMT+0