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Is acyclovir effective in the treatment of pityriasis rosea?

A2015 observer‐blind, randomized, parallel group, add‐on trial compared the efficacy of oral acyclovir 400 mg three times a day for seven days added to standard treatment (oral cetirizine 10 mg once at night and calamine lotion) for the treatment of pityriasis rosea in 24 adult patients. Patients with serious chronic illness or pregnancy were excluded. Outcomes included patient rating of itching using a zero to 10-point visual analog scale (VAS), appearance of new lesions, lesional score including erythema, scaling, and number of lesions (scored 0–5, with higher scores indicating worse), and pruritus score rated zero to three, with higher scores indicating worse. A threepoint change on the VASwas considered clinically relevant. Patients were assessed weekly for four weeks. Patients using acyclovir reported significant improvement on the VAS at three weeks compared with the standard treatment (3.08 vs 0.25 point change,P,.001); but no differencewas noted atweek 4. Patients taking acyclovir had a significantly lower lesional score at the third week of follow-up compared with the standard treatment (0 vs 1.58 points; P5.038) but not at the fourthweek. Patients using acyclovir reported significantly lower pruritus scores at week 4 compared with standard treatment (0 vs 0.75 points; P5.038). No difference was found in the proportion of patients reporting complete response at four weeks (100% vs 83%, P5.478). This study was limited by single blinding. A 2014 double-blind randomized controlled trial compared the efficacy of oral acyclovir 800 mg five times a day for adults and 20 mg/kg/dose, four times a day for children with placebo for the treatment of pityriasis rosea (N573; number of children not specified). Vitamin Cwas used as placebo. Exclusion criteria included patients who took systemic therapy for pityriasis and patients who had systemic illness. The primary outcome was regression of skin lesions at day 7 and day 14. Regression was designated as fully regressed, partially regressed (erythema decreased in $50% of the lesions), and unchanged (erythema decreased in#50% of the lesions). Patients who received acyclovir were more likely to have full lesion regression at day 7 (53% vs 10%; P5.0003) and at day 14 (87% vs 33%, P5.0001). This study was limited by subjective rating scales, no assessment of treatment adherence, and lack of intention-to-treat analysis. A 2011 randomized, investigator-blind trial compared the efficacy of oral acyclovir 400mg five times a day for one week with no treatment in 54 patients, 12 to 60 years old, with pityriasis rosea. Exclusion criteria included pregnancy or serious systemic disease. The primary outcomes included improvement of erythema and reduction of scaling, assessed by photographyweekly for fourweeks. At the end of the fourth week, more patients who received acyclovir had reduced erythema (measure not specified) compared with no treatment (93% vs 62%; P5.006). More patients experienced a reduction in skin scaling at week 4 in the acyclovir group compared with no treatment (80% vs 100%; P,.001). Side effects were not reported.