Author's Response - The efficacy of azithromycin in pityriasis rosea: A randomized, double-blind, placebo-controlled trial

Deepika Pandhi, Prashant Verma, Archana Singal, Reena Sharma

 Department of Dermatology and STD, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, India

Correspondence Address:
Deepika Pandhi
B 1/1101, Vasant Kunj,Delhi - 110 070
India

Sir,

We would like to thank Drago et al. for their interest in our publication. ^[1] The authors also point out that macrolides including azithromycin are known to have antiinflammatory and immuno-modulatory actions and therefore, their efficacy does not necessarily support bacterial infection (s) or exclude viral infection (s) from being the cause of pityriasis rosea (PR). ^[2] In 2000, Sharma et al.^[3] published a study that showed great success with oral erythromycin in inducing resolution of pityriasis rosea in a group of 45 patients. Similarly, Villarama et al. also found erythromycin to be effective in a randomized double-blind control trial (unpublished). ^[2] There was a dearth of randomized double-blind control trials of macrolides in pityriasis rosea. Amer et al.^[4] reported the only randomized double-blind placebo-controlled published trial in which azithromycin was not found to be effective. Their study comprised only 49 pediatric patients (mean age: 8 years) while the present study comprised a larger sample size of 70 and included patients with a mean age of 23.3 years (range 2-44 years). Further there were 2 other differences: pityriasis rosea was diagnosed by dermatologists and the objective pityriasis rosea severity score (PRSS) was employed in our study. ^[4] Chuh et al., in their comprehensive systematic review of interventions in pityriasis rosea, had recommended more randomized controlled trials in particular to investigate the efficacy of oral erythromycin or other macrolide antibiotics. ^[2] Also, it is pertinent to note that there have been several recent published case reports reporting successful treatment of pityriasis rosea with various macrolides including clarithromycin and roxithromycin. ^[5],[6] The aim of our study was not to find the ideal treatment for pityriasis rosea but to evaluate the efficacy of azithromycin in a double-blind placebo-controlled trial. The negative results obtained by us do not favor the prescription of azithromycin for pityriasis rosea. ^[1] The excellent results of acyclovir obtained by other workers can also be validated by similar double-blind placebo-controlled trial using a tool such as pityriasis rosea severity score (PRSS) in a large cohort of patients. ^[6],[7] Finally we concur with the author′s statement that as of now no treatment can be recommended on the basis of evidence-based medicine, and pityriasis rosea remains a self-limiting exanthematous disease that probably just needs reassurance of the patient, which significantly was also the concluding statement of our study.

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