Yüksel M. Pityriasis Rosea Recurrence is Much Higher than Previously Known: A Prospective Study. 124(6):1234-40. This is then followed, days to weeks later, by a rash of many similar but smaller round or oval lesions, mainly on the trunk and upper limbs. 1107532-overview This website also contains material copyrighted by 3rd parties. Pityriasis rosea is not associated with human herpesvirus 7. [Medline]. Thomas M, Yadav T, Khopkar U. [Medline].
Drago F, Rebora A.
Within 1-2 weeks after appearance of the herald patch, numerous small, pink scaly papules or plaques arise over the trunk and proximal extremities, sparing the face and distal extremities. [Medline]. 3.39a).
10(37):57-61. [Medline]. Although the cause of pityriasis rosea has not been established the frequent reporting of a viral-like prodrome, clustering of cases, occasional occurrence among close contacts, and peak incidence in winter and early spring suggest a viral etiology. 2000 Feb. 42(2 Pt 1):241-4. In many instances, a rapid plasma reagin test is advisable to exclude syphilis. J Am Acad Dermatol.
[Medline]. A viral etiology for PR is also supported by the observation of intranuclear and cytoplasmic virus-like particles and increased amounts of CD4 + lymphocytes in the papillary dermis. Anderson CR. Dermatology. Chuh A, Chan H, Zawar V. Pityriasis rosea--evidence for and against an infectious aetiology. [Medline]. [Medline]. Performing a KOH preparation can differentiate these two conditions. 2017 Feb 10. Treatment is primarily symptomatic, including topical corticosteroids and oral antihistamines. JOSÉ ANTONIO PLAZA, VICTOR G. PRIETO, in Modern Surgical Pathology (Second Edition), 2009, Pityriasis rosea is a common self-limited dermatitis that affects mainly children and young adults. Fast Five Quiz: Can You Answer These Challenging Primary Care Questions? 1982 Jul. 58(5 Suppl 1):S78-83. Sonthalia S, Kumar A, Zawar V, Priya A, Yadav P, Srivastava S, et al. Pregnancy outcome in patients with pityriasis rosea. Singh V, Sharma M, Narang T, Madan M. Vesicular palmoplantar pityriasis rosea.
J Eur Acad Dermatol Venereol. 2009 Sep-Oct. 13(5):383-7. [Medline].
In this variant, commonly referred to as pityriasis circinata et marginata of Vidal or limb-girdle pityriasis rosea, the eruption generally appears in the axillae, the groin, or both, with the trunk and extremities usually spared. These are effective only in the most severe inflammatory varieties of this syndrome. Some of the medications that have been associated with a PR-type rash include bismuth, bacillus Calmette-Guérin (BCG) vaccine, captopril, clonidine, diphtheria toxoid, gold, isotretinoin, ketotifen, metronidazole, and omeprazole. Amer A, Fischer H. Azithromycin does not cure pityriasis rosea. Pityriasis rosea begins with a scaly erythematous patch or plaque known as the herald patch in 50% to 80% of cases, which precedes and heralds the onset of widespread papulosquamous eruption by several days to up to 3 months. Drago F, Broccolo F, Zaccaria E, Malnati M, Cocuzza C, Lusso P, et al.
Recently an increasing number of studies have focused on human herpes virus 6 (HHV-6) and primarily on HHV-7 as causative agents. J Eur Acad Dermatol Venereol. Pityriasis rosea: an important papulosquamous disorder. Pityriasis rosea is a common, acute, self-limited skin disease of unknown etiology that affects young people. The history should include questions about the following: Close contacts with similar eruptions – This finding is uncommon because most cases of pityriasis rosea (PR) are sporadic, Medication intake – Several medications have been shown to cause a similar exanthema, Previous sexually transmitted disease, if appropriate, Previous dermatologic disease and manifestations thereof, including previous pityriasis rosea, Recent upper respiratory tract infection (URTI), The disease typically begins with a solitary patch, usually salmon-colored, that heralds the eruption and thus is commonly referred to as the herald patch or spot (see Physical Examination). 2010 Apr. The long axes of the patches often run parallel to the skin lines over the thorax and back, to create a ‘Christmas-tree’ pattern. Image courtesy of Drexel Department of Dermatology slide collection. Copyright © 2020 Elsevier B.V. or its licensors or contributors. [Full Text]. J Am Acad Dermatol. Alternatively, the herald patch may occur as multiple lesions or in atypical locations, such as the soles or the scalp.
Additional evidence that pityriasis rosea is associated with reactivation of human herpesvirus-6 and -7. 2011 Feb. 50(2):195-7. These oval 0.5- to 2-cm lesions have their long axis oriented along skin lines, and when present on the trunk, result in a “Christmas tree” pattern on the back (Fig. There are many other dermatoses that can resemble pityriasis rosea (Table 48.4). Lim SH, Kim SM, Oh BH, Ko JH, Lee YW, Choe YB, et al. J Invest Dermatol. 195(4):374-8. [Medline]. Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School [Medline]. . 2002 Oral lesions of various types have been reported with pityriasis rosea, including punctate hemorrhages, ulcers (with or without raised borders), petechiae, papulovesicles, bullae, and erythematous plaques. Rebora A, Drago F, Broccolo F. Pityriasis rosea and herpesviruses: facts and controversies. Drago F, Ciccarese G, Rebora A, Broccolo F, Parodi A. Pityriasis Rosea: A Comprehensive Classification. Int J Dermatol. Within 1–2 weeks, numerous smaller lesions appear on the body, usually concentrated on the trunk and proximal extremities (Fig. However, this skin rash is not considered to be contagious even though it may have viral roots. Pruritus is commonly evident in 25-75% of patients and usually of mild-to-moderate severity.
Pityriasis rosea. J Am Acad Dermatol. Clin Exp Dermatol.
Int J Dermatol. The diagnosis of PR can usually be made based on the appearance of the lesions and the history.
[Medline]. [Medline]. Rajpara SN, Ormerod AD, Gallaway L. Adalimumab-induced pityriasis rosea. [Medline]. [Medline]. The eruption consists of oval-shaped, erythematous papules or macules that enlarge to a maximum size of 5 to 30 mm. Treatment of pityriasis rosea with UV radiation. The “herald patch” is followed a few days or weeks later by a crop of smaller scaly lesions on the trunk and proximal extremities.
. 126-14). Furthermore, a prodrome of malaise, headache, and respiratory symptoms is occasionally observed. A prodrome of malaise, headache, and mild constitutional symptoms occasionally precedes the rash. 2012 Nov-Dec. 34(6):703.e5-7. 10(2):116-8. 2003 Feb. 42(2):138-40. 28 (1):15-20. 25(3):368-9. These scales correspond histologically to parakeratosis.
In children younger than 5 years, papular pityriasis rosea may be seen with a similar distribution. Rebora AE, Drago F. A novel influenza a (H1N1) virus as a possible cause of pityriasis rosea? As the rash grows, however, smaller spots (called "daughter" spots) can appear across the torso and on the arms and legs. 71(1):198-9. The natural history of pityriasis rosea in black American children: how correct is the "classic" description?. Other variants seen in children demonstrate lesions that are papular, vesicular, pustular, purpuric, or lichenoid.
Studies have associated PR with active human herpesvirus type 6 and type 7 and have suggested that PR represents a viral reactivation phenomenon. J Cutan Pathol. Postinflammatory hypopigmentation or hyperpigmentation may persist for weeks to months, especially in dark-skinned patients. Drago F, Ciccarese G, Javor S, Parodi A. Vaccine-induced pityriasis rosea and pityriasis rosea-like eruptions: a review of the literature. J Am Acad Dermatol. 1992 Oct. 50(4):276-80. 2009 Aug. 21(3):230-6. Photoexacerbated and photoprotected forms of pityriasis rosea have been documented, though photosensitivity is not a classic manifestation of the disease. A number of clinical variants have been seen. Please confirm that you would like to log out of Medscape. Kempf W, Adams V, Kleinhans M, Burg G, Panizzon RG, Campadelli-Fiume G, et al. This phase tends to resolve over the next 6 weeks, but variability is common and occasionally persistent. Clin Dermatol. 2010 Sep-Oct. 28(5):497-501.
2006 May. Indian J Dermatol.  ). EBM Guidelines. Interventions for pityriasis rosea.
Atypical cases make up 20% of the total and occur more commonly in children.
Drago F, Broccolo F, Ciccarese G, Rebora A, Parodi A. Topical corticosteroids help reduce pruritus, but they do not alter the course of the disease. Copyright © 2020 Elsevier B.V. or its licensors or contributors. Zawar V, Godse K. Segmental lesions in pityriasis rosea: a rare presentation. Characterization of the inflammatory cell infiltrate in herald patches and fully developed eruptions of pityriasis rosea. About 20% of cases show atypical deviations from this pattern. 2007 May. 2008 Jan. 7(1):35-8. The comparison between the efficacy of high dose acyclovir and erythromycin on the period and signs of pitiriasis rosea. Dermatology. Skin Therapy Lett. Similar “pityriasiform” skin eruptions occur in other skin diseases, but these are less common than pityriasis rosea. A biopsy is not indicated.
Bangash HK, Finch T, Petronic-Rosic V, Sethi A, Abramsohn E, Lindau ST. Pityriasis Rosea-Like Drug Eruption Due to Nortriptyline in a Patient With Vulvodynia. [Medline]. Drago F, Ciccarese G, Rebora A, Parodi A. It has been described in the medical literature for more than 200 years but was given its current name by Camille Gilbert in 1860. Sezer E, Saracoglu ZN, Urer SM, Bildirici K, Sabuncu I. Purpuric pityriasis rosea. In 10-50% of cases, the herald patch may be absent, a finding that is more frequently observed in drug-induced pityriasis rosea. Dermoscopy evaluation using a triple-light source may be useful. Richard Lichenstein, MD is a member of the following medical societies: American Medical Association, American Academy of PediatricsDisclosure: Nothing to disclose. CD005068. In 50 to 90% of patients, pityriasis rosea starts with a primary lesion (herald patch), which is an erythematous, scaly, oval patch a few centimeters in diameter. [Medline]. 8(5):YC01-4. This skin rash is associated with the non-contagious skin condition called pityriasis rosea. Oral erythromycin has also been shown to be beneficial.
2013 Feb 27. Kristen E. Holland, Paula J. Soung, in Nelson Pediatric Symptom-Based Diagnosis, 2018. The most important differential diagnosis is secondary syphilis, which, in contrast to, Journal of the American Academy of Dermatology, Actas Dermo-Sifiliográficas (English Edition).
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