Questionnaire/history: Scaly, reddened lesions? Itch? - None? - Mild/moderate/severe? Herald patch typically 5–15 days before the more generalized rash? Past medical history? Current medication? Drug allergies? Examination: Multiple, discrete, pink-red ('salmon coloured') or fawn coloured lesion? Flat or slightly raised? Circular or oval, and typically 0.5–1 cm in diameter? Slightly scaly (with the centre tends to clear leaving peripheral 'collarette' scaling)? Distribution? - Not palmar or plantar skin? - Symmetrical? - Most lesions at trunk and proximal limbs? - On the trunk, lesions occur along the lines of cleavage parallel to the ribs (forming a 'Christmas tree' pattern on the upper back and V-shaped pattern on the upper chest)? - Transversely across the lower abdomen and lower back? - Face and scalp may be involved in children? 'Herald patch' usually 5–15 days before other lesions? - Typically 2–5 cm in diameter? - Well defined, round or oval? - Usually on the trunk, thigh, upper arm, or neck? Images Management: If in pregnancy — discuss urgently with secondary care Advised: - For most people no specific treatment is required - Rash may worsen before it resolves, with new crops of skin lesions continuing to appear for up to 6 weeks - Rash will settle without treatment, usually within 2–3 months - After the rash has disappeared, there may be some hyperpigmentation or hypopigmentation of the affected skin for several months, but there will be no scarring - Rash does not usually recur (about 1 in every 50 people with pityriasis rosea may have a recurrence) - To read information 'Pityriasis rosea' at www.bad.org.uk - If itch: --- Emollient, hydrocortisone 1%, betamethasone valerate 0.025% or clobetasone 0.05% ointment or cream bd for up to 4 weeks - No treatment is required apart from symptomatic treatment for itch ---- Oral antihistamine (off-label) - To seek medical advice if new or worsening symptoms, no improvement or ongoing symptoms after 12 weeks Reference(s): NICE CKS: Pityriasis rosea Information for patient/carer(s): British Association of Dermatologists: Pityriasis rosea