Pityriasis Rosea vs. Guttate Psoriasis Compared - Verywell Health

Pityriasis rosea is a rash that typically appears on the upper arms and legs, trunk, or neck. It is sometimes confused with a type of psoriasis called guttate psoriasis because skin symptoms of each might appear similar. 

Guttate psoriasis appears as red, scaly, small, teardrop-like spots on the skin. It primarily affects children and young adults. It sometimes means that you might develop plaque psoriasis later on.

Psoriasis is considered an autoimmune skin disease that occurs when the immune system malfunctions and starts to attack healthy tissues, mainly the skin, which leads to accelerated skin cell growth.

This article covers the similarities and differences between pityriasis rosea and guttate psoriasis, including symptoms, diagnosis, treatment, and more.

Pityriasis Rosea and Psoriasis Aren't the Same

Pityriasis rosea and psoriasis have some things in common. They also differ in many ways.

Similarities 

Pityriasis rosea and psoriasis both cause patches of a scaly rash on the skin. With pityriasis rosea, there is one large, scaly patch called a herald patch or mother patch, as well as smaller patches called daughter patches. The guttate rash is typically large and consists of small bumps. 

Another type of psoriasis called plaque psoriasis causes thick, scaly lesions covered in silvery scales called plaques. Plaque psoriasis is the most common type of psoriasis and affects 80% to 90% of people with psoriasis. Guttate psoriasis affects around 8% of people with psoriasis.

Neither of these conditions is contagious. That means you cannot get the rash from close or intimate contact with someone with pityriasis rosea or psoriasis. 

Differences 

Pityriasis rosea clears on its own and is usually not serious. Even so, it is still a good idea to see a healthcare provider to rule out other conditions that share similar symptoms. 

Psoriasis also causes a skin rash due to inflammation. It is a chronic disease you will need to treat for the rest of your life. Some types of psoriasis can clear up on their own, especially guttate psoriasis. Still, there is the potential for a recurrence or development of plaque psoriasis after guttate psoriasis has cleared. 

Pityriasis rosea can affect anyone, but it often occurs during pregnancy and can cause pregnancy complications. Psoriasis is caused by specific genetic mutations and environmental factors and can affect anyone regardless of age or sex. 

Symptoms

Both pityriasis rosea and psoriasis cause skin rashes. Rashes are itchy and might affect multiple body areas.

Pityriasis Rosea 

The main symptom of pityriasis rosea is the large, scaly herald patch rash. One to two weeks after the herald patch, multiple smaller daughter patches appear on the chest, abdomen, back, arms, and legs. Pityriasis rosea also causes itchy skin in at least 50% of people with the condition.

How the pityriasis rosea rash appears on the skin will depend on your skin tone. It appears as one large patch with a rash of small bumps on the darker skin. The rash and bumps will be a darker violet or brown color. People with darker skin are more likely to have scales on the rash.

For people with lighter skin tones, the pityriasis rosea rash often appears as one patch, which are followed by smaller patches. The patches are pink to salmon in color. 

People with pityriasis rosea rash usually experience flu-like symptoms for a day or two before the rash appears. 

Pityriasis rosea rash on neck and chest.

dimid_86 / Getty Images

Flu-like symptoms linked to the pityriasis rosea rash include:

• A sore throat, as a primary symptom 
• Fatigue
• Headache 
• Fever 
• Aches
• Nausea 
• Sleep troubles 
  

Pityriasis rosea is generally harmless but is sometimes linked to an increased risk for birth complications, including the risk of miscarriage and neonatal hypotonia (poor muscle tone in a newborn).

Psoriasis 

Guttate psoriasis is one subtype of psoriasis. It is known for causing small, teardrop-like spots. These spots are raised and red with a silvery scaly appearance. Dry skin might peel off or flake off. Some people might experience irritated and itchy skin. 

The onset of guttate psoriasis can occur over a few days. Lesions might be widespread throughout the body, but they primarily will cover the trunk, arms, and legs. Some people might have lesions on the face, scalp, and ears.

Guttate psoriasis presents as small pink, violet, or brown spots. On darker skin, psoriasis lesions might appear dark brown, making diagnosing the condition harder.

Skin symptoms of guttate psoriasis will sometimes go away on their own. It is generally not chronic or as severe as other types of psoriasis. Some people might experience recurrences of symptoms, but these will go away without the condition becoming plaque psoriasis. 

Reproduced with permission from © DermNet New Zealand www.dermnetnz.org 2023.

Additional psoriasis subtypes include:  

• Plaque psoriasis causes thick, red lesions with silver scales that pile up on the skin. Some people might experience plaque psoriasis on their scalp.
• Inverse psoriasis causes red, inflamed skin in areas where skinfolds are located, such as under the arms and the breasts.
• Pustular psoriasis is rare and causes pus-filled bumps mainly found on the hands and feet.
• Erythrodermic psoriasis is also rare. It causes a red skin rash that looks like a burn over most of the body. This type of psoriasis is a medical emergency and requires hospital care.
• Nail psoriasis causes the fingernails and toenails to become damaged, pitted, and lifted. It is commonly seen with plaque psoriasis and psoriatic arthritis. 
• Psoriatic arthritis causes joint pain, severe swelling of the digits of the hands and feet, and inflammation of the entheses, areas where tendons and ligaments meet bone.
  

Triggers 

Pityriasis rosea might be triggered by a viral infection. The most common viral infections linked to pityriasis rosea are herpesvirus 6 and 7 strains.

Upper respiratory tract infections are also known triggers for pityriasis rosea. Some research suggests the COVID-19 virus might be a viral trigger. 

Guttate psoriasis is a condition that will appear suddenly. An infection like strep throat might initially trigger it. While there isn't enough research to confirm that COVID-19 might trigger psoriasis, psoriasis development is linked to various infections and viruses, including respiratory ones like COVID-19.

Recurrences of guttate psoriasis might be triggered by certain medicines (i.e., beta-blockers or antimalarials), infections (i.e., a sinus or upper respiratory infection), injury to the skin, or mental stress. An infection might also trigger plaque psoriasis.

Diagnosis: How to Know for Sure

Because pityriasis rosea and psoriasis can present similarly, it is crucial to determine the source of symptoms. Once a diagnosis is made, treatment can start, if necessary. 

Pityriasis rosea is usually not severe and often resolves without treatment. Even so, it is still a good idea to see a healthcare provider so they can rule out other conditions.

Most of the time, a healthcare provider can diagnose pityriasis rosea by examining your skin. If they are unsure or want to confirm the diagnosis, they may perform a biopsy. This procedure requires removing a small sample of affected skin to send to a lab for testing. 

For diagnosing psoriasis, a healthcare provider will review your medical history and examine your skin, scalp, and nails. If they suspect psoriasis, they may request a biopsy to determine the type of psoriasis and to rule out other conditions. 

Treatment Considerations

Treatment for pityriasis rosea is typically unnecessary, and the condition will resolve on its own. Psoriasis treatment will depend on the type and severity of the symptoms. 

Type of Psoriasis 

The goals of psoriasis treatment are to decrease disease severity, improve quality of life, and reduce skin lesions.

Psoriasis is treated with topical creams and ointments, phototherapy (light therapy), and oral and injected systemic (whole-body) drugs. Oral and injected drugs include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, disease-modifying antirheumatic drugs (DMARDs), and biologic DMARDs.

Treatment for different types of psoriasis may include:

• Guttate psoriasis will sometimes clear up on its own. Your healthcare provider may prescribe oral systemic drugs, such as methotrexate, to treat it and keep it from recurring. Severe cases are treated with biologic drug therapies. 
• Plaque psoriasis is treated with topical medicines, phototherapy, and oral and injected therapies. Topical therapy for scalp psoriasis might include medicated shampoos. 
• Inverse psoriasis is typically treated with topical creams. In more severe cases, oral systemic drugs are used. 
• Pustular psoriasis treatment includes topical medicines, phototherapy, and systemic medicines. The type of treatment prescribed will depend on the severity of your symptoms and might include a combination of therapies.
• Erythrodermic psoriasis is considered a medical emergency, and treatment starts by stabilizing body temperature and getting vital signs under control. Biologic drug therapy might be done by intravenous (IV) infusion, and systemic oral medicines and topical therapies might also be given. 
• Nail psoriasis is typically treated with topical, systemic drugs and phototherapy. Treatments might be tailored to treat your unique symptoms.
• Psoriatic arthritis treatments aim to manage pain and keep the condition from worsening. Treatment might include NSAIDs, corticosteroids, DMARDs, and biologic DMARDs. Your healthcare provider might recommend lifestyle modifications (exercising, losing weight, not smoking, etc.) and physical therapy.
  

Pityriasis Rosea Usually Goes Away 

Pityriasis rosea often clears on its own. It could take up to eight weeks, but it is possible to have a rash for five or more months.

Home Remedies for Symptoms

To relieve the itch, try these tactics:

• Cool compress
• Over-the-counter (OTC) pramoxine lotion, hyrocortisone cream, or calamine lotion
• OTC antihistamine pills

To reduce discomfort, take only lukewarm baths or showers, and switch to gentle, fragrance-free soaps and moisturizers. Avoid overheating and protect yourself from sunburn.

The condition generally requires no treatment, but a healthcare provider can prescribe medicines to relieve symptoms, especially itch. 

Such treatments might include: 

Similar Conditions to Psoriasis and Pityriasis Rosea

Other skin conditions, some of which are minor and others which might be serious, can be mistaken for psoriasis or pityriasis rosea. For your skin to clear up, it is essential to determine what is causing skin symptoms because each skin condition needs different treatments. 

Conditions that might be mistaken for psoriasis or pityriasis rosea include:

• Eczema: Also called atopic dermatitis, it causes itchy, dry, red, or brown bumpy skin. It might also cause fluid-filled bumps that ooze or crust over. It typically starts in childhood and might resolve before adulthood.
• Nummular dermatitis: This skin condition, sometimes called discoid eczema, causes coin-shaped spots on the skin. These spots are itchy and may ooze and crust. Nummular dermatitis appears as one patch or as multiple. It generally occurs after a burn, cut, or insect bite.
• Ringworm: Ringworm is a fungal infection that appears as an itchy, round rash with clear skin in the middle. 
• Keratosis pilaris: This skin condition causes hair follicles to become clogged with keratin protein. It causes bumpy, rough patches. 
• Rosacea: This skin condition causes redness and pus-filled bumps on the face. 
  

Summary

Pityriasis rosea and guttate psoriasis are different skin conditions. They both usually are temporary conditions, although guttate psoriasis can recur. Pityriasis rosea often clears without treatment, and guttate psoriasis may sometimes need treatment to clear up. 

Other types of psoriasis are chronic and will require long-term treatment. Psoriasis is a problem in the immune system that causes skin cells to turn over too quickly. This leads to a buildup of plaques on the top of the skin. Treatments for psoriasis include topical medicines, phototherapy, and oral and injected systemic drugs.

Pityriasis rosea also causes skin lesions, but those typically start in one area before the rash worsens and appears on other areas of the body. The condition lasts up to eight weeks, but in some cases, it may last five or more months. If treatment is needed, it is generally prescribed to manage itch or skin irritation.