How can the papular form of pityriasis rosea be managed?

Question

Hello doctor,

Last week I thought I had the flu and was extremely tired. Then I had a sore throat, mild cough, and runny nose for a few days. I took the Nyquil tablet. Five days ago, I noticed some itchy rashes and thought they would go away, but they just kept getting worse. I woke up today, and they are more red and itchier. I only have the rashes on my trunk, nothing on my limbs or face. Flu-like symptoms are gone. I got shingles two years ago; I do not know if that helps. Currently, I am taking birth control pills also. I am attaching the pictures for your reference. Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I saw your clinical picture (attachment removed to protect the patient's identity), and I suggest it is in Pityriasis Rosea papular form. I can see a few raised bumps. This requires close observation to appreciate scales, the pattern to say precisely that it is pityriasis rosea. Pityriasis Rosea is a noninfectious self-limiting condition usually seen after an episode of fever, sometimes drug-induced. It has been linked to HSV (herpes simplex virus-6 and 7). Classically there will be red patches with scales at the edges called collarette of scales. The rash which appeared first is called a mother patch; subsequent patches are called daughter patches. On the back, rashes will be seen along the skin lines that may seem like an inverted fir tree. You may also see some new patches on the thighs, neck, and arms. This is a self-limiting condition, but there will be a peak around the second week, where you will see new rashes that will subside in another one or two weeks. Topically you can apply Calamine (Zinc oxide and 0.5 % Ferric oxide) lotion to help with itching. If rashes become worse, you will need oral antiviral medications such as Acyclovir (Magnesium stearate, microcrystalline cellulose, Sodium starch glycollate, pregelatinized starch, and colloidal anhydrous silica) or Valacyclovir (Valacyclovir hydrochloride). This is not shingles. Shingles are Herpes zoster viral reactivation that presents with grouped blisters with redness involving half of the body with the dermatomal pattern. Thank you.