Sunday, 20 July 2014

High-dose aciclovir hastening resolution of pityriasis rosea

The evidence that pityriasis rosea is a viral exanthem associated with reactivation of HHV-6 and/or HHV-7 is strong. Based on this concept, trials of antiviral drugs have been reported. The standard dose regimen of aciclovir is ineffective, but high-dose acyclovir (herpes zoster treatment dosage), used early after the onset of the eruption, may lead to a more rapid clearance of skin lesions. Here, the rash began to resolve soon after starting high-dose aciclovir (second photo taken at 2 weeks of starting aciclovir therapy). Without treatment, the disease duration usually varies between 4 and 10 weeks. Rarely, a partial or complete relapse of a fading pityriasis rosea may be seen. Second attacks occur in about 2% of cases. 

Interestingly, pityriasis rosea has been classified in Rook’s textbook of dermatology as a viral infection for many years before a viral cause was actually found. 
It has been stated in Fitzpatrick’s Dermatology in General Medicine textbook that this form of therapy should be considered in pityriasis rosea patients presenting early in their disease course who demonstrate associated flu-like symptoms and/or extensive rash.

Before treatment 

Two weeks of starting treatment

The eruption is usually generalized, affecting chiefly the trunk and sparing sun-exposed surfaces but involvement of the face and scalp is quite common, especially in children. An inverse distribution, sparing covered areas, is not rare.

This page was last updated in February 2015.

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Main Works of Reference List (The first eight are my top favourites)

  • British National Formulary
  • British National Formulary for Children
  • Guidelines (BAD - BASHH - BHIVA - Uroweb)
  • Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health
  • Oxford Handbook of Medical Dermatology
  • Rook's Textbook of Dermatology
  • Simple Skin Surgery
  • Weedon's Skin Pathology
  • A Concise Atlas of Dermatopathology (P Mckee)
  • Andrews' Diseases of the Skin
  • Andrology (Nieschlag E FRCP, Behre M and Nieschlag S)
  • Bailey and Love's Short Practice of Surgery
  • Davidson's Essentials of Medicine
  • Davidson's Principles and Practice of Medicine
  • Fitzpatrick's Colour Atlas and Synopsis of Clinical Dermatology (Klaus Wolff FRCP and Richard Allen Johnson)
  • Fitzpatrick’s Dermatology in General Medicine
  • Ganong's Review of Medical Physiology
  • Gray's Anatomy
  • Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery
  • Hutchison's Clinical Methods
  • Lever's Histopathology of the Skin
  • Lever's Histopathology of the Skin (Atlas and Synopsis)
  • Macleod's Clinical Examination
  • Martindale: The Complete Drug Reference
  • Oxford Handbook of Clinical Examination and Practical Skills
  • Oxford Textbook of Medicine
  • Practical Dermatopathology (R Rapini)
  • Sexually Transmitted Diseases (Holmes K et al)
  • Statistics in Clinical Practice (D Coggon FRCP)
  • Stockley's Drug Interactions
  • Treatment of Skin Disease: Comprehensive Therapeutic Strategies
  • Yen & Jaffe's Reproductive Endocrinology