QuestionSBA
QuestionChoice
Systemic corticosteroids are not recommended for mild, uncomplicated pityriasis rosea. Their use is generally reserved for severe or refractory cases and would be prescribed by a Dermatologist, rather than in primary care.
10052657
d
Prescribe oral prednisolone
QuestionChoice
Topical antifungal agents like clotrimoxazole are not appropriate as pityriasis rosea is not a fungal infection. The scaly plaques may mimic tinea corporis, but the clinical presentation (herald patch, secondary rash, history of viral illness) is inconsistent with a fungal cause.
10052658
e
Prescribe topical clotrimoxazole
QuestionChoice
This is the correct answer. The patient's presentation of a herald patch followed by smaller secondary lesions distributed in a "Christmas tree" pattern on the trunk is classic for pityriasis rosea. Common triggers for the rash include viral illnesses such as influenza. Although the condition is self-limiting and usually resolves in 6-12 weeks, the pruritus can significantly impact quality of life. NICE guidelines recommend topical corticosteroids for symptomatic relief of itching.
10052654
a
Prescribe topical mild corticosteroid
QuestionChoice
While pityriasis rosea is a self-limiting condition, the itching is causing functional impairment for the patient, so management should address her symptoms. Simply reassuring her without treatment would not address the impact on her job.
10052655
b
Reassure and advise the rash will resolve on its own
QuestionChoice
Antihistamines like chlorphenamine can reduce itching, but oral sedating antihistamines are not first-line treatment, particularly when the patient reports that the rash is interfering with her ability to work. Non-sedating alternatives or topical treatment are preferable. This would have been an appropriate option if the patient complained that the itch was interfering with her sleep.
10052656
c
Prescribe oral chlorphenamine
Concept
Chapter
# Summary

Pityriasis rosea is a common rash that is characterized by a preceding **herald patch** - a single, large, discoid (coin-shaped), erythematous patch. This patch classically has a 'collarette' of scale just inside the edge of the lesion. A few days later a widespread rash appears across the trunk consisting of multiple small, erythematous, scaly patches (similar but smaller than the herald patch). These lesions are classically distributed across the trunk in a **'christmas tree' pattern**. There are associations with viral infections and drugs. The condition is self-limiting and resolves without any treatment.

# Definition

A self-limiting rash that resolves after 10 weeks characterised by a herald patch and subsequent fir-tree pattern eruption

# Pathophysiology

Triggers of pityriasis rosea:

- Viruses: such as HHV6/7, COVID-19, and Flu
- Drugs: such as gold, ACEi, penicillamine, and biologics. 
- Many vaccines: BCG, hepatitis B, and pneumococcal. 
	
# Clinical Features

- Usually, a few days after a viral infection e.g. an URTI, the patient presents with a 'herald patch.'
- This is a red-pink oval/discoid plaque with a peripheral colarette of scale on the trunk or upper arm/thigh. It may be misdiagnosed as ringworm.
- 1-20 days later, a similar widespread eruption (but the individual lesions may be smaller) occurs on the body that follows a fir tree (Christmas tree) pattern appears, with the long axis of the lesions sweeping from back to front as if following Langer's lines.
- In most cases, there are virtually no symptoms except for the rash.

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# Treatment

- 25% patients may have intense pruritus. Antihistamines, emollients, and topical steroids may be of use in these patients. It is self-limiting and will resolve on its own. 

# NICE Guidelines

[Click here for NICE CKS on pityriasis rosea](https://cks.nice.org.uk/topics/pityriasis-rosea/)
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Pityriasis rosea
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Dermatology
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NICE recommend prescribing a mild topical corticosteroid for pityriasis rosea to alleviate pruritus.
Presentation
48
Acute rash
UkmlaTopic
8
Dermatology
A 29 year old woman presents to the GP with a new rash that has developed over the past week. It started as a single patch on her thigh but over the past 48 hours the rash is now all over her back and abdomen. Other than suffering influenza 2 weeks ago, she has no other past medical history. On examination, there is a red, discoid plaque with a scaly periphery on her right thigh, with multiple smaller lesions over her abdomen and back. The rash is very itchy and it is starting to interfere with her job as a nail technician.

Given the most likely diagnosis, what is the most appropriate management?
a