Pityriasis rosea - Treating pityriasis rosea

As pityriasis rosea usually resolves by itself within two to twelve weeks, treatment is not usually necessary unless you experience uncomfortable itching.

There are three main treatments:

• emollients – skin creams that are designed to moisturise and sooth the skin
• topical corticosteroids – creams or ointments that contain steroid medication
• antihistamines – a type of medication widely used to treat allergy-related symptoms, such as itchiness

If these don't work, you may be referred to a dermatologist (a specialist in treating skin conditions) who may recommend a treatment called UVB light therapy.

These treatments are described in more detail below.

Emollients

Emollients are creams, ointments and lotions designed to help the skin retain moisture to relieve itchiness.

You can use the emollient as often as is required to relieve itching. Apply the emollient gently in the direction of the hair growth and avoid vigorously rubbing the skin.

Some emollients are designed to act as a soap substitute and are usually recommended because normal soap can irritate the rash. These types of emollients are available over the counter from most pharmacists.

Topical corticosteroids

You should visit your GP if emollients fail to control the symptoms of itchiness. You may need additional treatments with a topical corticosteroid. Topical corticosteroids are applied directly to the skin and include hydrocortisone or betamethasone cream.

The main aim of topical corticosteroids is to reduce inflammation (redness of the skin) and to help relieve the symptoms of itching. It's usually recommended that you apply topical corticosteroid cream or ointment lightly to affected areas of skin once or twice a day - depending on the advice of your doctor.

If you use topical steroids as directed by your doctor, side effects are rare.  Some people may experience a slight burning or stinging sensation when first applying the cream. This side effect is usually temporary and should pass once your body gets used to the medication.

Antihistamines

If you're having trouble sleeping due to itching, your GP may prescribe a sedating antihistamine, such as hydroxyzine or chlorphenamine.

Sedating antihistamines are antihistamines originally designed to treat allergic conditions such as hay fever, but it was subsequently found that they caused drowsiness in many people. This is a useful side effect in some cases because the drowsiness will help you sleep better.

You usually need to take the medication just before you go to bed. Many people still feel quite drowsy when they wake up the following morning. If this is the case, avoid driving or using tools or machinery.

UVB light therapy

If your symptoms fail to respond to the above treatments, you may be referred for UVB light therapy. This involves the controlled exposure of your skin to ultraviolet light for a few seconds to minutes at regular intervals under the guidance of a specialist. This is not the same as using a sunbed.

However, there are some uncertainties about how effective UVB light therapy is for pityriasis rosea. Although some medical trials suggest it can help relieve itchiness, others have found it only helps improve the appearance of the rash (without relieving itchiness) during the first few weeks of the condition.

Some people find exposure of their skin to natural sunlight for short periods can also be useful, although you should take care not to stay in the sun too long because prolonged exposure to the sun can damage your skin and increase your risk of developing skin cancer.

Other treatments

A number of other treatments have also been suggested for pityriasis rosea, but their use is controversial. They include:

• aciclovir – an antiviral medication that was originally designed to treat herpes infections
• erythromycin – an antibiotic that's designed to treat bacterial infections
• oral (tablet) corticosteroids

If you're offered these treatments, you should be aware that evidence of their effectiveness and safety when used to treat pityriasis rosea is limited.