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Pityriasis Rosea Diagnosis and Treatment, NJ

Without fail, every spring and fall , we see numerous patients with pityriasis rosea.  Pityriasis rosea (PR) is a common rash, thought to be caused by a virus.  There are two candidate viruses, but which one causes PR has not been completely worked out.  Often patients have cold or flu-like symptoms about 1-2 weeks prior to the eruption of the rash.

Interestingly, we see the rash in many people in the same geographic area at the same time of the year (this is how the idea that it is caused by a virus came about in the first place) but we rarely see two family members have the rash at the same time.

The rash starts as one oval reddish-orange plaque (herald patch) with the scale located slightly inside the border of the plaque (trailing scale).  Because the herald patch has a ring-like appearance, it is often

What the herald patch of pityriasis rosea looks like

Herald Patch of Pityriasis Rosea

thought to be ringworm or a fungal infection of the skin, and patients often give a history of having been treated with topical anti-fungal creams.

The herald patch lasts for approximately 2 weeks, then crops of new smaller, oval, scaling papules start appearing on the trunk, distributed along skin tension lines, giving the rash its classic “Christmas tree distribution.”   These new lesions appear for the next two weeks, and even if nothing is done to treat this rash, it starts disappearing by itself after 6-8 weeks.

Occasionally the rash can be distributed only on the arms and legs, the so-called pityriasis rosea inversa.

Pityriasis rosea is usually treated with topical corticosteroid creams for 1-2 weeks, particularly if there is itching or discomfort.  Often the rash is completely asymptomatic.  Occasionally pityriasis rosea needs to be treated with oral medications, like prednisone.

It is also important to know that in pityriasis rosea there are no lesions on the palms or soles.  If you have lesions on the palms or soles, you need an immediate evaluation by a dermatologist to rule out other causes of this rash.

What Pityriasis Rosea looks like

Pityriasis Rosea in "Christmas Tree" distribution on the back


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