The correct answer is E. It poses fetal risk in pregnant patients. 

The case depicts pityriasis rosea (PR), a benign papulosquamous eruption. PR poses a risk of premature delivery and fetal death, likely related to fetal infection with HHV-6.  A series of 38 pregnant women with PR found a 13% abortion rate overall and 62% abortion rate when it developed within 15 weeks gestation. Of the pregnancies carried to birth, 24% were premature and some neonates showed hypotonia that improved with time.

Most cases of pityriasis rosea occur in young healthy persons, not elderly immunocompromised patients. Reassurance alone is appropriate in asymptomatic patients who are not pregnant. High-dose acyclovir is an effective treatment, clearing about 80% of patients within 2 weeks compared to 4% on placebo. Terbinafine plays no role in the treatment of pirtyriasis rosea, since it’s not related to a fungal infection. Drugs reported to cause PR-like eruptions includes beta-blockers, ACE inhibitors, metronidazole, isotretinoin, terbinafine, TNF inhibitors, omeprazole and many more. Drug-induced cases tend to take longer to resolve.

References: Drago F, Broccolo F, Zaccaria E, et al: Pregnancy outcome in patients with pityriasis rosea. J Am Acad Dermatol 2008; 58: pp. S78-83
Drago F, Vecchio F, and Rebora A: Use of high-dose acyclovir in pityriasis rosea. J Am Acad Dermatol 2006; 54: pp. 82-85.
Sharma PK, Yadav TP, Gautam PK, et. al.: Erythromycin in pityriasis rosea: a double-blind, placebo-controlled clinical trial. J Am Acad Dermatol 2000; 42: pp. 241-244.

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