Oral acyclovir in treatment of pityriasis rosea
Abstract
OBJECTIVE
To identify the efficacy of oral acyclovir in treatment of pityriasis rosea (PR).
METHODS
Four independent reviewers systematically searched through electronic databases without language restriction, included Pubmed, Cochrane library, Scopus, and Trip Database. We also performed hand searching to find all relevant studies outside the databases. We assessed quality and risk of bias of the included studies using Jadad score and The Cochrane Collaboration’s Tool for Assessing Risk of Bias. We extracted data from the included studies. The meta-analysis was performed where appropriate.
RESULTS
There were four randomized controlled trials identified, involving 251 patients with PR. Using oral acyclovir comparing with placebo or no treatment was associated with 2.76 times higher response rate to treatment (95% confidence interval (CI), 1.86 to 4.09; P<0.001; I2=11%), 2.19 times higher response rate to treatment (95% CI, 1.73 to 2.78; P<0.001; I2=18%) at the first week and the second week, respectively, and 44% relative risk reduction (RR 0.56, 95% CI, 0.41 to 0.77; P=0.004; I2=21%) in occurrence rate of new skin lesion after following in the first week.
CONCLUSION
Oral acyclovir was superior to placebo or no treatment for treating patients with PR regarding response rate to treatment at the first and the second week as well as occurrence rate reduction of the new skin lesion in the first week after starting the treatment.
References
Drago F, Ciccarese G, Rebora A, Broccolo F,Parodi A. Pityriasis Rosea: A Comprehensive Classification. Dermatology. 2016 Apr 21;232(4):431–7.
Miranda S, Lupi O, Lucas E. Vesicular pityriasis rosea: response to erythromycin treatment. Journal of the European Academy of Dermatology and Venereology. 2004 Sep 1;18(5):622–5.
Stulberg DL, Wolfrey J. Pityriasis rosea. Am Fam Physician. 2004 Jan 1;69(1):87–91.
González LM, Allen R, Janniger CK, Schwartz RA. Pityriasis rosea: an important papulosquamous disorder. Int J Dermatol. 2005 Sep;44(9):757–64.
Chuh A, Lee A, Zawar V, Sciallis G, Kempf W. Pityriasis rosea--an update. Indian J D e r m a t o l Ve n e r e o l L e p r o l . 2 0 0 5 Oct;71(5):311–5.
Chuh A, Chan H, Zawar V. Pityriasis rosea--evidence for and against an infectiousaetiology. Epidemiol Infect. 2004 Jun;132(3):381–90.
Drago F, Ranieri E, Malaguti F, Losi E, Rebora A. Human herpesvirus 7 in pityriasis rosea. Lancet 1997; 349: 1367–1368.
Drago F, Malaguti F, Ranieri E, Losi E, Rebora A. Human herpes virus-like particlesin pityriasis rosea lesions: an electron microscopy study. J Cutan Pathol 2002; 29:359–361.
Drago F, Broccolo F, Rebora A. Pityriasisrosea: an update with a critical appraisal of its possible herpesviral etiology. J Am Acad Dermatol 2009;61: 303–318.
Rebora A, Drago F, Broccolo F. Pityriasis rosea and herpesviruses: facts and controversies. Clin Dermatol 2010; 28:497–501.
Drago F, Broccolo F, Ciccarese G, Rebora A, Parodi A. Persistent pityriasis rosea: an unusual form of pityriasis rosea with persistent active HHV-6 and HHV-7 infection. Dermatology 2015; 230: 23–26.
Elion GB. Mechanism of action and selectivity of acyclovir. Am J Med. 1982 Jul 20;73(1A):7–13.
Zhang Y. Selective activity of various antiviral compounds against HHV-7 infection. Antiviral Research 1999;43:23–35.
McKnight SL (1980). The nucleotide sequence and transcript map of the herpes simplex virus thymidine kinase gene. Nucleic Acids Res. 8 (24): 5949–64.
Jadad, A.R., Moore R.A., Carroll D.,Jenkinson C., Reynolds D.J.M., Gavaghan D.J. McQuay H.J. (1996). Assessing the quality of reports of randomized clinical trials: Is blinding necessary. Controlled Clinical Trials. 17 (1): 1–12.
Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions. John Wiley & Sons Ltd, The
Atrium, Southern Gate, Chichester, West Sussex PO19 8SQ, England; 297-325 p.
7 . E h s a n i A , E s m a i l y N , N o o r m o h a m m a d p o u r P, To o s i S , Hosseinpour A, Hosseini M, et al. The
Comparison Between The Efficacy of High Dose Acyclovir and Erythromycin on The Period and Signs of Pityriasis Rosea. Indian J Dermatol. 2010;55(3):246–8.
Amatya A, Rajouria EA, Karn DK. Comparative study of effectiveness of oral acyclovir with oral erythromycin in the treatment of Pityriasis rosea. Kathmandu Univ Med J (KUMJ). 2012 Mar;10(37):57–61.
Daliri M. Effects of oral acyclovir on the treatment of pityriasis rosea (PR). Zahedan Journal of Research in Medical Sciences (TABIB-E-SHARGH). 2008 Jan 1;10(1):37–43.
Rassai S, Feily A, Sina N, Abtahian S. Low dose of acyclovir may be an effective treatment against pityriasis rosea: a random investigator-blind clinical trial on 64 patients. Journal of the European A c a d e m y o f D e r m a t o l o g y a n d Venereology. 2011 Jan 1;25(1):24–6.
Ganguly S. A Randomized, Doubleblind, Placebo-Controlled Study of Efficacy of Oral Acyclovir in the Treatment of Pityriasis Rosea. J Clin Diagn Res. 2014 May;8(5):YC01-YC04.
Das A, Sil A, Das NK, Roy K, Das AK, Bandyopadhyay D. Acyclovir in pityriasis rosea: An observer-blind, randomized controlled trial of effectiveness, safety and tolerability. Indian Dermatol Online J. 2015 Jun;6(3):181–4.
Drago F, Vecchio F, Rebora A. Use of high-dose acyclovir in pityriasis rosea. J Am Acad Dermatol. 2006 Jan;54(1):82–5.
Singh S, Anurag, Tiwary NK. Acyclovir is not effective in pityriasis rosea: Results of a randomized, triple-blind, placebocontrolled trial. Indian J Dermatol Venereol Leprol. 2016 Oct;82(5):505–9.
Nilsen A, Aasen T, Halsos A, Kinge BR, Tjtta EL, Wikström K, et al. Efficacy of Oral Acyclovir in the Treatment of Initial and Recurrent Genital Herpes. The Lancet. 1982 Sep 11;320(8298):571–3.
6 . S c h u s t e r A K , H a r d e r B C , Schlichtenbrede FC, Jarczok MN, Tesarz J. Valacyclovir versus acyclovir for the treatment of herpes zoster ophthalmicus in immunocompetent patients. Cochrane D a t a b a s e S y s t R e v . 2016 Nov 14;11:CD011503.
Gopal MG, Shannoma, Kumar B.C. S, M. R, A.S. N, Manjunath NC. A Comparative Study to Evaluate the Efficacy and Safety of Acyclovir and Famciclovir in the Management of Herpes Zoster. J Clin Diagn Res. 2013 Dec;7(12):2904–7.
Js B, I A, S S, M S, M B. Delirium during oral therapy of herpes zoster with acyclovir. Case report and brief review of central nervous system side-effects of acyclovir. Nervenarzt. 1998 1998;69(11):1015–8.
Fleischer R, Johnson M. Acyclovir N e p h r o t o x i c i t y : A Case Report High lighting the Importance of Prevention, Detection, and Treatment of Acyclovir-Induced Nephropathy. Case Reports in Medicine . 2010 Aug
;2010:e602783.
Chuh A, Zawar V, Sciallis G, Kempf W. A position statement on the management of patients with pityriasis rosea. J Eur Acad D e r m a t o l V e n e r e o l . 2 0 1 6 Oct;30(10):1670–81.
Stulberg DL, Wolfrey J. Pityriasis rosea. Am Fam Physician. 2004 Jan 1;69(1):87–91.
