Pityriasis Rosea vs Tinea Infections
Pityriasis Rosea and Tinea Infections are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Pityriasis Rosea vs Tinea Infections at a glance
- Pityriasis Rosea: Self-limited papulosquamous eruption with herald patch and Christmas-tree distribution; likely HHV-6/7 reactivation.
- Tinea Infections: Superficial dermatophyte (and Malassezia) infections of skin, hair, and nails with site-specific presentations.
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Side-by-side comparison
| Feature | Pityriasis Rosea | Tinea Infections |
|---|---|---|
| At a glance | Self-limited papulosquamous eruption with herald patch and Christmas-tree distribution; likely HHV-6/7 reactivation. | Superficial dermatophyte (and Malassezia) infections of skin, hair, and nails with site-specific presentations. |
| Classic presentation | Herald patch + Christmas-tree distribution on trunk + collarette of scale on peripheral lesions.; Mild prodrome (50%): headache, malaise, low-grade fever, sore throat; Pruritus mild to moderate (25-75%), occasionally severe; Asymptomatic in many patients; Herald patch: 2-10 cm single oval, salmon-pink plaque with collarette of scale at… | Active raised scaly border with central clearing (corporis); KOH 'spaghetti and meatballs' (versicolor); Wood's lamp yellow-green fluorescence (Microsporum tinea capitis).; Pruritus (mild to moderate); Scalp scaling, hair loss (capitis); Burning, fissuring between toes (pedis); Cosmetic concerns (versicolor); Tinea corporis: annular… |
| Workup / key labs | Clinical: herald patch + secondary eruption in characteristic distribution + collarette of scale; self-limited course 6-8 weeks.; Clinical diagnosis; RPR/VDRL to exclude secondary syphilis in all sexually active adults; KOH of herald patch if tinea suspected; Skin biopsy rarely needed: spongiosis, parakeratosis in mounds, mild… | KOH and/or culture positivity in characteristic clinical setting.; KOH preparation of scale or hair: branching septate hyphae (dermatophyte) or short hyphae + spores ('spaghetti and meatballs') for versicolor; Fungal culture (Sabouraud or DTM agar) — confirms species, especially for capitis and onychomycosis before systemic therapy;… |
| Imaging | Not indicated | Not indicated |
| First-line treatment | Reassurance — disease is self-limited, resolving in 6-8 weeks (range 2 weeks to 3 months) without scarring; Symptomatic care for pruritus: emollients, low-mid potency topical corticosteroid (triamcinolone 0.1%), oral antihistamines (cetirizine, hydroxyzine for sleep); Oatmeal baths, calamine lotion for itch; Sun exposure or narrowband… | Tinea corporis / cruris / pedis (limited): topical antifungal — clotrimazole 1% BID, ketoconazole 2% BID, terbinafine 1% BID, ciclopirox 0.77% BID — continue 1-2 weeks beyond clinical resolution (typically 2-4 weeks); Tinea pedis (moccasin or extensive): oral terbinafine 250 mg daily × 2 weeks OR oral itraconazole 200 mg BID × 1 week… |
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