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Hatami P, Aryanian Z, Asl HN, Khayyat A, Hatami D. Pregnancy and pityriasis rosea: Current concepts. J Cosmet Dermatol 2024; 23:2298-2300. [PMID: 38348731 DOI: 10.1111/jocd.16233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/05/2024] [Indexed: 05/19/2024]
Affiliation(s)
- Parvaneh Hatami
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Aryanian
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Dermatology, Babol University of Medical Sciences, Babol, Iran
| | - Hamed Nicknam Asl
- Department of Dentistry, Rafsanjan University of Medical Sciences (RUMS), Rafsanjan, Iran
| | - Azadeh Khayyat
- PGY2 resident physician, Pathology Department of Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Dorsa Hatami
- Student Research Center, Kharazmi University, Tehran, Iran
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Khan I, Elsanousi AA, Shareef AM, Tebha SS, Arif A, Gul S. Manifestation of pityriasis rosea and pityriasis rosea-like eruptions after Covid-19 vaccine: A systematic review. Immun Inflamm Dis 2023; 11:e804. [PMID: 37102660 PMCID: PMC10091373 DOI: 10.1002/iid3.804] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/18/2023] [Accepted: 02/24/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND After introducing Covid-19 vaccines, a few side effects were reported, pityriasis rosea being one of them. Therefore, this study will systematically review its manifestation afteradministration. METHODS Databases were searched, covering a timeline from December 1, 2019 to February 28, 2022. Data were independently extracted and accessed for bias. SPSS statistical software version 25 was used for appropriate inferential statistics. RESULTS Thirty-one studies were included for data extraction after screening following the eligibility criteria. A total of 111 people were identified to have developed pityriasis rosea or pityriasis rosea-like eruptions after vaccination, out of which 36 (55.38%) were female. The average age of incidence was calculated to be 44.92 years, and 63 (62.37%) people presented after administration of the first dose. It was found popularly in the trunk area, either asymptomatically or with mild symptoms. Meantime the onset, was 8.58 days, and meantime it took to recover, was 6.44 weeks. CONCLUSION The association between pityriasis rosea and pityriasis rosea-like eruptions after Covid-19 vaccines was established, but given the scarcity of studies, there is a need to conduct different clinical trials to confirm this association further and study the etiology and mechanism of the disease.
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Affiliation(s)
- Iman Khan
- Department of Medicine, Ziauddin Medical University, Karachi, Sindh, Pakistan
| | - Ahmed A Elsanousi
- Department of Medicine, University of Medical Science and Technology, Khartoum, Sudan
| | - Amena M Shareef
- Department of Medicine, Deccan College of Medical Sciences, Hyderabad, India
| | - Sameer S Tebha
- Department of Neurosurgery and Neurology, Jinnah Medical and Dental College, Karachi, Sindh, Pakistan
| | - Aabiya Arif
- Department of Medicine, Ziauddin Medical University, Karachi, Sindh, Pakistan
| | - Sana Gul
- Department of Dermatology, Jinnah Medical and Dental College, Karachi, Sindh, Pakistan
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Wenger-Oehn L, Graier T, Ambros-Rudolph C, Müllegger R, Bittighofer C, Wolf P, Hofer A. Pityriasis rosea in der Schwangerschaft: Eine Fallserie und Literaturübersicht. J Dtsch Dermatol Ges 2022; 20:953-960. [PMID: 35881085 DOI: 10.1111/ddg.14763_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/12/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Lena Wenger-Oehn
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
| | - Thomas Graier
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
| | | | - Robert Müllegger
- Abteilung für Dermatologie und Venerologie, Landesklinikum Wiener Neustadt, Wiener Neustadt, Österreich
| | - Christina Bittighofer
- Abteilung für Dermatologie und Venerologie, Landesklinikum Wiener Neustadt, Wiener Neustadt, Österreich
| | - Peter Wolf
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
| | - Angelika Hofer
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
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Tzur L, Yang FSC, Deverapalli S. The use of antivirals in severe or recalcitrant cases of pityriasis rosea: A case series. JAAD Case Rep 2022; 28:100-103. [PMID: 36159717 PMCID: PMC9489874 DOI: 10.1016/j.jdcr.2022.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Wenger-Oehn L, Graier T, Ambros-Rudolph C, Müllegger R, Bittighofer C, Wolf P, Hofer A. Pityriasis rosea in pregnancy: A case series and literature review. J Dtsch Dermatol Ges 2022; 20:953-959. [PMID: 35616213 PMCID: PMC9542365 DOI: 10.1111/ddg.14763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/12/2022] [Indexed: 11/30/2022]
Abstract
Background and objective Pityriasis rosea (PR), a common skin disease in young adults, may adversely affects the course of pregnancy and the unborn child. Patients and methods Data from forty‐six pregnant women with PR seen in the dermatological university clinic between 2003 and 2018 were analyzed and compared with patient data (n = 53) from previously published studies to determine the incidence and risk factors for an unfavorable pregnancy outcome after PR infection. Results Unfavorable pregnancy outcomes (defined as miscarriage, preterm delivery before week 37 of gestation, or birth weight < 2,500 g) were significantly less frequent in our study population than in a pooled cohort obtained from previously published studies (10.9 % vs. 39.6 %; P = 0.0012). Analysis of pooled data from our study and from previous studies revealed that the week of pregnancy at onset of PR was inversely associated with an unfavorable outcome (odds ratio [OR] = 0.937; 95 % CI 0.883 to 0.993). In addition, duration of PR (OR = 1.432; 95 % CI 1.129 to 1.827), additional extracutaneous symptoms (OR = 4.112; 95 % CI 1.580 to 10.23), and widespread rash distribution (OR 5.203, 95 % CI 1.702 to 14.89) were directly associated with unfavorable outcome. Conclusion In most cases, PR does not influence pregnancy or birth outcomes.
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Affiliation(s)
- Lena Wenger-Oehn
- Department of Dermatology and Venereology, Medical University of Graz, Austria
| | - Thomas Graier
- Department of Dermatology and Venereology, Medical University of Graz, Austria
| | | | - Robert Müllegger
- Department of Dermatology and Venereology, State Hospital, Wiener Neustadt, Austria
| | | | - Peter Wolf
- Department of Dermatology and Venereology, Medical University of Graz, Austria
| | - Angelika Hofer
- Department of Dermatology and Venereology, Medical University of Graz, Austria
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Drago F, Ciccarese G, Casazza S, Parodi A. Pityriasis rosea, human herpesvirus 6 infection and pregnancy. J Med Virol 2022; 94:4069-4070. [PMID: 35556254 DOI: 10.1002/jmv.27852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/26/2022] [Accepted: 05/10/2022] [Indexed: 11/05/2022]
Abstract
we read the interesting article by Bortolotti et al. on the relationship between human herpesvirus 6 (HHV-6) infection and intrauterine growth restriction (IUGR)1 that prompted us to describe our experience about pityriasis rosea (PR) occurring during pregnancy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Francesco Drago
- Dermatology Unit, Ospedale Policlinico San Martino, Largo R. Benzi, 10, 16132, Genoa, Italy
| | - Giulia Ciccarese
- Dermatology Unit, Ospedale Policlinico San Martino, Largo R. Benzi, 10, 16132, Genoa, Italy
| | - Stefania Casazza
- Unit of Dermatology, Department of Health Sciences, University of Genoa, Via Pastore, 1, 16132, Genoa, Italy
| | - Aurora Parodi
- Dermatology Unit, Ospedale Policlinico San Martino, Largo R. Benzi, 10, 16132, Genoa, Italy.,Pathology Unit, Galliera Hospitals, Via Mura delle Cappuccine, 14, 16128, Genoa, Italy
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AlBalbeesi AO, Qadoumi TA. Papulosquamous Disorders and Pregnancy. Cureus 2021; 13:e18762. [PMID: 34796057 PMCID: PMC8590085 DOI: 10.7759/cureus.18762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Pregnancy can influence the course of a number of dermatologic disorders. Interestingly, these disorders can also influence pregnancy outcomes negatively, due to a variety of underlying pathogenic mechanisms. These outcomes may range from low fetal birth weight, preterm birth, and miscarriages to perineal lacerations complicating deliveries. Our review highlights the impact that papulosquamous disorders may have on pregnancy and their course throughout pregnancy. We chose papulosquamous disorders due to their relatively high prevalence worldwide compared to other dermatologic disorders. This review also sheds light on any gaps in the literature relevant to this topic that should be addressed.
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Heymann WR. Probing pityriasis rosea in pregnancy. J Am Acad Dermatol 2021; 85:1413. [PMID: 34624414 DOI: 10.1016/j.jaad.2021.09.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022]
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Shmeleva EV, Colucci F. Maternal natural killer cells at the intersection between reproduction and mucosal immunity. Mucosal Immunol 2021; 14:991-1005. [PMID: 33903735 PMCID: PMC8071844 DOI: 10.1038/s41385-020-00374-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/24/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023]
Abstract
Many maternal immune cells populate the decidua, which is the mucosal lining of the uterus transformed during pregnancy. Here, abundant natural killer (NK) cells and macrophages help the uterine vasculature adapt to fetal demands for gas and nutrients, thereby supporting fetal growth. Fetal trophoblast cells budding off the forming placenta and invading deep into maternal tissues come into contact with these and other immune cells. Besides their homeostatic functions, decidual NK cells can respond to pathogens during infection, but in doing so, they may become conflicted between destroying the invader and sustaining fetoplacental growth. We review how maternal NK cells balance their double duty both in the local microenvironment of the uterus and systemically, during toxoplasmosis, influenza, cytomegalovirus, malaria and other infections that threat pregnancy. We also discuss recent developments in the understanding of NK-cell responses to SARS-Cov-2 infection and the possible dangers of COVID-19 during pregnancy.
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Affiliation(s)
- Evgeniya V Shmeleva
- Department of Obstetrics & Gynaecology, University of Cambridge, National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, CB2 0SW, UK
- Centre for Trophoblast Research, University of Cambridge, Cambridge, UK
| | - Francesco Colucci
- Department of Obstetrics & Gynaecology, University of Cambridge, National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, CB2 0SW, UK.
- Centre for Trophoblast Research, University of Cambridge, Cambridge, UK.
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Porras-Villamil JF, Hinestroza AC, López-Moreno GA, Parra-Sepúlveda DJ. Atypical pityriasis rosea in a young Colombian woman. Case report. CASE REPORTS 2021. [DOI: 10.15446/cr.v7n2.88809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Pityriasis rosea is an acute and self-limited exanthemfirst described by Gilbert in 1860. Its treatment is symptomatic, and although there is no conclusive evidence, it has been associated with the reactivation of the human herpesviruses 6 and 7 (HHV-6 and HHV-7).
Case presentation: A 28-year-old woman, from Bogotá, Colombia, ahealth worker, attended the emergency room due to the onset ofsymptoms that began 20 days earlier with the appearance of punctiformlesions in the left arm that later spread to the thorax, abdomen, opposite arm, and thighs. The patient reported a history of bipolar II disorder and retinal detachment. After ruling out several infectious diseases, and due to the evolution of the symptoms, pityriasis rosea was suspected. Therefore, treatment was started with deflazacort 30mg for 21 days, obtaining a favorable outcome and improvement of symptoms after 2 months. At the time of writing this case report, the patient had not consulted for recurrence.
Conclusion: Primary care physicians should have sufficient training indermatology to recognize and treat dermatological diseases since manyof them are diagnosed based on clinical findings. This is an atypicalcase, in which the patient did not present with some of the pathognomonic signs associated with pityriasis rosea.
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Fölster-Holst R. Infectious exanthemas in childhood. J Dtsch Dermatol Ges 2021; 18:1128-1155. [PMID: 33112060 DOI: 10.1111/ddg.14301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/09/2020] [Indexed: 12/15/2022]
Abstract
Most childhood exanthemas are harmless. However, recognizing serious diseases with life-threatening complications at an early stage is important for the timely initiation of adequate therapy. This requires knowledge of the specific patterns of the exanthema, obtained from the medical history and the clinic, including the patient's general condition and physical examination. In unclear cases, additional diagnostic measures are undertaken, such as blood tests and smears (cutaneous, mucocutaneous). Viruses are the most common cause of childhood exanthemas. New variants of infectious agents, improved diagnostics and stays in tropical and subtropical countries have expanded the spectrum of infectious exanthemas.
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Affiliation(s)
- Regina Fölster-Holst
- Dermatology, Venereology, Allergology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
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Fölster-Holst R. Infektiöse Exantheme im Kindesalter. J Dtsch Dermatol Ges 2020; 18:1128-1157. [PMID: 33112074 DOI: 10.1111/ddg.14301_g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/10/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Regina Fölster-Holst
- Dermatologie, Venerologie, Allergologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Kiel
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Miura H, Kawamura Y, Ohye T, Hattori F, Kozawa K, Ihira M, Yatsuya H, Nishizawa H, Kurahashi H, Yoshikawa T. Inherited Chromosomally Integrated Human Herpesvirus 6 Is a Risk Factor for Spontaneous Abortion. J Infect Dis 2020; 223:1717-1723. [PMID: 32984876 DOI: 10.1093/infdis/jiaa606] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/25/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Human herpesvirus 6 (HHV-6) can be genetically transmitted from parent to child as inherited chromosomally integrated HHV-6 (iciHHV-6). HHV-6 reactivation occurs in pregnant women with iciHHV-6. We found no sex differences in the frequency of index cases with iciHHV-6 but inheritance from the father was more common. We evaluated the association between iciHHV-6 status and spontaneous abortion. METHODS iciHHV-6 was confirmed by high viral DNA copy numbers in whole blood and somatic cells. The origin of integrated viral genome, paternal or maternal, was examined using the same method. The pregnancy history of 23 mothers in families with iciHHV-6 and 285 mothers in families without iciHHV-6 was abstracted. RESULTS Of 23 iciHHV-6 index cases, 8 mothers and 15 fathers had iciHHV-6. Spontaneous abortion rates in mothers with and mothers without/fathers with iciHHV-6 and mothers in families without iciHHV-6 were 27.6%, 10.3%, and 14.8%, respectively (P = .012). Mothers with iciHHV-6 (odds ratio [OR], 6.41; 95% confidence interval [CI], 1.10-37.4) and maternal age at the most recent pregnancy ≥40 years (OR, 3.91; 95% CI, 1.30-11.8) were associated with 2 or more spontaneous abortions. CONCLUSIONS Mothers with iciHHV-6 is a risk factor for spontaneous abortion.
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Affiliation(s)
- Hiroki Miura
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yoshiki Kawamura
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tamae Ohye
- Department of Clinical Laboratory Medicine, Graduate School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Fumihiko Hattori
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kei Kozawa
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masaru Ihira
- Faculty of Clinical Engineering, Fujita Health University School of Health Sciences, Toyoake, Japan
| | - Hiroshi Yatsuya
- Department of Public Health, Fujita Health University School of Medicine, Toyoake, Japan
| | - Haruki Nishizawa
- Department of Obstetrics and Gynecology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroki Kurahashi
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Japan
| | - Tetsushi Yoshikawa
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
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Nasca MR, Giuffrida G, Micali G. The Influence of Pregnancy on the Clinical Evolution and Prognosis of Pre-Existing Inflammatory and Autoimmune Skin Disorders and Their Management. Dermatology 2020; 237:771-785. [PMID: 32950977 DOI: 10.1159/000509726] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/24/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Although the possible occurrence of typical dermatoses during pregnancy is well recognized, little is known about the influence of pregnancy on the clinical evolution and prognosis of different pre-existing chronic dermatological disorders. SUMMARY In this study a comprehensive search of the available literature and reviews has been undertaken in order to collect and analyze articles reporting pre-existing chronic skin disorders in pregnant women and report current knowledge on their particular clinical and therapeutic aspects.
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Management guidelines for pregnant health care workers exposed to infectious dermatoses. Int J Womens Dermatol 2020; 6:142-151. [PMID: 32313827 PMCID: PMC7165119 DOI: 10.1016/j.ijwd.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 01/08/2023] Open
Abstract
Exanthematous diseases are frequently of infectious origin, posing risks, especially for pregnant health care workers (HCWs) who treat them. The shift from cell-mediated (Th1 cytokine profile) to humoral (Th2 cytokine profile) immunity during pregnancy can influence the mother’s susceptibility to infection and lead to complications for both mother and fetus. The potential for vertical transmission must be considered when evaluating the risks for pregnant HCWs treating infected patients because fetal infection can often have devastating consequences. Given the high proportion of women of childbearing age among HCWs, the pregnancy-related risks of exposure to infectious diseases are an important topic in both patient care and occupational health. Contagious patients with cutaneous manifestations often present to dermatology or pediatric clinics, where female providers are particularly prevalent; a growing number of these physicians are female. Unfortunately, the risks of infection for pregnant HCWs are not well defined. To our knowledge, there is limited guidance on safe practices for pregnant HCWs who encounter infectious dermatologic diseases. In this article, we review several infectious exanthems, their transmissibility to pregnant women, the likelihood of vertical transmission, and the potential consequences of infection for the mother and fetus. Additionally, we discuss recommendations with respect to avoidance, contact, and respiratory precautions, as well as the need for treatment after exposure.
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Affiliation(s)
- Ali Alajmi
- 54473 Division of Dermatology, McGill University Health Centre, Montreal General Hospital, QC, Canada
| | - Abdulhadi Jfri
- 54473 Division of Dermatology, McGill University Health Centre, Montreal General Hospital, QC, Canada
| | - Kevin Pehr
- 5620 Division of Dermatology, Jewish General Hospital, McGill University, Montreal, QC, Canada
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Pityriasis rosea during pregnancy – what obstetricians should know about it? GINECOLOGIA.RO 2020. [DOI: 10.26416/gine.28.2.2020.3177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Contreras‐Ruiz J, Peternel S, Jiménez Gutiérrez C, Culav‐Koscak I, Reveiz L, Silbermann‐Reynoso MDL. Interventions for pityriasis rosea. Cochrane Database Syst Rev 2019; 2019:CD005068. [PMID: 31684696 PMCID: PMC6819167 DOI: 10.1002/14651858.cd005068.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pityriasis rosea is a scaly, itchy rash that mainly affects young adults and lasts for 2 to 12 weeks. The effects of many available treatments are uncertain. This is an update of a Cochrane Review first published in 2007. OBJECTIVES To assess the effects of interventions for the management of pityriasis rosea in any individual diagnosed by a medical practitioner. SEARCH METHODS We updated our searches of the following databases to October 2018: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We searched five trials registers. We also checked the reference lists of included and excluded studies, contacted trial authors, scanned the abstracts from major dermatology conference proceedings, and searched the CAB Abstracts database. We searched PubMed for adverse effects to November 2018. SELECTION CRITERIA Randomised controlled trials of interventions in pityriasis rosea. Treatment could be given in a single therapy or in combination. Eligible comparators were no treatment, placebo, vehicle only, another active compound, or placebo radiation treatment. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by the Cochrane. Our key outcomes were good or excellent rash improvement within two weeks, rated separately by the participant and medical practitioner; serious adverse events; resolution of itch within two weeks (participant-rated); reduction in itch score within two weeks (participant-rated); and minor participant-reported adverse events not requiring withdrawal of the treatment. MAIN RESULTS We included 14 trials (761 participants). In general, risk of selection bias was unclear or low, but risk of performance bias and reporting bias was high for 21% of the studies. Participant age ranged from 2 to 60 years, and sex ratio was similar. Disease severity was measured by various severity indices, which the included studies did not categorise. Six studies were conducted in India, three in Iran, two in the Philippines, and one each in Pakistan, the USA, and China. The included studies were conducted in dermatology departments and a paediatric clinic. Study duration ranged from 5 to 26 months. Three studies were funded by drug manufacturers; most studies did not report their funding source. The included studies assessed macrolide antibiotics, an antiviral agent, phototherapy, steroids and antihistamine, and Chinese medicine. None of the studies measured participant-rated good or excellent rash improvement. All reported outcomes were assessed within two weeks of treatment, except for adverse effects, which were measured throughout treatment. There is probably no difference between oral clarithromycin and placebo in itch resolution (risk ratio (RR) 0.84, 95% confidence interval (CI) 0.47 to 1.52; 1 study, 28 participants) or rash improvement (medical practitioner-rated) (RR 1.13, 95% CI 0.89 to 1.44; 1 study, 60 participants). For this comparison, there were no serious adverse events (1 study, 60 participants); minor adverse events and reduction in itch score were not measured; and all evidence was of moderate quality. When compared with placebo, erythromycin may lead to increased rash improvement (medical practitioner-rated) (RR 4.02, 95% CI 0.28 to 56.61; 2 studies, 86 participants, low-quality evidence); however, the 95% CI indicates that the result may also be compatible with a benefit of placebo, and there may be little or no difference between treatments. Itch resolution was not measured, but one study measured reduction in itch score, which is probably larger with erythromycin (MD 3.95, 95% CI 3.37 to 4.53; 34 participants, moderate-quality evidence). In the same single, small trial, none of the participants had a serious adverse event, and there was no clear difference between groups in minor adverse events, which included gastrointestinal upset (RR 2.00, CI 0.20 to 20.04; moderate-quality evidence). Two trials compared oral azithromycin to placebo or vitamins. There is probably no difference between groups in itch resolution (RR 0.83, 95% CI 0.28 to 2.48) or reduction in itch score (MD 0.04, 95% CI -0.35 to 0.43) (both outcomes based on one study; 70 participants, moderate-quality evidence). Low-quality evidence from two studies indicates there may be no difference between groups in rash improvement (medical practitioner-rated) (RR 1.02, 95% CI 0.52 to 2.00; 119 participants). In these same two studies, no serious adverse events were reported, and there was no clear difference between groups in minor adverse events, specifically mild abdominal pain (RR 5.82, 95% CI 0.72 to 47.10; moderate-quality evidence). Acyclovir was compared to placebo, vitamins, or no treatment in three trials (all moderate-quality evidence). Based on one trial (21 participants), itch resolution is probably higher with placebo than with acyclovir (RR 0.34, 95% CI 0.12 to 0.94); reduction in itch score was not measured. However, there is probably a significant difference between groups in rash improvement (medical practitioner-rated) in favour of acyclovir versus all comparators (RR 2.45, 95% CI 1.33 to 4.53; 3 studies, 141 participants). Based on the same three studies, there were no serious adverse events in either group, and there was probably no difference between groups in minor adverse events (only one participant in the placebo group experienced abdominal pain and diarrhoea). One trial compared acyclovir added to standard care (calamine lotion and oral cetirizine) versus standard care alone (24 participants). The addition of acyclovir may lead to increased itch resolution (RR 4.50, 95% CI 1.22 to 16.62) and reduction in itch score (MD 1.26, 95% CI 0.74 to 1.78) compared to standard care alone. Rash improvement (medical practitioner-rated) was not measured. The trial reported no serious adverse events in either group, and there may be no difference between groups in minor adverse events, such as headache (RR 7.00, 95% CI 0.40 to 122.44) (all results based on low-quality evidence). AUTHORS' CONCLUSIONS When compared with placebo or no treatment, oral acyclovir probably leads to increased good or excellent, medical practitioner-rated rash improvement. However, evidence for the effect of acyclovir on itch was inconclusive. We found low- to moderate-quality evidence that erythromycin probably reduces itch more than placebo. Small study sizes, heterogeneity, and bias in blinding and selective reporting limited our conclusions. Further research is needed to investigate different dose regimens of acyclovir and the effect of antivirals on pityriasis rosea.
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Affiliation(s)
- Jose Contreras‐Ruiz
- Hospital General Dr. Manuel Gea GonzálezDepartment of DermatologyPuente de Piedra 150‐T1‐C111. Col. Toriello GuerraMexico CityMexico14050
| | - Sandra Peternel
- Clinical Hospital Center RijekaDepartment of DermatovenereologyKresimirova 42RijekaCroatia51000
- University of Rijeka, Faculty of MedicineRijekaCroatia51000
| | - Carlos Jiménez Gutiérrez
- Universidad Tecnologica de México‐Laureate International UniversitiesAdscrito Unidad de Investigación TraslacionalKinchil 234‐3Col. Heroes de Padierna. Delegación TlalpanMéxico.DFDFMexico14200
| | - Ivana Culav‐Koscak
- General hospital "Dr. Ivo Pedisic"Department of Dermatology and VenereologyJ.J. Strossmayera 59SisakCroatia44000
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Rebora A, Ciccarese G, Herzum A, Parodi A, Drago F. Pityriasis rosea and other infectious eruptions during pregnancy: Possible life-threatening health conditions for the fetus. Clin Dermatol 2019; 38:105-112. [PMID: 32197740 DOI: 10.1016/j.clindermatol.2019.10.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Any infectious illness presenting with an eruption in a pregnant patient may be associated with an increased risk of fetal loss. The viruses that can infect the placenta during maternal infection and can be transmitted to the fetus and cause congenital disease include the rubella virus, the measles virus, the varicella zoster virus, parvovirus B19, human cytomegalovirus, arboviruses, and hepatitis E virus type 1. In addition, some bacteria responsible for exanthematous diseases, like Treponema pallidum, can be transmitted during pregnancy from the mother to the fetus and cause fetal loss. All these infectious agents can cause typical and/or atypical exanthems whose etiologic diagnosis is sometimes difficult but important to determine, especially in pregnant women because of the potential risk to the fetus. In the last 20 years, we have extensively studied pityriasis rosea from the clinical and laboratory perspectives, demonstrating the pathogenic role of human herpesvirus (HHV)-6 and -7. We synthesize the available evidence that PR may be associated with active HHV-6/7 infection and therefore with complications during pregnancy and fetal loss. We have also summarized the emerging infectious illnesses of dermatologic interest that may represent life-threatening health conditions for the fetus: measles, rubella, arbovirus infection, and syphilis.
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Affiliation(s)
- Alfredo Rebora
- DISSAL, Section of Dermatology, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy
| | - Giulia Ciccarese
- DISSAL, Section of Dermatology, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy.
| | - Astrid Herzum
- DISSAL, Section of Dermatology, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy
| | - Aurora Parodi
- DISSAL, Section of Dermatology, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy
| | - Francesco Drago
- Dermatologic Clinic, Policlinico San Martino, Largo R. Benzi 10, 16132 Genoa, Italy
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Chang HC, Sung CW, Lin MH. The efficacy of oral acyclovir during early course of pityriasis rosea: a systematic review and meta-analysis. J DERMATOL TREAT 2018; 30:288-293. [DOI: 10.1080/09546634.2018.1508820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Hua-Ching Chang
- Department of Dermatology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chih-Wei Sung
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Ming-Hsiu Lin
- Department of Dermatology, Taipei Medical University Hospital, Taipei, Taiwan
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Abstract
Paraviral exanthems are distinct skin diseases due to infections with different viruses. Although no virus has been identified so far in some exanthems, the main age of manifestation, the clinical course of the exanthem, and the extracutaneous symptoms are suggestive for a viral genesis. While many viral infections are a direct result of the infection, paraviral exanthems reflect the response of the immune system to the infectious pathogens. Viruses cannot be identified in the skin. Typical paraviral exanthems include Gianotti-Crosti syndrome, pityriasis rosea, pityriasis lichenoides, papular-purpuric gloves and sock syndrome, and asymmetrical periflexural exanthema. Unilateral mediothoracic exanthem, eruptive pseudoangiomatosis are rare and eruptive hypomelanosis has been described recently.
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22
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Pityriasis rosea in a patient with retrovirus infection and a history of syphilis and positive results of infection with hepatitis A virus, hepatitis B virus and hepatitis C virus. Postepy Dermatol Alergol 2017; 34:276-278. [PMID: 28670260 PMCID: PMC5471383 DOI: 10.5114/ada.2017.67850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/24/2016] [Indexed: 01/25/2023] Open
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Eliassen E, Marci R, Di Luca D, Rizzo R. The use of heparin in infertility and recurrent pregnancy loss: Are its antiviral properties at play? Med Hypotheses 2017; 102:41-47. [DOI: 10.1016/j.mehy.2017.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 03/05/2017] [Indexed: 12/31/2022]
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De A, Roy S, Sukla S, Ansari A, Biswas S. Occult Hepatitis B Virus Infections (Often with Human Herpesvirus 7 Co-Infection) Detected in Pityriasis rosea Patients: A Pilot Study. Indian J Dermatol 2017; 62:598-605. [PMID: 29263533 PMCID: PMC5724307 DOI: 10.4103/ijd.ijd_235_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The etiopathogenesis of Pityriasis rosea (PR), a papulo-squamous skin disease, remains elusive and hypothesized to be caused primarily by human herpesvirus (HHV) 6 or 7 or immune dysfunction. Aims The recent increasing incidences of hepatitis B virus (HBV) infections, including asymptomatic occult HBV infections (OBIs), in a densely populated city in India, prompted us to investigate whether PR patients (from varied socioeconomic and immune status) harbor the underlying HBV infections. These cases were also investigated for HHV 6 and 7 infections. Materials and Methods DNA from ethylenediaminetetraacetic acid blood samples from PR-diagnosed individuals (n = 13; mostly young adults) and healthy controls (n = 11) were subjected to virus gene-specific polymerase chain reactions (PCRs) for HBV and HHV 6 and 7. PCR products of expected length, when observed, were sequenced (bidirectional) using overlapping primers. Sequences were identified by NCBI BLAST and analyzed by multiple sequence alignment and phylogenetic studies. The blood samples were tested for HBsAg by EIA. Results In 5/13 PR samples, only HBV DNA (4/5 being HBsAg negative) was detected, providing first-time evidence that PR may be manifested in asymptomatic HBV carriers. 6/13 cases were HHV 7 (not HHV 6) DNA positive, providing confirmatory molecular genetic evidence for the first time of PR association with HHV 7 from India. Surprisingly, 5/6 HHV 7-positive PR cases were also HBV positive. Overall, 10/13 PR samples showed evidence of HBV infection. 8/13 were OBI, harboring at least one OBI-signature S protein mutation. All healthy controls were HBsAg EIA and PCR negative. Conclusions 77% of PR patients presented the evidence of underlying HBV infection (genotype D2), suggestive of horizontal HBV transmission. This warrants for mass HBV vaccination. PR patients should be tested for underlying virus infections for appropriate therapy and management.
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Affiliation(s)
- Abhishek De
- Department of Dermatology, Calcutta National Medical College and Hospital, Kolkata, West Bengal, India
| | - Subrata Roy
- Infectious Diseases & Immunology Division, CSIR Indian Institute of Chemical Biology, Kolkata, West Bengal, India
| | - Soumi Sukla
- Infectious Diseases & Immunology Division, CSIR Indian Institute of Chemical Biology, Kolkata, West Bengal, India
| | - Asad Ansari
- Department of Dermatology, Calcutta National Medical College and Hospital, Kolkata, West Bengal, India
| | - Subhajit Biswas
- Infectious Diseases & Immunology Division, CSIR Indian Institute of Chemical Biology, Kolkata, West Bengal, India
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Werntz M, Chun C, Togioka BM. Anesthetic Considerations for Neuraxial Anesthesia in Pregnant Patients With Pityriasis Rosea With Skin Lesions Covering the Lumbar Spine. ACTA ACUST UNITED AC 2016; 7:165-168. [PMID: 27513966 DOI: 10.1213/xaa.0000000000000371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pityriasis rosea (PR) is an acute exanthematous skin disease that is likely due to reactivation of human herpesviruses (HHVs) 6b and 7. In contrast to herpes simplex and zoster (alphaherpesviruses), HHV-6b and -7 (betaherpesviruses) are not found predominantly in skin lesions. This difference in virion location may decrease the possibility of causing central nervous system infection through skin contamination, but the risk for hematogenous spread likely remains the same. This article uses the first-known epidural placement through active PR to illustrate risk-benefit considerations when deciding between neuraxial and general anesthesia for obstetric patients with PR.
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Affiliation(s)
- Megan Werntz
- From Oregon Health & Science University, Portland, Oregon
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27
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Loh TY, Cohen PR. Pityriasis rosea in pregnancy: report of a spousal occurrence and craniosynostosis in the healthy newborn. Dermatol Pract Concept 2016; 6:39-46. [PMID: 27648382 PMCID: PMC5006551 DOI: 10.5826/dpc.0603a08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 05/01/2016] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Pityriasis rosea is a papulosquamous disease. It may occur during pregnancy; in this setting, it has occasionally been associated with adverse outcomes. PURPOSE A woman who developed pityriasis rosea at the beginning of her eighth week of gestation is described. The outcomes in newborns delivered by pregnant women who developed pityriasis rosea during gestation are summarized. METHOD A 28-year-old woman developed pityriasis rosea during her eighth week of pregnancy. Her husband had pityriasis rosea two months earlier. PubMed was searched for the following terms: conjugal, craniosynostosis, newborn, pityriasis, pregnancy, rosea, sagittal, spouse. The papers were reviewed and the references cited were evaluated. RESULTS Our patient delivered a healthy male infant after 41 weeks of gestation. He had normal weight, height, and Apgar scores. Isolated sagittal craniosynostosis was diagnosed and was successfully treated at nine weeks after birth without complications. CONCLUSION Several retrospective studies have investigated the possibility of adverse outcomes in infants born to women who developed pityriasis rosea during pregnancy, such as stillbirth, low gestational weight, hypotonia, and premature delivery. However, there are also reports of healthy newborns in women who have had pityriasis rosea during gestation. Our patient carried the fetus one week post-term and delivered a healthy boy via C-section; isolated sagittal craniosynostosis was later diagnosed and successfully repaired. The occurrence of craniosynostosis in a woman who developed pityriasis rosea during her first trimester of pregnancy may be two coincidental events.
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Affiliation(s)
- Tiffany Y Loh
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Philip R Cohen
- Department of Dermatology, University of California San Diego, La Jolla, CA, USA
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Das BB, Rakheja D, Lacelle C, Sedlak RH, Gulve N, Chowdhury SR, Prusty BK. Possible progesterone-induced gestational activation of chromosomally integrated human herpesvirus 6B and transplacental transmission of activated human herpesvirus 6B. J Heart Lung Transplant 2016; 35:1373-1376. [PMID: 27646062 DOI: 10.1016/j.healun.2016.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/12/2016] [Accepted: 08/17/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- Bibhuti B Das
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dinesh Rakheja
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chantale Lacelle
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ruth Hall Sedlak
- Molecular Virology Laboratory, Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Nitish Gulve
- Department of Microbiology, University of Würzburg, Germany
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Mahajan K, Relhan V, Relhan AK, Garg VK. Pityriasis Rosea: An Update on Etiopathogenesis and Management of Difficult Aspects. Indian J Dermatol 2016; 61:375-84. [PMID: 27512182 PMCID: PMC4966395 DOI: 10.4103/0019-5154.185699] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pityriasis rosea (PR) is a benign papulosquamous disorder seen commonly in clinical practice. Despite its prevalence and benign nature, there are still times when this common disorder presents in an uncommon way or course posing diagnostic or management problems for the treating physician. The etiopathogenesis of PR has always been a dilemma, and extensive research is going on to elicit the exact cause. This review focuses mainly on the difficult aspects of this benign common disorder such as etiopathogenesis, atypical manifestations, recurrent cases, differential diagnosis, therapy and pregnancy considerations. Although we could not find a black and white solution to all these problems, we have tried to compile the related literature to draw out some conclusions.
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Affiliation(s)
- Khushbu Mahajan
- Department of Dermatology, North Delhi Municipal Corporation Medical College, Hindu Rao Hospital, New Delhi, India
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30
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Chuh A, Zawar V, Sciallis G, Kempf W. A position statement on the management of patients with pityriasis rosea. J Eur Acad Dermatol Venereol 2016; 30:1670-1681. [PMID: 27406919 DOI: 10.1111/jdv.13826] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 05/18/2016] [Indexed: 02/02/2023]
Abstract
Many clinical trials have been conducted on the treatment of pityriasis rosea (PR). Our aim was to establish a position statement for the management of adults with PR based on the best available evidence. We searched PubMed for all reports on randomized controlled trials for the treatment of PR published in the past 30 years. We retrieved 14 articles reporting randomized controlled trials, and found five which met our quality requirements for in-depth analyses. Erythromycin was found in a well-conducted triple-blind study to cast significant impacts on clinical outcomes. However, adverse gastrointestinal effects were fairly common. Another well-conducted study on azithromycin reported no significant benefit. It was reported in three well-conducted studies on oral acyclovir in low dose (400 mg three times daily for 7 days or 400 mg five times daily for 7 days) and high dose (800 mg five times daily for 7 days), that acyclovir is effective in attaining rash regression and lessening the pruritus. When compared against each other, the high-dose regimen demonstrated no benefit over the low-dose regimens. Our statement comprises the follows: (i) The diagnosis of PR should be ascertained; (ii) The patients should be assessed for rash severity and impacts on quality of life; (iii) PR is a self-limiting disease, and most patients do not necessitate any treatment; (iv) For patients necessitating active treatment, oral acyclovir as 400 mg three times daily for 7 days can be considered; (v) Attention should be given to adverse effects and contraindications of acyclovir; (vi) When PR occurs in early pregnancy, oral antiviral therapy could be considered after consulting experienced clinicians; (vii) Inadequate information exists in the use of acyclovir to treatment PR in children and breastfeeding women; and (viii) Treating PR is an off-label use of acyclovir, and this has to be discussed with experienced colleagues and the patients.
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Affiliation(s)
- A Chuh
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong and Prince of Wales Hospital, Shatin, Hong Kong.
| | - V Zawar
- Department of Dermatology, Godavari Foundation Medical College and Research Center, DUPMCJ, Nashik, India
| | - G Sciallis
- Department of Dermatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - W Kempf
- Histologische Diagnostik, Department of Dermatology, University Hospital Zürich, Zurich, Switzerland
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Yang CS, Teeple M, Muglia J, Robinson-Bostom L. Inflammatory and glandular skin disease in pregnancy. Clin Dermatol 2016; 34:335-43. [DOI: 10.1016/j.clindermatol.2016.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Drago F, Ciccarese G, Rebora A, Broccolo F, Parodi A. Pityriasis Rosea: A Comprehensive Classification. Dermatology 2016; 232:431-7. [PMID: 27096928 DOI: 10.1159/000445375] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/29/2016] [Indexed: 12/13/2022] Open
Abstract
Pityriasis rosea (PR) is an acute, self-limiting exanthematous disease associated with the endogenous systemic reactivation of human herpesvirus (HHV)-6 and/or HHV-7. The disease typically begins with a single, erythematous plaque followed by a secondary eruption with lesions on the cleavage lines of the trunk (configuration of a 'Christmas tree'). The duration may vary from 2 weeks to a few months. Besides the typical presentation of PR, atypical forms have been described. The previous classifications of PR are mainly based on its atypical morphological features rather than on the pathogenetic mechanisms that underlie the different presentations of the disease. Notably, most of the morphologically atypical forms follow a course amenable to the classic form. The classification that we propose, taking into account the pathogenesis, clinical features, and course of the disease, is easy and intuitive and may be helpful in identifying the atypical forms of PR in order to avoid misdiagnosis and establish the best treatment options. Finally, this classification provides indications for managing potentially harmful forms of PR (such as PR in pregnancy) and PR-like eruptions.
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Affiliation(s)
- Francesco Drago
- DISSAL, Department of Dermatology, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
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Drago F, Broccolo F, Javor S, Drago F, Rebora A, Parodi A. Evidence of human herpesvirus-6 and -7 reactivation in miscarrying women with pityriasis rosea. J Am Acad Dermatol 2014; 71:198-9. [PMID: 24947696 DOI: 10.1016/j.jaad.2014.02.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 02/05/2014] [Accepted: 02/16/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Francesco Drago
- Department of Endocrinological and Metabolic Sciences, Section of Dermatology, University of Genoa, Italy
| | | | - Sanja Javor
- Department of Endocrinological and Metabolic Sciences, Section of Dermatology, University of Genoa, Italy.
| | - Francesca Drago
- Department of Endocrinological and Metabolic Sciences, Section of Dermatology, University of Genoa, Italy
| | - Alfredo Rebora
- Department of Endocrinological and Metabolic Sciences, Section of Dermatology, University of Genoa, Italy
| | - Aurora Parodi
- Department of Endocrinological and Metabolic Sciences, Section of Dermatology, University of Genoa, Italy
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Ganguly S. A Randomized, Double-blind, Placebo-Controlled Study of Efficacy of Oral Acyclovir in the Treatment of Pityriasis Rosea. J Clin Diagn Res 2014; 8:YC01-4. [PMID: 24995231 DOI: 10.7860/jcdr/2014/8140.4360] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 04/14/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pityriasis rosea is an acute self-limiting skin disorder of unknown aetiology. Recently human herpes virus 6 and 7 has been hypothesized to be the cause of pityriasis rosea. OBJECTIVE To determine the efficacy of acyclovir, an anti-viral drug, in the treatment of pityriasis rosea. MATERIALS AND METHODS A randomized, double-blind, placebo-controlled study of efficacy of oral acyclovir in the treatment of pityriasis rosea was conducted on 73 patients. Thirty eight randomly selected patients were started on oral acyclovir. Thirty-five patients were prescribed placebo. The patients as well as the chief investigator were unaware of the therapeutic group to which patients belonged (acyclovir or placebo). Patients in both the groups were evaluated clinically after 7 and 14 days following the first visit and the data were analysed. RESULTS Follow up data of 60 patients was available and these were included in the statistical analysis. 53.33% and 86.66% of the patients belonging to the acyclovir group showed complete resolution on the 7(th) day and 14(th) day respectively following the first visit compared to 10% and 33.33% of patients from the placebo group. The findings were statistically significant. CONCLUSION The study showed that high dose acyclovir is effective in the treatment of pityriasis rosea.
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Affiliation(s)
- Satyaki Ganguly
- Assistant Professor, Department of Dermatology, Venereology & Leprosy, Pondicherry Institute of Medical Sciences , Pondicherry, India
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36
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Russo D, Malnati MS. Absolute quantification of viral DNA: the quest for perfection. Methods Mol Biol 2014; 1160:75-86. [PMID: 24740222 DOI: 10.1007/978-1-4939-0733-5_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In spite of the impressive technical refinement of the PCR technology, new-generation real-time PCR assays still suffer from two major limitations: the impossibility to control both for PCR artifacts (with the important caveat of false-negative results) and for the efficiency of nucleic acid recovery during the preliminary extraction phase of DNA from the biological sample. The calibrator technology developed at the Unit of Human Virology overcomes both of these limitations, leading to a substantially higher degree of accuracy and reproducibility in the quantification, which is especially useful for the measurement of pathogen loads in sequential samples and for the reliable detection of low-copy pathogens.
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Affiliation(s)
- Domenico Russo
- Human Virology Unit, Division of Immunology, Transplantation and Infectious Diseases, Fondazione Centro San Raffaele, via Olgettina 60, Milan, 20132, Italy
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37
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Gordon RA, Mays R, Sambrano B, Mayo T, Lapolla W. Antibiotics used in nonbacterial dermatologic conditions. Dermatol Ther 2012; 25:38-54. [PMID: 22591498 DOI: 10.1111/j.1529-8019.2012.01496.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The majority of nonbacterial dermatological conditions treated with antibiotics benefit from the anti-inflammatory properties of these medications, usually dapsone or tetracycline. Many other antimicrobials are used to treat noninfectious conditions. The following chapter is an overview of select noninfectious dermatological conditions for which antibiotics are used, with a focus on the most common antibiotics used for their nonantimicrobial properties.
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Cruz MJ, Baudrier T, Azevedo F. Atypical pityriasis rosea in a pregnant woman: first report associating local herpes simplex virus 2 reactivation. J Dermatol 2011; 39:490-2. [PMID: 21958020 DOI: 10.1111/j.1346-8138.2011.01349.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Pityriasis rosea is an acute exanthem with many clinical and epidemiologic features of an infectious disease. To date, human herpesvirus (HHV)-6 and HHV-7 appear to be the most indicted culprits, and the evidence in favor of this hypothesis and the controversial results produced elsewhere are discussed. The complex pathophysiology of HHV-6 and HHV-7 infection, their diffusion in the population at large, the difficulties of understanding whether the infection is still latent or is clinically manifest, and well as whether pityriasis rosea depends on a reinfection or on a viral reactivation, all make the issue extremely difficult to study and understand.
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Affiliation(s)
- Alfredo Rebora
- Section of Dermatology, University of Genoa, Genova, Italy.
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40
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[Chronic inflammatory and autoimmune mediated dermatoses during pregnancy. Course and prognosis for mother and child]. Hautarzt 2010; 61:1021-6. [PMID: 21076804 DOI: 10.1007/s00105-010-2007-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Chronic inflammatory dermatoses during pregnancy can take varying courses in mother and child. The dominant Th2-response characteristic for pregnancy may explain why atopic eczema or lupus erythematosus may deteriorate while psoriasis vulgaris may improve. In contrast, impetigo herpetiformis frequently shows a severe course. Lupus erythematosus and other autoantibody-triggered dermatoses like pemphigus vulgaris pose an increased risk for the child because of placental transfer of autoantibodies with specific skin changes or systemic manifestations of the disease as well as placental insufficiency, growth retardation and premature birth. Such risks are not associated with linear IgA dermatosis. A severe pityriasis rosea during the first 20 weeks of pregnancy may lead to an increased risk of abortion or premature delivery. Early diagnosis and individually adjusted therapy of skin diseases is mandatory to avoid any risk for mother or child.
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Drago F, Broccolo F, Rebora A. Pityriasis rosea: an update with a critical appraisal of its possible herpesviral etiology. J Am Acad Dermatol 2009; 61:303-18. [PMID: 19615540 DOI: 10.1016/j.jaad.2008.07.045] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 07/21/2008] [Accepted: 07/21/2008] [Indexed: 01/26/2023]
Abstract
Pityriasis rosea is an acute, self-healing exanthem characterized by oval erythematous-squamous lesions of the trunk and limbs, that usually spares face, scalp, palms, and soles. Constitutional symptoms, which have the character of true prodromes; clinical features, which resemble those of the known exanthems; and many epidemiologic data all suggest an infectious origin. A host of infectious agents have been incriminated, but, recently, human herpesvirus 6 and 7 have been extensively studied. The goal of this review is to outline the epidemiologic, clinical, histologic, and ultrastructural features of pityriasis rosea, but mainly to stress its possible human herpesvirus nature. In addition, clues have been added to help the reader to go through the complex subtleties of the virologic investigation.
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Affiliation(s)
- Francesco Drago
- Department of Endocrinological and Metabolic Sciences, Section of Dermatology, University of Genoa, Genoa, Italy
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Abstract
PURPOSE OF REVIEW Pityriasis rosea is a common skin condition seen in children and adults. Whereas pityriasis rosea is a benign condition, it is important to distinguish it from other childhood exanthems. RECENT FINDINGS Pityriasis rosea can present in a variety of manners. Most often a herald patch precedes the generalized eruption, although this is not always the case. Pityriasis rosea may lead to undesirable outcomes when affecting pregnant women. Guttate psoriasis, secondary syphilis, cutaneous lupus erythematosus, capillaritis, pityriasis versicolor, nummular eczema, and cutaneous T-cell lymphoma are important to consider in the differential diagnosis of pityriasis rosea. SUMMARY Pityriasis rosea is self-limiting, usually lasting 1-3 months. Treatment may be considered in certain cases, although there is a paucity of medical studies supporting any definitive treatment. However, treatment may be warranted for other conditions that mimic pityriasis rosea.
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Current world literature. Curr Opin Pediatr 2009; 21:553-60. [PMID: 19622920 DOI: 10.1097/mop.0b013e3283300b10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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