Patient Query - Pityriasis rosea
My 17-year-old son has developed a strange rash. It started as patches on his chest but spread to other parts of his body, though not to his face, neck, lower legs or lower arms. The spots are oval in shape and are dry and flaky. What has caused this, is it contagious and what can be done to treat it?
Your son sounds as if he may have a condition known as pityriasis rosea, which is thought to be caused by a virus. It is most common in the 15-30 age group, but it can occur at any age.
The rash is characterised by the appearance of "herald" patches, like those you describe. These usually precede the spreading of the spots, which cover a T-shirt distribution (chest, back and upper arms) and the upper legs. It rarely spreads to the neck and face.
The spots can be mildly itchy and become oval, red or copper-coloured patches with dry, scaly margins.
The main symptom is itching. Some people do not experience an itch while others can have extreme discomfort from it. The rash can last for between four and 10 weeks. Unfortunately, there is no medication available to speed recovery.
A visit to your doctor to confirm the diagnosis and to rule out another cause would be advisable.
Washing with a mild soap and using a soothing lotion to minimise the itch may be helpful. The use of calamine lotion will also help. If the itch is severe your doctor will prescribe an antihistamine to minimise discomfort.
There are no known after-affects with pityriasis rosea. It is inconvenient and uncomfortable for some, but it is not contagious and complications are unusual.
Dr Muiris Houston
This is an inflammatory skin condition mainly affecting young adults and more commonly occurring in the autumn and winter months.
The first sign is an oval-shaped pink rash with a scaly edge, generally around the lower abdominal area. This herald patch is unique in dermatology and may be confused with a fungal rash in the beginning.
The diagnosis is confirmed by the appearance of a relatively symmetrical rash, mainly in the trunk, lower neck and upper arms, over the next few weeks.
In the vast majority of cases, patients generally feel well and the skin will spontaneously clear within six weeks or so.
The exact cause of pityriasis remains elusive, although an infectious agent, such as a virus, is the most likely cause. Stress is another possible contributory factor. The condition also may be more common in patients with atopic diseases such as eczema.
Because of the tendency for the condition to clear within six weeks, patients do not normally seek complementary treatment. A small minority of patients - either when the rash is very itchy or when it persists for a long period - are more likely to seek a complementary approach.
This would require the patient to answer a comprehensive questionnaire in relation to his or her general health and any other accompanying symptoms.
Specific homeopathic medicines may be considered, depending on the exact nature of the rash and general health of the patient. Commonly used remedies include apis, belladonna, graphites and sulphur.
In view of the proposed viral theory and provided that there are no contraindications, echinacea may be used for a four- to six-week period.
In particularly resistant cases, advice on a healthy diet may be given and the use of selected anti-oxidants, such as zinc, recommended to help the immune system.
Dr Brendan Fitzpatrick
Dr Brendan Fitzpatrick is a medically trained doctor who is a member of the Irish Medical Homeopathic Association (01-2697768)
The advice in this column is not intended as a substitute for advice received directly from a medical doctor or alternative practitioner. Individuals should receive a thorough diagnosis of complaints before embarking on a course of treatment.