What is Pityriasis Rosea? What is Psoriasis?

As autumn approaches, our providers at Advanced Dermatology expect to see a predictable shift in the types of skin issues that they diagnose and treat. Many skin conditions tend to follow a seasonal pattern. For example, pityriasis rosea (PR) is a peculiar skin rash that is very common in the fall and spring seasons. Usually it begins as a large pink or red patch with a scaly border. This typically appears on the torso and it may be confused with eczema or ringworm, even by the well-trained eye. Within several days, the rash progresses to include between a few and many dozen smaller, oval, scaly, pink patches, which may or may not itch. These primarily occur on the torso, upper arms, and upper legs. Classically, the patches on the back resemble a “Christmas tree” pattern, with a downward-slanting orientation of the outermost patches.

Although usually quite concerning to patients, the good news is that PR has no medical significance. Without treatment it usually lasts about 6-12 weeks, and it leaves no permanent marks or scars on the skin. The official cause is unknown, but it is suspected that PR may be due to a yet-unidentified virus. This is because in some people, the rash occurs following a mild illness, and once a person has had PR, the rash does not typically ever recur. Finally, cases of PR tend to cluster, similar to what one would expect with viral illness.

Diagnosing PR is usually straightforward, but may occasionally involve a minor skin biopsy or skin scraping. There is no blood test for PR. The treatment of PR is generally simple and involves topical steroid creams, though in severe cases oral steroids may be prescribed. Treating the rash is optional, as all cases resolve spontaneously within a few weeks. Most patients are relieved to find out that their sudden-onset rash is not dangerous and will not affect their health.

The onset of cooler weather can also worsen more challenging and chronic genetic skin conditions such as psoriasis. In individuals with psoriasis, affected areas of skin can become very inflamed and thickened, and a silvery scale can develop. It commonly appears on the scalp, elbows, knees, torso, palms, and soles, although any part of the skin may be involved. People with very mild psoriasis may have clear skin during the summer months, but those with more moderate to severe psoriasis often deal with symptoms throughout the year. Psoriasis can also cause extreme itching, and in some individuals, psoriatic arthritis with resulting joint pain, inflammation, and ultimately permanent joint damage.

Fortunately, over the past decade, treatment options for psoriasis have evolved to such a great extent that even the most difficult cases can generally be treated very successfully. The newer biologic agents have changed many people’s lives dramatically in the past few years. These drugs are injected by the patient or health care provider, and they offer long-term improvement or even clearance of psoriasis in the skin and joints. These drugs may also provide additional benefit to people with psoriasis by decreasing inflammation in other organ systems, and they may even decrease the risk of cardiovascular disease.

More mild cases of psoriasis can often be managed by choosing from multiple classes of topical medications. These are applied once or twice daily to affected areas and are generally effective in clearing up minor or limited psoriasis. Patients with psoriasis may also benefit from treatment with an Xtrac laser. This is a narrowband ultraviolet laser that can treat involved areas of skin without affecting the adjacent normal skin. Xtrac treatment usually takes ten to fifteen minutes per session, and is typically administered twice weekly until clearance is achieved. Private insurance and Medicare generally cover the cost of Xtrac laser treatment. Advanced Dermatology has Xtrac laser treatment available to patients with psoriasis (as well as vitiligo). If you think you may have psoriasis or are interested in the treatment of psoriasis, feel free to schedule a medical visit with one of our providers.