Pityriasis rosea

Patients might initially notice flu-like symptoms, such as sore throat, mild fever, and fatigue. Typically, a single large, oval, scaly "herald patch" appears on the trunk or upper limbs, followed by smaller lesions in the next 1–2 weeks. These lesions can cause itching, which varies in intensity. 

Examination reveals a single “herald patch” with a raised, scaly border, often followed by smaller, salmon-colored patches distributed in a “Christmas tree” or “fir tree” pattern, mainly on the back. In Black patients, the lesions may have darker pigmentation and can appear hyperpigmented, which can aid in visual diagnosis. 

tyriasis rosea is self-limiting and resolves in about 6–8 weeks. However, treatments can help manage symptoms:

1. Topical Corticosteroids: For mild-to-moderate itching, low- to medium-potency corticosteroids like hydrocortisone (1%) or triamcinolone acetonide can be applied twice daily to affected areas.

2. Oral Antihistamines: For persistent itch, oral antihistamines such as diphenhydramine (25–50 mg at night) or cetirizine (10 mg daily) can be prescribed.

3. Phototherapy: UVB phototherapy may help in severe or persistent cases, shortening the disease duration, although it is usually reserved for severe pruritus or when cosmetic appearance is a concern.

4. Antiviral Therapy: In certain severe or widespread cases, acyclovir (800 mg five times daily for a week) may be considered as an off-label option.