What causes pityriasis rosea?

While the exact cause of pityriasis rosea is unknown, viral infections—herpes viruses HHV-6 and HHV-7, in particular—are often mentioned as possible causes or triggers.

Does COVID-19 cause pityriasis rosea?

The COVID-19 virus may trigger pityriasis rosea. There are related case reports in both children and adults.

Pityriasis Rosea: Stages, Photos, Treatments

Pityriasis rosea is a common rash that usually begins as a round or oval-shaped patch and spreads in stages in a characteristic pattern. It may or may not be itchy and usually lasts six to eight weeks before resolving on its own.

The four stages of pityriasis rosea are:

Preliminary stage: You feel ill for a day or two.
Herald patch stage: A large round or oval patch that's red or pink develops on your skin.
Rash stage: Many smaller patches or bumps appear.
Resolution: Your skin clears up.

Before the rash appears, some people may develop a fever, headache, sore throat, or other flu-like symptoms.

This article includes photos of pityriasis rosea at different stages and on different parts of the body. It details specific characteristics of the rash, as well as potential treatment options.

Herald Patch

Pityriasis rosea is an itchy rash that begins with a herald patch. This is a single round or oval-shaped lesion that is 2 to 10 centimeters (cm) in diameter. It looks like ringworm and usually appears on the torso.

Within a few days, smaller lesions appear. The smaller lesions are usually on the torso or wherever the herald patch is located. They can also spread to the arms, legs, and face. The lesions can continue to spread for several weeks.

This is another example of a herald patch. A full rash usually develops within a few days or several weeks of its appearance.

The appearance of the rash and its striking resemblance to ringworm can be concerning. However, it's a non-threatening skin condition that resolves on its own.

Typical Rash

Typical pityriasis rosea full fash — Joe Miller

This is what pityriasis rosea looks like when the full rash has broken out. Lesions start to appear around the herald patch. They can spread to the arms, legs, and face. The lesions tend to be oval-shaped with thin, tissue-like scales. They can be itchy.

On light skin the lesions are salmon-colored and can be hard to see. On dark skin they can be very dark, even black.

In most cases, a pityriasis rosea outbreak will clear up in six to eight weeks. Occasionally it can last for up to five months or more.

Torso

Pityriasis rosea most often takes hold on the torso. Some patients have a fever, fatigue, headache, and sore throat before the rash appears.

Studies have tried to find a viral or bacterial cause of pityriasis rosea. So far, these studies have been inconclusive and the cause is still unknown.

Pityriasis rosea tends to occur most often in the colder months. It affects all ethnicities equally. Only 2.8% to 3.7% of those who have had the condition will have a recurrence.

Recap

Typical pityriasis rosea lesions appear around the herald patch and spread to the limbs. Some patients may have a fever and other flu-like symptoms before the rash appears.

Atypical Rash - Generalized

Atypical Pityriasis Rosea Rash — Gavin Hart / CDC

Most of the time, pityriasis rosea rashes look typical. An atypical rash like the one above, however, is not uncommon. The lesions in this photo are not as distinct. Instead, they are more generalized over the area.

The rash can be more papular, or bumpy, in certain people, including:

Young children
Pregnant women
People with darker skin tones

Infants sometimes get blisters and raised wheals. Oral lesions can happen, too, and in some cases, the rash covers the entire body.

Atypical Rash - Raised

Generalized pityriasis rosea rash — Joe Miller

This is an atypical pityriasis rosea rash on the upper back. Normally there are fewer lesions that are more spread out over the torso. These solid, raised lesions cover a lot of area and are very close together.

An atypical rash is often misdiagnosed as ringworm, psoriasis, or eczema.

If the rash can't be diagnosed based on appearance, a potassium hydroxide (KOH) test will be done.

Pityriasis Rosea on the Neck

pityriasis rosea rash on the neck — Joe Miller

Pityriasis rosea appears mostly on the torso, but it's not uncommon for it to spread around the body. It may appear on the arms, neck and even the scalp. The rash rarely spreads to the face.

It's unknown whether pityriasis rosea is contagious, and there is no cure. The condition runs its course and usually clears up after six to eight weeks.

Your healthcare provider may prescribe an oral antihistamine or topical steroids to help with itching. Few studies have looked at treatment options, but there are few theories about things that may shorten the rash's course. This includes:

Concentrated doses of erythromycin, an antibiotic used to treat acne
Sun exposure
UVB therapy, where the skin is exposed to ultraviolet light

Summary

Pityriasis rosea is a very common skin condition. It begins with a round or oval-shaped herald patch and spreads outwards over the course of a few weeks. No one knows what causes it and there is no cure, but it is not dangerous and resolves on its own.

Pityriasis rosea can be itchy. Your healthcare provider may prescribe oral antihistamines or a topical steroid to help with this symptom. According to some theories, you may also be able to shorten the course of the rash by spending time in the sun.

Frequently Asked Questions

What causes pityriasis rosea?

While the exact cause of pityriasis rosea is unknown, viral infections—herpes viruses HHV-6 and HHV-7, in particular—are often mentioned as possible causes or triggers.
Does COVID-19 cause pityriasis rosea?

The COVID-19 virus may trigger pityriasis rosea. There are related case reports in both children and adults.

9 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Vanravenstein K, Edlund BJ. Diagnosis and management of pityriasis rosea. Nurse Pract. 2017;42(1):8-11. doi:10.1097/01.NPR.0000511012.21714.66
American Academy of Dermatology Association. Pityriasis rosea: signs and symptoms.
Drago F, Ciccarese G, Parodi A. Pityriasis rosea and pityriasis rosea-like eruptions: how to distinguish them? JAAD Case Rep. 2018;4(8):800-801. doi:10.1016/j.jdcr.2018.04.002
Trayes KP, Savage K, Studdiford JS. Annular lesions: diagnosis and treatment. Am Fam Physician. 2018;98(5):283-291.
Urbina F, Das A, Sudy E. Clinical variants of pityriasis rosea. World J Clin Cases. 2017;5(6):203-211. doi:10.12998/wjcc.v5.i6.203
Campbell J, Macconnell V, Sacco L, Zuill R, Bosque E. Use of potassium hydroxide (KOH) test reduces antifungal medication prescription for suspected monilial diaper dermatitis in the neonatal intensive care unit: a quality improvement project. Adv Neonatal Care. 2019;19(6):E3-E10. doi:10.1097/ANC.0000000000000643
Villalon-Gomez JM. Pityriasis rosea: diagnosis and treatment. Am Fam Physician. 2018;97(1):38-44.
Mahajan K, Relhan V, Relhan AK, Garg VK. Pityriasis rosea: an update on etiopathogenesis and management of difficult aspects. Indian J Dermatol. 2016;61(4):375-384. doi:10.4103/0019-5154.185699
Khalili M, Abtahi-Naeini B, Rastegarnasab F, Afshar K. COVID-19-associated pityriasis rosea in children: Case report and literature review. Clin Case Rep. 2022 Jul 19;10(7):e6096. doi:10.1002/ccr3.6096

By Heather L. Brannon, MD
Heather L. Brannon, MD, is a family practice physician in Mauldin, South Carolina. She has been in practice for over 20 years.

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How to Recognize Pityriasis Rosea