Effectiveness of acyclovir in the treatment of pityriasis rosea. A systematic review and meta-analysis

Abstract

BackgroundThere is a lack of evidence to support acyclovir administration in pityriasis rosea.ObjectiveTo determine the efficacy of acyclovir in patients with typical pityriasis rosea.MethodsA systematic review and meta-analysis of experimental studies was performed in MEDLINE, SCOPUS, EMBASE and others, from January 1990 to October 2016 on acyclovir for pityriasis rosea. Random effect model was used to find the pooled Risk Ratio. Outcomes, evaluated between weeks 1 to 8, were regression of lesions, cessation of lesions, decrease of symptoms and duration of disease. Comparisons were acyclovir vs. placebo; acyclovir vs. symptomatic treatment; acyclovir vs. antibiotic; acyclovir vs. observation and combined therapy (acyclovir plus symptomatic treatment) vs. symptomatic treatment alone.ResultsSeven papers were analyzed with 324 participants, of which 159 received acyclovir and 165 were controls. Acyclovir was superior to placebo for complete regression of lesions at week 1 (Risk Ratio 5.72, CI95% 2.36-13.88). However, combined therapy was not superior to symptomatic treatment at week 4 (Risk Ratio 1.46, CI95% 0.93-2.29). Individual studies showed the superiority of acyclovir for the control of symptoms and pruritus.Study limitationsWe faced differences designs of trials and inconsistency between reports.ConclusionSymptomatic treatment is a reasonable option for pityriasis rosea, and the addition of acyclovir is justified for the control of symptoms and pruritus.

Pityriasis rosea, COVID‐19 and vaccination: new keys to understand an old acquaintance

“…Regression of lesions in response to acyclovir therapy strengthens that hypothesis. 4 Nonetheless, other studies have failed to detect such findings, so PR appearing in association with COVID-19 may question the link between the former and herpesviruses. Given that HHV-6/7 reactivation might represent an epiphenomenon in the setting of immune dysregulation, a doubt arises on whether PR could be a direct manifestation of viral primoinfections, like SARS-CoV-2.…”

L‐lysine therapy to control the clinical evolution of pityriasis rosea: Clinical case report and literature review

“…In recent years, several treatment options have been proposed to combat clinical manifestations of PR, including the use of antivirals 28 . Systematic reviews concluded that acyclovir was superior to placebo in controlling dermal symptoms and itching, helping with remission of PR by act to suppress viral replication 29,30 …”

“…Consideration that acyclovir acts in PR 18,29,30 as well as in Herpes Labial with the same mechanism of action and effect, 31,32 and that the amino acid L‐lysine has similar results to acyclovir, 19,20 it is suggested that L‐lysine can act positively in PR.…”

Pityriasis rosea‐like cutaneous eruption as a possible dermatological manifestation after Oxford‐AstraZeneca vaccine: Case report and brief literature review

“…Studies have shown a strong association of PR with human herpesviruses (HHV‐6 and HHV‐7) as an etiological factor 12 , 14 , 15 , 16 and with the suspicion of this viral involvement, therapy with antivirals such as acyclovir was indicated 15 , 17 , 18 as well as alternative therapy with l ‐Lysine amino acid 14 , 19 that showed positive results in reducing healing time as limiting the number of lesions when started at the beginning of the dermal manifestation, as soon as possible, still the first 2 weeks, in the viral multiplication phase. 14 , 19 , 20 …”