Rodriguez-Zuniga M, Torres N, Garcia-Perdomo H.
An Bras Dermatol. 2018 Sep-Oct;93(5):686-695. doi: 10.1590/abd1806-4841.20187252. Review.
PMID: 30156618
Pityriaisis rosea manifests as an acute and self-limiting rash. An important goal of treatment is to control pruritus. Some of the recommendation include topical steroids, oral antihistamines, and even oral steroids. This objective of this article was to determine the efficacy of acyclovir in patients with typical pityriasis rosea. This is a systematic review and meta-analysis published in 2018 with 7 trials. There was a total of 324 participants with PR., with 159 were allocated to acyclovir, and 165 to control. Only 2 studies used low dose acyclovir (400mg 5 times daily), while the rest used high dose (800mg 5 times daily).
Results:
- Comparison of Acyclovir vs Placebo
- Acyclovir was superior to placebo after 1 week of treatment (RR 5.72, 95% CI, 2.36-13.88, I^2=0%). There was no difference at two weeks (RR 6.08, 95% CI 0.94-39.36, I^2=85%)
- Comparison of Acyclovir vs antibiotic
- Acyclovir was similar to erythromycin after 2 weeks, but superior after four weeks (RR 8.0 95% CI 1.13-56.33) and eight weeks (RR 2.16 95% CI 1.13-4.15) of treatment.
- Comparison of Acyclovir vs observation
- Acyclovir was superior to observation after one (RR 3.02 95% CI 1.13-8.08), two (RR 2.92 95% CI 1.50-5.66), and four weeks (RR 1.51 95% CI 1.10-2.08) of treatment.
- Comparison of combined therapy (Acyclovir + symptomatic treatment) vs. symptomatic treatment alone
- Combined treatment was not significant superior after two, four, and eight weeks of treatment
Conclusion: Acyclovir was superior to placebo and observation. However, combined therapy was not superior to symptomatic treatment for control of lesions. This result reflects that symptomatic treatment plays an important role for treatment. It is a reasonable option for PR, and the addition of acyclovir is justified for the control of severe symptoms.
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