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Pityriasis Rosea

What It Is, Causes, Signs, Symptoms, and More

Author:Ashley Mauldin, MSN, APRN, FNP-BC

Editors:Alyssa Haag,Emily Miao, PharmD

Illustrator:Jillian Dunbar

Copyeditor:Sadia Zaman, MBBS, BSc


What is pityriasis rosea?

Pityriasis rosea is a common skin condition that causes a temporary scaly rash on the body. Typically, pityriasis rosea occurs in the spring and fall, and can last for several weeks to months. Pityriasis rosea usually affects children and young adults, however, in more rare cases, individuals over the age of 60 can be affected. 

What causes pityriasis rosea?

Pityriasis rosea is usually associated with a viral infection, however, no specific pathogens have ever been identified as the cause. Some individuals theorize that the body’s immune system may also play a part in the development of pityriasis rosea, though currently there is no control-study evidence available to support this. 

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What are the signs and symptoms of pityriasis rosea?

Pityriasis rosea manifests differently on each individual, and some individuals may even be asymptomatic. Nonetheless, the most common initial signs and symptoms include a single, slightly raised, oval-shaped pink scaly patch called the herald patch, that presents on the trunk, upper arms, neck, or thigh. The herald patch is typically 2-5 centimeters in diameter and salmon in color. It presents as a scaly patch that begins to clear centrally, leaving a scale-like border. Some individuals may also experience severe itching, though the rash is typically not painful.  

In addition to the scaly rash, some individuals may experience headaches, fevers, sore throat, and joint pain. The herald patch will usually appear 2-3 days before, as well as 1-2 weeks after, a more widespread rash appears. The widespread rash may appear similar to the herald patch, however, is typically smaller in size and can last as long as 12 weeks. In some rare cases, the rash may localize to one particular area of the body (i.e., the arms). Finally, when there is an underlying viral infection, pityriasis rosea may present with a prodrome of headache, malaise, and pharyngitis.

How is pityriasis rosea diagnosed?

Pityriasis rosea is diagnosed through a history and physical exam, where the healthcare provider will inspect the characteristics of the scaly rash. Though diagnosis is typically confirmed during the history and physical exam, the healthcare provider may also consult clinical dermatology in order to conduct a skin biopsy and rule out other potential diagnoses. In rare cases, the healthcare provider may require blood testing to rule out syphilis, which also presents with a disseminated maculopapular rash. 

How is pityriasis rosea treated?

Treatment of pityriasis rosea depends on the severity of the rash. It usually includes symptomatic and supportive therapies, such as gentle bathing, mild lubricants, and hydrocortisone cream to help soothe the affected areas of skin and reduce itching. Antihistamines may also be prescribed in cases of persistent itchiness. 

Systemic corticosteroids, certain antiviral medications, and antibiotics, like erythromycin, can be prescribed if the rash is persistent or long-lasting; however, the evidence from clinical trials to support the use of these medications is limited. 

The use of phototherapy, or moderate safe sun exposure, helps shorten the duration of pityriasis rosea in some individuals. 

How long does pityriasis rosea last?

Pityriasis rosea can last up to 12 weeks in some individuals, but typically self resolves after 6-8 weeks. 

What are the most important facts to know about pityriasis rosea?

Pityriasis rosea is a common skin condition that causes a temporary scaly rash on the body. Pityriasis rosea occurs in the spring and fall, and it can last for several weeks to months. Pityriasis rosea is usually associated with a viral infection. Pityriasis rosea appears differently on each individual, however, the most common initial signs and symptoms include a single, slightly raised, oval-shaped pink scaly patch, called the herald patch. In addition to the scaly rash, some individuals may have headaches, fevers, sore throat, and joint pain. The herald patch will usually appear 2-3 days before, as well as 1-2 weeks after a more widespread rash appears. Pityriasis rosea is diagnosed through a history and physical exam, where the healthcare provider will inspect the characteristics of the scaly rash to determine a diagnosis. Treatment of pityriasis rosea depends on the severity of the rash, but topical steroids are commonly used. Pityriasis rosea may last anywhere from 4 to 12 weeks in some individuals.

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Related links

Pityriasis Rosea
Skin anatomy and Physiology
Skin Histology

Resources for research and reference

American Osteopathic College of Dermatology. (2021). Pityriasis Rosea. In American Osteopathic College of Dermatology. Retrieved November 9, 2021, from https://www.aocd.org/general/custom.asp?page=PityriasisRosea

Browning, J. (2018, May 9). Pityriasis Rosea. In National Organization for Rare Disorders (NORD). Retrieved November 9, 2021, from https://rarediseases.org/rare-diseases/pityriasis-rosea/

National Library of Medicine (NLM). (2021). Pityriasis rosea. In MedlinePlus: Medical Encyclopedia. Retrieved November 09, 2021, from https://medlineplus.gov/ency/article/000871.htm

NHS. (2021). Pityriasis rosea. In NHS. Retrieved November 09, 2021, from https://www.nhs.uk/conditions/pityriasis-rosea/

Oakley, A. (2021). Pityriasis rosea. In DermNet NZ. Retrieved November 09, 2021, from https://dermnetnz.org/topics/pityriasis-rosea

Stulberg, D. L., & Wolfrey, J. (2004). Pityriasis rosea. American family physician, 69(1), 87–91.