Shingles was another fear, as I had chicken pox when I was four, but we ruled that out too: “Shingles is a nerve-mediated process; it tends to be very painful, not so itchy,” Lam says. “And it has a particular [dermatomal] distribution because it’s along a nerve,” which also presents as fluid-filled blisters, rather than lesions. “It looks very different.”
According to King, an in-person skin exam is usually enough to make an accurate diagnosis, though a biopsy or blood work may be necessary for some. Though there’s no single-known cause, it may be brought on by a drug interaction, or the reactivation of herpes simplex virus 6 or 7.
Lastly, Hartman says PR can present differently in patients with darker skin: “The characteristic erythematous plaques may appear more hyperpigmented or violaceous in darker skin types. In my experience, patients with darker skin are more likely to present with atypical forms of the disorder. For instance, the rash sometimes appears only under the arms or on the flanks. The typical distribution of the rash is on the trunk between the neck and the knees.”
How is pityriasis rosea treated?
Pityriasis rosea usually resolves on its own without treatment in most cases, King says, but topical corticosteroids can be used for itchy control if necessary, which is what I used. “Other treatments including phototherapy or oral medications can be considered for extensive or persistent cases, [and] some small case studies support the use of oral antivirals like acyclovir or oral anti-inflammatory antibiotics erythromycin,” King explains.
In addition to a corticosteroid cream, New York City-based dermatologist Macrene Alexiades recommends keeping showers short and lukewarm, as “water, sweat, and soap reportedly irritate and inflame the lesions. I tell my patient to use a gentle non-soap cleanser.” I also had to stop working out and hiking for about a week, as Alexiades is right — excessive perspiration worsened the itch.
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