Pityriasis Rosea: Symptoms, Causes & Treatment

Pityriasis rosea is an inflammatory skin condition that causes red or pink scaly patches, usually on the chest, back, or abdomen. It often begins with a single larger patch, known as a herald patch, followed by smaller spots that spread across the skin.

Pityriasis rosea is more common in people between 10 and 35 years old and typically appears once in a lifetime, often during the spring or fall. In some cases, symptoms like mild fever, sore throat, or joint pain may appear a few days before the skin rash develops.

Pityriasis rosea usually goes away on its own within 6 to 8 weeks, but itching and discomfort may require treatment. Management may include moisturizers, corticosteroid creams, antihistamines, antivirals, or phototherapy, along with simple self-care measures to support healing.

Pityriasis rosea symptoms

The main symptoms of pityriasis rosea are:

• Pink or red patches on the skin measuring between 2 and 10 cm

• A single large patch, also called a herald patch or mother patch, with several smaller patches around it

• Oval, scaly plaques with a wrinkled center

• Itching where the patches appear, which can be intense

• General discomfort and loss of appetite

The skin lesions caused by pityriasis rosea are usually symmetrical and appear on the chest, back, abdomen, neck, or arms. According to the American Academy of Dermatology, pityriasis rosea often lasts 6 to 8 weeks in teens and adults, although the skin may take longer to fully clear.

A few days before the skin patches appear, some people may have a sore throat, fever above 100.4ºF (38ºC), gastrointestinal (GI) symptoms, or joint pain. These skin changes should always be checked by a dermatologist to confirm the cause and start the most appropriate treatment.

Final stage

The final stage of pityriasis rosea usually occurs about 6 to 8 weeks after symptoms begin. In this stage, the skin patches become lighter, whitish, or darker, and may take a few months to completely disappear.

Confirming a diagnosis

Pityriasis rosea is diagnosed by a dermatologist through an evaluation of symptoms, health history, and a physical exam. The doctor will assess the characteristics of the skin patches, usually with dermoscopy.

This exam helps the doctor rule out other skin conditions with similar features, such as erythema multiforme, guttate psoriasis, lichen planus, or tinea versicolor. If there is still uncertainty, the doctor may request a skin biopsy to be analyzed in the lab to confirm the diagnosis.

Possible causes

The exact cause of pityriasis rosea is not fully known, but it appears to be related to:

• Reactivation of viral infections, such as human herpesvirus 6 or 7

• Infections caused by bacteria or spirochetes

• Genetic or autoimmune factors

• Use of medications, such as hydrochlorothiazide, captopril, imatinib, or isotretinoin

• Vaccines, such as BCG (tuberculosis), smallpox, H1N1 (flu), pneumococcal, COVID-19, or hepatitis B

Pityriasis rosea is more common in women, pregnant people, and people under 35 years old. However, this skin condition can happen to anyone at any age.

Pityriasis rosea and stress

Stress does not cause pityriasis rosea. However, in some people, pityriasis rosea symptoms may appear after periods of excessive stress.

One possible explanation is that stress triggers an inflammatory response in the body and weakens immune system activity. This may make symptoms more intense or trigger the reactivation of human herpesvirus 6 or 7.

Pityriasis rosea treatment

Pityriasis rosea usually goes away on its own after about 6 to 8 weeks. According to the American Academy of Dermatology, most people do not need treatment.

However, if there is itching, discomfort, or a bothersome rash, the dermatologist may recommend treatment with:

1. Emollient creams

Emollient creams may be recommended by the dermatologist to deeply moisturize the skin, support healing, and soothe irritation.

Examples of emollient creams include Eucerin or Aquaphor.

2. Corticosteroid ointments

Corticosteroid creams and ointments, such as hydrocortisone or betamethasone, may be recommended by the dermatologist to reduce skin inflammation and swelling and relieve itching. In more severe cases, the doctor may also recommend oral corticosteroids.

3. Antihistamines

Antihistamines may also be recommended by the doctor, especially when itchy skin affects sleep.

Examples of antihistamines include hydroxyzine or chlorpheniramine.

4. Antivirals

Antiviral medications, such as acyclovir, may be recommended if pityriasis rosea is linked to herpesvirus infection.

Antivirals are usually used for about 7 days to help speed up recovery and relieve symptoms more quickly.

5. Phototherapy

If symptoms do not improve with medication, the doctor may recommend UVB phototherapy.

This treatment involves exposing the affected skin to a special light device. In some people, the patches may take more than 2 months to disappear and usually do not leave scars or marks on the skin.

Self-care tips

Some self-care measures are important during pityriasis rosea treatment, such as:

• Applying moisturizer to the skin after bathing and as directed by the doctor

• Avoiding bar soaps and choosing liquid or creamy soaps or bath oils instead

• Taking lukewarm showers and avoiding very hot water

• Avoiding more than one shower per day or taking shorter showers

• Wearing loose, cotton, or breathable clothing to avoid further skin irritation

• Avoiding activities that can cause excessive sweating

In addition, exposing the skin to sunlight may help speed up recovery, but it is important to avoid staying in the sun too long to prevent burns or worsening symptoms.

These self-care measures complement the treatment prescribed by the dermatologist and help support recovery and relieve symptoms.