Many people aren't familiar with pityriasis rosea, and seeing the strange rash develop can be really alarming. My guest today will explain what it is, and why you shouldn't freak out if you have it.
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My guest today is Dr. Ingels, ND, FAAEM, a respected leader in natural medicine with more than 28 years experience in the healthcare field. He is Board certified in Integrated Pediatrics and a Fellow of the American Academy of Environmental Medicine.
Dr. Ingels has been published extensively and is the author of The Lyme Solution: A 5-Part Plan to Fight the Inflammatory Autoimmune Response and Beat Lyme Disease, a comprehensive natural approach to treating Lyme disease.
He specializes in Lyme disease, autism and chronic immune dysfunction. He uses diet, nutrients, herbs, homeopathy and immunotherapy to help his patients achieve better health.
Join us as we discuss pityriasis rosea.
Have you dealt with pityriasis rosea? Let me know in the comments!
In this episode:
- What exactly is pityriasis rosea?
- Is it contagious?
- What could help the condition?
- What is chickweed and how can it help with itchy skin?
Quotes
“And topically, just for some comfort, if you've got one or two lesions that really seem to bother you we've got a lot of great herbal topicals that are quite helpful so you can use calendula, you can use comfrey, you can use chickweed.” [9:24]
“Chickweed, its botanical name is called stellaria. It's an herb and chickweed is one of the herbs that has one of the best anti-itch effects.” [9:59]
Links
Get Dr. Ingels's FREE Top 10 Immune Boosting Recipes eBook HERE
Think you might have Lyme Disease? Take this quiz!
Healthy Skin Show ep. 056: Hidden Lyme Disease And Your Skin w/ Dr. Darin Ingels
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126: Pityriasis Rosea – What Is It & How To Deal With It Before You Freak Out w/ Darin Ingels, ND, FAAEM FULL TRANSCRIPT
Jennifer: Hi everyone. Welcome back. Today I have a recurring guest with me, one of my favorite guests, one of my favorite people actually. His name is Dr Darin Ingels, and he is a respected leader in natural medicine with more than 28 years experience in the healthcare field. He's board certified in integrated pediatrics and a fellow of the American Academy of Environmental Medicine. Dr Ingels has published extensively and is the author of the Lyme Solution: A Five Part Plan to Fight the Inflammatory Autoimmune Response and Beat Lyme Disease, and this is a comprehensive natural approach to treating Lyme disease. You guys might remember we talked about Lyme last year. Also he specializes not just in line but in autism and chronic immune dysfunction using diet, nutrients, herbs, homeopathy and immunotherapy to help his patients achieve better health. Dr Ingels, thank you so much for joining us again.
Dr. Ingels: Oh, thanks for having me back on, Jen.
Jennifer: This is exciting. We're going to talk about a topic that has never been covered on the Healthy Skin Show yet. It's the first time ever, and frankly I had never heard of this condition when you shared this with me, and when I went to look at pictures, I'd be like, “Oh my gosh, if that happened to me, I would freak out.” So I think it's a really good topic to talk about because when we deal with rashes, it can be really frustrating and sometimes you don't know whether you need to go to the doctor or whether it's something really serious, and even you shared too that you've actually had this issue and you thought it was something coming back. So why don't you share it with us? What exactly pityriasis rosea is and why might one freak out if they started to get this rash?
Dr. Ingels: Yeah, so pityriasis rosea is a… Fortunately it's a benign condition and I think what really freaks people out is the initial presentation of the skin rash is you get a thing called a herald patch and what it is, it's a large lesion. Typically it occurs somewhere on your trunk, so it could be on your back, it could be on your belly, could be on your sides. It can be about anywhere from three to about six centimeters, but usually it's oval shaped. It's a flat rash. It doesn't tend to be terribly itchy, it's mildly itchy, but it kind of appears out of nowhere. And then shortly thereafter it follows by several other smaller lesions that typically run or long your back, your upper arms, your upper legs.
Dr. Ingels: One thing about this skin rash that's very unique is we call it a Christmas tree distribution. So if you stand back from someone who has it and you just look at their back, basically, you can imagine these lesions start at the spine and almost like the branch is coming off a pine tree or a Christmas tree, they start to swerve out from the spine out to your sides and it'll go from your neck all the way down to your waist. That herald patch, that one large lesion will be much larger than all the other lesions. So if the herald patch runs three to six centimeters plus, these other lesions may only be one to two centimeters or smaller. Again, it's a non raised, mildly itchy rash. And the good news about it again is it is a benign skin rash, so for people who develop it and see it and go, “Oh my gosh,” there really isn't a whole lot of conventional treatment for it because it's not problematic.
Dr. Ingels: You could use steroids or some sort of moisturizer just if one lesion does get a little irritated, but it's a self-limiting skin condition and typically within six to eight weeks it resolves on its own. We don't really know what causes pityriasis. I'd say in my population where I've seen it, typically I see it in people who've undergone some sort of stress, so I imagine it's a function of when your immune system's compromised, the skin rash is allowed to surface. Again, it happened to me, and for anyone who's had Lyme disease and particularly if you ever had a Lyme skin rash, that classic erythema migrans bullseye rash, there are different manifestations of Lyme rashes. So when I saw it on myself, I actually had it on my left side. I'm like, “Oh my gosh, is this a Lyme rash again?” And then within a couple of days of that first patch showing up, I saw that whole Christmas tree distribution. So I'm like, “Okay, it's fine. It's just pityriasis.” Panic button went down and everything's cool again. But again, the good news is it is self-limiting and usually within about two months it'll go away on its own.
Jennifer: So with this, it sounds like there could also be confusion with ringworm and some other rashes that people have, because when I looked at the pictures, I was like, “Ooh.” I would freak out, I'm being honest with you. I would definitely freak out and think I got into something or I was exposed to something. Is it that it's confused sometimes at the dermatologist's office or is it more just confusion in general when you're trying to self-diagnose what it is?
Dr. Ingels: A dermatologist really won't have much problem diagnosing it. Again, the pattern of it looks very different than ringworm. Ringworm compared to pityriasis tends to get very scaly around the edges of the lesion and ring word is much more itchy. I mean, ringworm, you want to peal your skin off sometimes. With pityriasis generally it's mildly itchy, not nearly to the intensity you see with ringworm. Ringworm also tends, the lesions tend to be much more circular in their pattern, where the lesions of pityriasis are a bit more oblong, they're smaller, but again, the distribution's really the key difference between the two. And again, if you were confused, particularly with that herald patch, if you tried using an antifungal on it, it really wouldn't do anything. Where with ringworm, typically a topical antifungal will help pretty quickly.
Jennifer: Oh, that's an interesting little test.
Dr. Ingels: Yeah. If you were really unclear you could go buy an over the counter Tinactin or one of those topical antifungals, and if it starts to get better, we have a pretty good idea it's fungal, and if it doesn't change at all, then there's a pretty good chance it's not fungal. But again, if you started getting that wider distribution throughout your back, your front and your shoulders, again, if you went to a dermatologist, they really wouldn't have much difficulty making that diagnosis.
Jennifer: Okay. And is this something that is potentially contagious, if you've got little ones in the house or a spouse or any… Is it contagious?
Dr. Ingels: No, it's not contagious at all. It's one of those things that looks worse than it is, but yeah, there's nothing to spread. It's not caused by a bacteria, virus, at least as far as we know. But yeah, it's not a contagious lesion.
Jennifer: That's so interesting that it pops up. Any ideas or thoughts that you have about why maybe the Christmas tree pattern in the back?
Dr. Ingels: Well, the only thing that follows a Christmas tree pattern back is our nerves. Our nervous system kind of has that distribution, from where the nerve root comes out of your spine as it goes around your body, it does kind of follow that distribution. When we see shingles outbreaks, it will follow a nerve line, although it doesn't break out to the same degree that that pityriasis does. It may just be one little spot that you get a shingles outbreak and you would never confuse shingles for pityriasis. Shingles are blisters, they're vesicles, they're fluid filled, completely different, and shingles typically is very painful.
Jennifer: I can actually agree with you. I had shingles when I was 27.
Dr. Ingels: Oh yeah, shingles is brutal.
Jennifer: It is. Fortunately my dad, because he's an ophthalmologist, he would see it so frequently in his office, of people that would get shingles on their face and the primary care doctors didn't know what it was, and unfortunately it got worse. So I really got good at being like “Dad, I think there's a shingles case in room two.” And sure enough, it was always shingles. So when it started to come on, I knew the symptoms quite well and I said to my parents, I said, “I think I have shingles,” and my mom's like, “You're too young.” Sure enough I had shingles.
Dr. Ingels: I don't think shingles necessarily has an age group that it discriminates against. And again, if your immune system is compromised for any reason, you potentially can get shingles, particularly if you've had chicken pox when you were little. It's the same virus. With pityriasis, like I said, fortunately it's not contagious. It goes away on its own, even if you did absolutely nothing. But I think when it first comes on, again, like you said, it really freaks people out because they see these lesions developing all over their torso, not really understanding why. But again, my best guess is that they're probably something related to our nerve roots, just because that distribution is… It's so characteristic that we don't see really another skin lesion that does that.
Jennifer: And is there anything in your experience when you've had patients come in with it that they could do just in general to help care for it? I know you mentioned steroid creams, but if somebody doesn't want to go the steroid cream route because obviously they're uncomfortable with that, what… Is there anything else you could suggest even if it's not topical? Do even things like stress reduction could be helpful?
Dr. Ingels: Stress reduction, immune support definitely helps in my practice. A lot of nutrients that help support the immune system. So we have people up their vitamin C, you can use vitamin D, vitamin A, zinc, those four nutrients are kind of my go to to help support the immune system. And topically, just for some comfort, if you've got one or two lesions that really seem to bother you we've got a lot of great herbal topicals that are quite helpful so you can use calendula, you can use comfrey, you can use chickweed. All of those are really good for helping taking the itch out, moisturizing the skin, and there's a lot of companies that make combinations of those three herbs. Chickweed is actually one of the best for the itch.
Jennifer: Can you actually talk a little bit about that for a moment, because I don't think anybody's ever mentioned chickweed in all of the episodes I've done. So what is chickweed?
Dr. Ingels: So it's chickweed, its botanical name is called stellaria. It's an herb and a chickweed is one of the herbs that has one of the best anti-itch effects. You'll find that a lot of botanical companies, if they make a topical for eczema or any other itchy lesion, they'll typically include chickweed where calendula and comfrey are probably a little bit better just in terms of smoothing out or soothing the irritated skin, the chickweed very specifically is really effective for reducing the itch. What ends up happening with all these itchy skin lesions, of course, as the new skin starts to lay down, people start scratching and particularly if they've got long nails, you break that new skin and you recycle that process over and over and over. So a lot of getting skin to heal, no matter what the lesion is, if we can just stop you from itching it and letting that new skin lay down, it heals a lot faster. So I love chickweed as a part of a topical, just because, again, if we can stop you from itching it, that's going to make a big difference in getting the skin lesion to heal.
Jennifer: And just out of curiosity, I realized that we're talking about pityriasis rosea, but for anyone else who's got maybe eczema or an itchy psoriasis or something like that, would that also potentially be helpful to help the itch?
Dr. Ingels: Absolutely. Yeah, and there's several companies that we work with that actually make creams and stuff like that. In fact, we used to call it CCC cream, it was comfrey, chickweed and coneflower, which is actually echinacea. That combination, again, gets used a lot. You'll see calendula, comfrey, chickweed, echinacea, you'll see some of these herbs get mixed together. But again, where itch is the bigger problem, I would want to make sure that stellaria or chickweed was part of that formula.
Jennifer: Oh that's really cool. So basically anybody that gets this, if they've got that pattern, I would assume it's best to go see a doctor, just to make sure and rule out that it's not anything more serious. And then from there it's just about taking care of the lesions essentially until they eventually resolve.
Dr. Ingels: Exactly. And again, I think this is about self care. it's getting better sleep, make sure you're eating clean. Again, some of these nutrients I just discussed you can do to help support your immune system. But again, even if you did absolutely nothing, it'll probably go away in a couple of months. But I do find when people do those things more proactively, the lesions go away faster. It is really a cosmetic issue more than anything else.
Jennifer: And one last question. As I was saying like as far as stress reduction is concerned, because I do find that there is… Whether the skin rash is caused stress or stress can cause… I think it's a probably a vicious cycle. It's a chicken and egg problem. Do you find in your practice that there is any common recommendation that you give to your patients just about helping to manage stress that you had I find is helpful.
Dr. Ingels: Well I think our mutual friend Heidi Hanna frames it that it's not about managing stress, it's about mastering stress. I like that concept much better, because we all have stress. If you live in the United States in 2019 it's a problem. The key to it, I think, is the consistency of whatever it is that you do that helps you master your stress. I think what happens to a lot of people is that they just don't have a consistent routine where they're doing that kind of self care. So for some people it's their exercise regimen. For other people its doing art, for other people it's whatever it is that you do that really allows your body to kind of down-regulate, get off grid for a moment, and just know really take care of it yourself. But people may do it very sporadically, “I don't have enough time. I've got too much to do at work,” whatever the excuse is that we don't do that. The key is really the consistency of whatever it is that you do that you're doing on a regular basis that's helping you deal with that stress that is ongoing in your life.
Jennifer: Absolutely. Well I just want to thank you so much for not just sharing this, even though this, yes, is a relatively benign condition, it still could freak someone out, and it's great to know that there are sometimes things that are self limiting that can come on and they just need time to go away and we just need to really tune in, check in with ourselves, manage stress and support, do a lot of self care and support the body. But also I want to remind everyone to, if they haven't, to go back and check out your Lyme disease interview just simply because apparently I, in Pennsylvania, live in a hotbed for Lyme disease.
Dr. Ingels: You do.
Jennifer: And you did mention that. This could also look like that potential… Like a weird line pattern. So I think getting yourself acquainted with Lyme disease, no matter where you live, because it is such a huge problem is important. Your book is an excellent resource, the Lyme Solution: A Five Part Plan to Fight the Inflammatory Autoimmune Response and Beat Lyme Disease. We'll put the links to that in the show notes, and you also have… I know you have a Lyme quiz on your website, which is great to check out. We'll put a link to that, and you've got the top 10 immune boosting recipes ebook for everybody. I just think that you're such a great wealth of knowledge and I really appreciate you coming back to share this with us.
Dr. Ingels: My pleasure.
Jennifer: Well, thank you everyone for tuning in and we'll see you in the next interview.
Thank you for this interview re: Pityriasis Rosea. I was diagnosed with this condition thirty years ago in 1990. I was 3 months pregnant at the time and was referred to a dermatologist who diagnosed it. He said it wasn’t contagious and would go away in 6 weeks or so. A week later, my husband also developed it. Dermatologist said we may have been exposed to the cause at the same time. My husband’s rash went away in 6 weeks – a classic case. Mine did not go away. Doctor thought it was due to suppressed immune function during the pregnancy. After having my baby, it still did not go away. Doctor thought it would go away after I stopped nursing. It didn’t go away for another two years, but eventually tapered off. Except in the initial stage, it was not very itchy. After it went away, it continued to return at least once a year (sometimes twice) for another 20 years. I still occasionally get something similar to a herald patch but I don’t develop a greater rash. No doctor has been able to provide an explanation, and one primary care doctor I had insisted it couldn’t be true. She’s no longer my doctor. I understand that the classic case resolves in about 6 weeks (as it did for my husband), but there are anomalies such as my situation.
Thanks for sharing your experience, Arda! This is a great reminder that everyone’s experience is different.