Pityriasis rosea

Last Updated: 2022-02-25

Author(s): Anzengruber F., Navarini A.

ICD11: EA10

Gibert, 1860.

Röschenflechte, Gibert's disease.

Self-limiting, exanthematous, inflammatory skin disease.

  • Age peak: 10-35 years
  • Women > men
  • Occurring in all ethnicities
  • Prevalent mainly in spring and autumn

  • The cause is not yet known
  • Possible triggers:
    • Viral infections (HHV-6, HHV-7, H1N1, EBV, CMV)
    • Drugs
    • Stress
  • Increases in tissue-derived interleukin-17 (IL-17) and -22, interferon-γ, vascular endothelium growth factor (VEGF) and CXCL10 (IP-10) have been shown

  • Prodromi
    • ↓ general condition, nausea, (sub-)febrile temperatures, cephalgia
  • Sharply demarcated, erythematous, oval plaques with collerett-like scaling. A tache mère (sometimes called plaque mère, herald patch or primary medallion) manifests first. This is usually located on the trunk and is larger than all the others
  • As it progresses, the skin lesions spread along the cleavage lines (Christmas tree pattern)
  • The face and distal halves of the extremities are usually left out. The oral mucosa (enanthema) is involved only in exceptional cases
  • Special forms:
    • Pityriasis rosea inversa: It mainly affects the axillae and the groin region. An inverse form may be seen in children or African-Americans
    • The skin lesions may also be atypical: urticarial, haemorrhagic, follicular bound, vesicular, psoriasiform and circine

  • Anamnesis (previous infections?)
  • Clinical image (search for plaque mère)

Discreet focal spongiosis and parakeratosis are visible in the epidermis. Erythrocyte extravasations are typical but rare. A perivascular lymphocytic infiltrate is seen in the dermis.

  • Healing after 3-8 weeks
  • Disease can lead to abortion or premature birth in pregnant women (up to 15 weeks gestation)

  • No causal therapy!
  • Spontaneous healing after 3-8 weeks
  • Avoidance of heat by e.g.: Sports, sauna, sun exposure and spicy foods


Topical therapy

  • No greasy externals.
  • Tanning solution


  • Refatting
    • Carbamide lotion / cream


  • Antipruritic topicals
    • 5% polidocanol in cold cream several times a day
    • Carbamide cum 2% menthol (sic!) ad libitum several times a day
      • Achtung Kühlstärke!


Systems therapy therapy

  • Anithistamines
  • Levocetirizine p.o. 5 mg 1x daily.
  • Desloratadine p.o. 5 mg 1x daily.
  • Fexofenadine p.o. 180 mg 1x daily.


Therapy of 1st choice according to Lebwohl

Evidence level

Topical glucocorticoids




Oral antihistamines



Therapy of the 2nd choice after Lebwohl







Therapy of the 3rd choice according to Lebwohl


Glucocorticoids p.o.


Erythromycin p.o.


Aciclovir p.o.


Dapsone p.o.





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