The comparison between the efficacy of high dose acyclovir and erythromycin on the period and signs of pitiriasis rosea

Abstract

Background:Pityriasis Rosea (PR) is an acute inflammatory and self-limiting skin disorder, sometimes with troublesome symptoms. To date, there are few treatments available for this disorder.Aim:Compare the traditional treatment with erythromycin to a newly introduced antiviral treatment acyclovir for PR.Materials and Methods:Patients with clinically confirmed diagnosis of PR, matching our exclusion criteria, were enrolled. They were randomized in two groups that received high-dose oral acyclovir or erythromycin. The participants were evaluated two, four, and eight weeks after commencement of the study and followed for one year.Results:A total of 30 patients including 15 males and 15 females completed the study. After eight weeks, 13 patients in the acyclovir group experienced complete response, while in the erythromycin group only six patients had complete response (P < 0.05). Also, patients in the acyclovir group experienced faster resolution of pruritus in comparison with the erythromycin group (not significant). No adverse drug reaction was detected in both groups.Conclusion:It seemed that a high-dose of oral acyclovir was a safe and effective therapy for PR, although this remained to be confirmed in larger studies.

Gianotti-Crosti Syndrome, Pityriasis Rosea, Asymmetrical Periflexural Exanthem, Unilateral Mediothoracic Exanthem, Eruptive Pseudoangiomatosis and Papular-Purpuric Gloves and Socks Syndrome: A Brief Review and Arguments for Diagnostic Criteria

“…33 – 35 With the viral etiologies unknown, antiviral therapies and immuno-modulating therapies are already in use. 36 – 38 These agents might cause significant adverse effects, and we have to gather adequate data to support or refute their use.…”

Intervenciones terapéuticas en pitiriasis rosada: revisión de la literatura

“…En otro estudio en que se comparó el uso de aciclovir a altas dosis (800 mg, 5 veces al día), se encontró que su uso disminuía el tiempo hasta la resolución, sobre todo en aquellos pacientes en quienes el tratamiento se iniciaba en la primera semana desde la aparición de las lesiones (14) . En cuanto a los ensayos clínicos que comparaban la eficiencia del uso de aciclovir con la de la eritromicina en la resolución de la pitiriasis rosada, se encontró que, aunque ambos tratamientos eran efectivos en disminuir la gravedad y la duración de la reacción exantemática, el aciclovir era mejor que la eritromicina (15) ; en el otro estudio en que se comparó el aciclovir con la eritromicina, se obtuvieron resultados similares; el uso de aciclovir estaba asociado con la resolución completa de la reacción cutánea y resolución más rápida del prurito, en comparación con la eritromicina (16) . En lo referente al uso de antibióticos, no se sabe con exactitud el mecanismo de acción por el cual actúan en la pitirasis rosada, aunque se sabe que los macrólidos tienen actividad inmunomoduladora y antiinflamatoria, por lo que su efectividad no implicaría una etiología bacteriana (2) .…”

Acyclovir in pityriasis rosea: An observer-blind, randomized controlled trial of effectiveness, safety and tolerability

“…Such a study conducted by Ehsani et al on 30 patients with PR showed that patients in the acyclovir group responded significantly better than the patients treated with erythromycin. [ 8 ] In another study conducted by Amatya et al , response to oral acyclovir compared with that to oral erythromycin was better and statistically significant in the first, second, fourth and sixth weeks. [ 9 ] Drago et al conducted a similar study with either oral acyclovir (800 mg 5 times daily) or placebo.…”

“…Pruritus was graded as 0 (absent itching); 1 - mild (itching present but not disturbing life); 2 - moderate (disturbing, but not hampering daytime activities and/or sleep); 3 - severe/intense (disturbing and hampering daytime activities and/or sleep). Response to therapy[ 8 ] was categorized as: (a) Complete response - no new lesions, disappearance of all previous lesions, with or without residual postlesional pigmentation; (b) partial response - a few new lesions, regression or disappearance of some previous lesions; (c) no response - no regression of lesions, appearance of new lesions.…”