In addition to typical papules and scales, forms appearing as very large plaques (pityriasis rosea gigantea), urticaria, large blisters, patches resembling erythema multiforme, oral lesions, and various other appearances have been noted. A vesicular form can mimic chicken pox. Variations in distribution include inverted forms, with rashes on the face or extremities without appearing on the trunk, as well as more uncommon versions localized to the armpits, groin, or extremities (pityriasis rosea circinata et marginata of Vidal) or unilateral spread. Causes
The cause of pityriasis rosea is not certain, but its clinical presentation and immunologic reactions suggest a viral infection as a cause. Some believe it to be a  reactivation of herpes viruses 6 and 7, which cause roseola in infants, though some investigations have found no evidence of this. Diagnosis
Experienced practitioners may make the diagnosis clinically. Classical symptoms are usually straightforward to recognize, but the wide range of atypical forms may cause difficulty for the clinician in diagnosing some cases. Misdiagnosis by nondermatologists is not uncommon. If the diagnosis is in doubt, tests may be performed to rule out similar conditions such as Lyme disease, ringworm, guttate psoriasis, nummular or discoid eczema, drug eruptions, other viral exanthems. The clinical appearance of pityriasis rosea in some cases is similar to that of secondary syphilis, and rapid plasma reagin testing should be performed if there is any clinical concern for syphilis.
A biopsy of the lesions will show extravasated erythrocytes within dermal papillae and dyskeratotic cells within the dermis.A set of validated diagnostic criteria for pityriasis rosea is as follows:
A patient is diagnosed as having pityriasis rosea if:

On at least one occasion or clinical encounter, the patient has all the essential clinical features and at least one of the optional clinical features, and
On all occasions or clinical encounters related to the rash, the patient does not have any of the exclusional clinical features.The essential clinical features are the following:
Discrete circular or oval lesions,
Scaling on most lesions, and
Peripheral collarette scaling with central clearance on at least two lesions.The optional clinical features are the following:
Truncal and proximal limb distribution, with less than 10% of lesions distal to mid-upper-arm and mid-thigh,
Orientation of most lesions along skin cleavage lines, and
A herald patch (not necessarily the largest) appearing at least two days before eruption of other lesions, from history of the patient or from clinical observation.The exclusional clinical features are the following:
Multiple small vesicles at the centre of two or more lesions,
Two or more lesions on palmar or plantar skin surfaces, and
Clinical or serological evidence of secondary syphilis. Treatment
The condition usually resolves on its own, and treatment is not required. Oral antihistamines or topical steroids may be used to decrease itching. Steroids do provide relief from itching, and improve the appearance of the rash, but they also cause the new skin that forms (after the rash subsides) to take longer to match the surrounding skin color.