Brief Answer: ?Pityriasis Rosea ?Syphilis Detailed Answer: Hi. Thanks for posting your concern at XXXXXXX Pityriasis Rosea classically begins with a Herald patch(Mother patch) which is a large circular or oval patch on trunk or extremities commonly. It is usually single but may be two patches on body. It might be confused with ringworm. This is followed 2-4 weeks later by a crop (multiple cycles of crops may last 2-4 weeks) of lesions on trunk and extremities. They are round or oval patches with very fine scaling (cigarette paper like scaling) that is adherent at the periphery and loose centrally. They might be arranged classically in a christmus-tree pattern on the back. Pityriasis Rosea is a reaction pattern to various infections (viral infections like herpes have been implicated), drugs etc. Syphilis is a great imitator. Syphilis rash is one of the differential diagnosis of Pityriasis Rosea. *A useful distinguishing feature of syphilis is that the rash of syphilis characteristically involves the palms and soles. A blood test for syphilis will confirm or rule it out. Looking at the pictures you sent it seems that the patch on the center of your neck looks to me like a Herald patch(Mother patch). The rash on the sides of your neck looks like part of a crop that may have appeared later with similar lesions on the back and trunk (Oval patches with their long axis oriented diagonally). Yes, but i would have kept a differential of syphilis since i did'nt get the opportunity to examine your palms and soles. A blood test like VDRL Would confirm or rule out syphilis. Syphilis rash is usually not that itchy. Also in syphilis their are palpable nodes in the neck, groin, and classically elbow(epitrochlear) Pityriasis Rosea is self limiting. As a treating doctor i usually prescribe a moderately potent steroid like mometasone for topical application for 2-4 weeks. Sometimes people develop new crops of lesions but that usually stops by itself. An oral antihistamine would help you with the itch part. Hope this information helps take care

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Brief Answer: Topical steroids+oral erythromycin Detailed Answer: Hi. thanks for the additional information. I would still advice a blood test to rule out syphilis. Pityriasis rosea is indeed a very close differential of syphilis!! Antifungal creams won't benefit Pityriasis Rosea at all. In addition it may or may not cause irritation but it won't benefit in pityriasis rosea. As a treating doctor i usually prescribe a moderately potent steroid like mometasone for topical application for 2-4 weeks. Studies have also shown a role of oral erythromycin 250mg QID for 10-14 days. I usually prescribe it in my patients of Pityriasis Rosea. You might get breakthough episodes/crops of new lesions but that usually stops once you are on treatment. I would advice that you visit a dermatologist for a prescription for these. take care regards

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