When should I consider referring a patient with pityriasis rosea to a dermatologist?

Consider referring a patient with pityriasis rosea to a dermatologist if:

• The diagnosis is uncertain or the presentation is atypical, as a biopsy may be needed to confirm the diagnosis.
• The patient has extensive disease or severe itch that is not controlled by simple treatments in primary care, such as emollients, topical corticosteroids, or oral antihistamines.
• The patient is pregnant, especially if pityriasis rosea develops in the first 15 weeks of pregnancy, due to associated risks like miscarriage and premature delivery, requiring urgent secondary care discussion.
• There is a need for specialist management for severe or refractory cases, where treatments like oral corticosteroids, acyclovir, or phototherapy might be considered.

Do not prescribe oral corticosteroids in primary care for severe itch without specialist input.

These referral criteria are based on expert opinion and position statements from dermatology authorities and clinical guidance.

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