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Ashforth GM, Youssef S, Bhagavathi V, Wassef C, Miller JH. What's old is new: Valacyclovir for the treatment of pityriasis rosea, a retrospective case series. JAAD Case Rep 2023; 37:98-102. [PMID: 37360652 PMCID: PMC10285503 DOI: 10.1016/j.jdcr.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Affiliation(s)
- Gina M. Ashforth
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Sara Youssef
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Veena Bhagavathi
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Cindy Wassef
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Jason H. Miller
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
- Schweiger Dermatology Group, Freehold, New Jersey
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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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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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Makhecha M, Singh T, Khatib Y. Dermoscopy Differentiates Guttate Psoriasis from a Mimicker-Pityriasis Rosea. Dermatol Pract Concept 2021; 11:e2021138. [PMID: 33614216 DOI: 10.5826/dpc.1101a138] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2020] [Indexed: 12/26/2022] Open
Abstract
Background Guttate psoriasis (GP) and pityriasis rosea (PR) are a part of papulosquamous disorders that have very similar clinical features and often require histopathology to confirm the diagnosis. Dermoscopy has emerged as a noninvasive, cost-effective technique that can aid in the diagnosis of inflammatory skin diseases like GP and PR. Objective To study and compare the dermoscopic features of GP and PR. Methods Twenty consecutive patients each with GP or PR were enrolled in the study. The diagnosis of GP and PR were made clinically and on histopathology. Dermoscopic images were taken of the representative lesions from each patient using a manual dermoscope attached to a digital camera after applying ultrasound gel. Vascular morphology, vascular arrangement, background color, along with color and distribution of scales were noted in each case. Statistical analysis was done using chi-square test to determine the significance of findings in both groups. Results The combination of a bright red background with dotted vessels in uniform diffuse distribution with diffuse white scales was highly specific for the diagnosis of GP. Lesions of PR showed a red background with dotted blood vessels in nonspecific distribution. Scales were either white in color or brown pigmented with patchy distribution. Brown pigmentation and brown dots were additional findings in cases of PR. Conclusions Combinations of dermoscopic patterns can aid in the diagnosis of GP and PR in the majority of the cases.
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Affiliation(s)
- Meena Makhecha
- Department of Dermatology, HBT Medical College & Dr. R.N. Cooper Hospital, Mumbai, India
| | - Tishya Singh
- Department of Dermatology, HBT Medical College & Dr. R.N. Cooper Hospital, Mumbai, India
| | - Yasmeen Khatib
- Department of Pathology, HBT Medical College & Dr. R.N. Cooper Hospital, Mumbai, India
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Pedrazini MC, Groppo FC. L-lysine therapy to control the clinical evolution of pityriasis rosea: Clinical case report and literature review. Dermatol Ther 2020; 34:e14679. [PMID: 33326128 DOI: 10.1111/dth.14679] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 12/15/2022]
Abstract
Pityriasis rosea (PR) is a dermatological disease with an erythemato-papulosquamous manifestation, distributed on the trunk and extremities affecting healthy people, especially children and young people between 10 and 35 years of age. The evolution is 6 to 8 weeks and may remain for 3 to 6 months. It regresses spontaneously and can leave changes in the skin color but reversibly. Acyclovir is indicated to minimize clinical manifestations with the suspected of viral association (HHV-6 and 7). Another group of the human herpesvirus family (HHV-1 and 2), causes herpes simplex that is controlled with the antivirals, including acyclovir, as well as the amino acid L-lysine, both showing positive and similar results in reducing the number of annual manifestations and the healing time of the lesions. The aim of this study is to report a case of PR in a child, to review the literature on the etiopathogenesis of the disease and on the effects of L-lysine as well as another amino acid in the treatment. An 11-year-old girl, phototype II, presented lesions diagnosed as PR. The cycle would be 6 to 8 weeks on average. A solution of L-lysine was prescribed for 30 days, on an empty stomach. After the fourth day of therapy, the cycle of new eruptions was interrupted, initial lesions regressed, accelerating the repair of larger lesions resulting in an improvement of the clinical condition. We concluded that the administration of L-lysine, in therapeutic doses, can be a safe alternative for the PR control.
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Affiliation(s)
- Maria Cristina Pedrazini
- Department of Dental Sciences, São Leopoldo Mandic Research Center, Campinas, Brazil.,Department of Biosciences, Piracicaba Dental School - UNICAMP, Piracicaba, Brazil
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Affiliation(s)
- Christopher Del Mar
- The University of QueenslandUniversity General Practice, Wirrawong Parade, Inala, QLD 4077
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Chhabra N, Prabha N, Kulkarni S, Ganguly S. Pityriasis Rosea: Clinical Profile from Central India. Indian Dermatol Online J 2018; 9:414-417. [PMID: 30505781 PMCID: PMC6232983 DOI: 10.4103/idoj.idoj_12_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Pityriasis rosea (PR) is a common, self-limiting dermatologic disorder. The information regarding the clinical profile of the disease in India is limited because of inadequate studies. Materials and Methods: A retrospective, record-based study on the clinical presentation of PR was conducted in a tertiary care center based in Central India. Data of all the patients presenting to our outpatient department from October 2014 to March 2015 with a clinical diagnosis of PR were analyzed. Results: The age of the patients ranged from 9 to 54 (mean-20.32) years. There was a male preponderance with a male-to-female ratio of 1.3:1. History of prodromal symptoms was present in 11 (27.5%) patients. Pruritus was a common symptom in 30 of 40 (75%) patients. Of 40 patients, 15 (35%) had herald patch. The morphology of skin lesions was typical in most of the patients (77.5%). Two (5%) patients had papular skin lesions, four (10%) patients had erythema multiforme-like skin lesions, and one patient each had papulovesicular, psoriasiform, and eczematous skin lesions. Conclusion: The clinical features of most of the cases were mostly in accordance with the classical pattern of PR, with few unusual features.
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Affiliation(s)
| | - Neel Prabha
- Department of Dermatology, Shri Shankaracharya Institute of Medical Sciences, Bhilai, Chhattisgarh, India
| | - Sandeep Kulkarni
- Department of Dermatology, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
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Rodriguez-Zuniga M, Torres N, Garcia-Perdomo H. Effectiveness of acyclovir in the treatment of pityriasis rosea. A systematic review and meta-analysis. An Bras Dermatol 2018; 93:686-695. [PMID: 30156618 PMCID: PMC6106661 DOI: 10.1590/abd1806-4841.20187252] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 09/20/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is a lack of evidence to support acyclovir administration in pityriasis rosea. OBJECTIVE To determine the efficacy of acyclovir in patients with typical pityriasis rosea. METHODS A systematic review and meta-analysis of experimental studies was performed in MEDLINE, SCOPUS, EMBASE and others, from January 1990 to October 2016 on acyclovir for pityriasis rosea. Random effect model was used to find the pooled Risk Ratio. Outcomes, evaluated between weeks 1 to 8, were regression of lesions, cessation of lesions, decrease of symptoms and duration of disease. Comparisons were acyclovir vs. placebo; acyclovir vs. symptomatic treatment; acyclovir vs. antibiotic; acyclovir vs. observation and combined therapy (acyclovir plus symptomatic treatment) vs. symptomatic treatment alone. RESULTS Seven papers were analyzed with 324 participants, of which 159 received acyclovir and 165 were controls. Acyclovir was superior to placebo for complete regression of lesions at week 1 (Risk Ratio 5.72, CI95% 2.36-13.88). However, combined therapy was not superior to symptomatic treatment at week 4 (Risk Ratio 1.46, CI95% 0.93-2.29). Individual studies showed the superiority of acyclovir for the control of symptoms and pruritus. STUDY LIMITATIONS We faced differences designs of trials and inconsistency between reports. CONCLUSION Symptomatic treatment is a reasonable option for pityriasis rosea, and the addition of acyclovir is justified for the control of symptoms and pruritus.
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Affiliation(s)
- Milton Rodriguez-Zuniga
- Dermatology Department, Hospital Nacional Daniel Alcides Carrion,
Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Natalie Torres
- Dermatology Department, Hospital Nacional Dos de Mayo, Universidad
Nacional Mayor de San Marcos, Lima, Peru
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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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Gru AA. Introduction to inflammatory dermatoses: Histological clues for the practicing pathologist. Semin Diagn Pathol 2017; 34:210-219. [DOI: 10.1053/j.semdp.2016.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Jairath V, Mohan M, Jindal N, Gogna P, Syrty C, Monnappa PM, Kaur S, Sehrawat M. Narrowband UVB phototherapy in pityriasis rosea. Indian Dermatol Online J 2015; 6:326-9. [PMID: 26500862 PMCID: PMC4594391 DOI: 10.4103/2229-5178.164480] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Pityriasis rosea (PR) is an acute self-limiting disease. Despite vigorous efforts by generations of researchers since nearly 150 years, present treatment modalities for PR are not very gratifying. Ultraviolet radiation has been recommended in PR, although only a few studies validate this proposal. This study was conducted to explore the therapeutic effect of NBUVB on the symptoms, course, and severity of PR. MATERIALS AND METHODS This study involved a hundred patients who were randomly divided into two groups, using computer-generated randomization chart. Group A underwent treatment with fixed dose NBUVB of 250 mJ/cm(2) three times (nonconsecutive) a week for 4 weeks. Group B formed the placebo group who did not receive any treatment. The two groups were compared with each other for the intensity of pruritis, course and duration of disease, and PR severity score (PRSS). RESULTS The t values of improvement in PRSS score in Group A (t = 12.796) were higher as compared with that in Group B (t = 10.066). Similarly, the t value of the pruritus scale in Group A (t = 7.758) was higher than Group B (t = 5.754) indicating the symptomatic improvement in itching. CONCLUSION Fixed-dose NBUVB phototherapy resulted in marked improvement in the severity and symptoms of the disease as quantitatively assessed by PRSS.
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Affiliation(s)
- Vijayeeta Jairath
- Department of Dermatology, Venereology, and Leprosy, Dr. BR Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India
| | - Madan Mohan
- Department of Dermatology, Venereology, and Leprosy, Dr. BR Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India
| | - Nidhi Jindal
- Department of Dermatology, Venereology, and Leprosy, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Paritosh Gogna
- Department of Dermatology, Venereology, and Leprosy, Dr. BR Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India
| | - Clarify Syrty
- Department of Dermatology, Venereology, and Leprosy, Dr. BR Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India
| | | | - Sarabjit Kaur
- Department of Dermatology, Venereology, and Leprosy, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Manu Sehrawat
- Department of Dermatology, Venereology, and Leprosy, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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Ataseven A, Kurtipek GS, Akyurek FT, Kucukosmanoglu I, Dilek N. Unilateral pityriasis rosea. Indian Dermatol Online J 2014; 5:528-9. [PMID: 25396152 PMCID: PMC4228664 DOI: 10.4103/2229-5178.142550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Arzu Ataseven
- Department of Dermatology, Konya Training and Research Hospital, Meram, Konya, Turkey
| | | | - Fatma Tuncez Akyurek
- Department of Dermatology, Konya Training and Research Hospital, Meram, Konya, Turkey
| | | | - Nursel Dilek
- Department of Dermatology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
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Moloney GR, Goh MSY, Mitchell C, McCormack CJ. Localised pityriasis rosea-like eruption during radiotherapy. Report of 2 cases. Australas J Dermatol 2014; 56:303-6. [PMID: 25331085 DOI: 10.1111/ajd.12244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 07/09/2014] [Indexed: 11/29/2022]
Abstract
Pityriasis rosea is a common skin condition that presents acutely with asymptomatic, scaly and oval plaques, usually in a well-recognised distribution over the trunk. Two men developed ovoid, scaly and annular lesions limited to the radiotherapy field during treatment for pelvic malignancies and without a preceding herald patch. Other causes of the eruption were excluded on clinical and pathological grounds and the histopathological features were consistent with a pityriasis rosea-like eruption. In both cases the lesions resolved spontaneously by 8 weeks. These are the first reported cases of a localised pityriasis rosea-like eruption arising during radiotherapy.
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Affiliation(s)
- Gary R Moloney
- Department of Cancer Surgery (Dermatology), Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michelle S Y Goh
- Department of Cancer Surgery (Dermatology), Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Catherine Mitchell
- Department of Anatomical Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Chris J McCormack
- Department of Cancer Surgery (Dermatology), Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Guarneri F, Cannavò SP, Minciullo PL, Gangemi S. Pityriasis rosea of Gibert: immunological aspects. J Eur Acad Dermatol Venereol 2014; 29:21-5. [PMID: 25200809 DOI: 10.1111/jdv.12701] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 07/17/2014] [Indexed: 01/22/2023]
Abstract
More than 200 years after first description and 150 years after complete definition by Gibert, pityriasis rosea (PR) is still a clinical entity with many obscure aspects. Although great interest was focused on aetiology, studies on immunological mechanisms associated with this disease were rather discontinuous. We present a review of the literature on immunological features of PR, aimed to outline a unified picture of currently available knowledge in this field and create a useful starting point for future research.
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Affiliation(s)
- F Guarneri
- Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Aydogan K, Karadogan SK, Adim SB, Tunali S. Pityriasis Rosea-Like Eruption due to Ergotamine: A Case Report. J Dermatol 2014; 32:407-9. [PMID: 16043908 DOI: 10.1111/j.1346-8138.2005.tb00917.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Relhan V, Sinha S, Garg VK, Khurana N. Pityriasis rosea with erythema multiforme - like lesions: an observational analysis. Indian J Dermatol 2013; 58:242. [PMID: 23723495 PMCID: PMC3667307 DOI: 10.4103/0019-5154.110855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Pityriasis rosea (PR) is an acute or subacute inflammatory skin disease characterized by erythematous papulosquamous eruptions localized on the trunk and arms. The eruptions are self-limiting and usually disappear gradually in 2-10 weeks, without any treatment. Typical PR is much easier to diagnose than the rare atypical forms. There is a passing mention of PR with erythema multiforme-like lesions in the literature, but no extensive case series have been published till date. We present a series of five patients for whom we believe atypical PR is the likely diagnosis.
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Affiliation(s)
- Vineet Relhan
- Department of Dermatology and STD, Maulana Azad Medical College and Lok Nayak Hospital, Delhi, India
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Affiliation(s)
- Naveen Kikkeri Narayanasetty
- Department of Dermatology, Sri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital (SDMCMS and H), Sattur, Dharwad, India
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Chuh A, Zawar V, Law M, Sciallis G. Gianotti-Crosti syndrome, pityriasis rosea, asymmetrical periflexural exanthem, unilateral mediothoracic exanthem, eruptive pseudoangiomatosis, and papular-purpuric gloves and socks syndrome: a brief review and arguments for diagnostic criteria. Infect Dis Rep 2012; 4:e12. [PMID: 24470919 PMCID: PMC3892651 DOI: 10.4081/idr.2012.e12] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 11/14/2011] [Accepted: 11/14/2011] [Indexed: 12/11/2022] Open
Abstract
Several exanthems including Gianotti-Crosti syndrome, pityriasis rosea, asymmetrical periflexural exanthem, eruptive pseudoangiomatosis, and papular-purpuric gloves and socks syndrome are suspected to be caused by viruses. These viruses are potentially dangerous. Gianotti-Crosti syndrome is related to hepatitis B virus infection which is the commonest cause of hepatocellular carcinoma, and Epstein-Barr virus infection which is related to nasopharyngeal carcinoma. Pityriasis rosea has been suspected to be related to human herpesvirus 7 and 8 infections, with the significance of the former still largely unknown, and the latter being a known cause of Kaposi's sarcoma. Papular-purpuric gloves and socks syndrome is significantly associated with human B19 erythrovirus infection which can lead to aplastic anemia in individuals with congenital hemoglobinopathies, and when transmitted to pregnant women, can cause spontaneous abortions and congenital anomalies. With viral DNA sequence detection technologies, false positive results are common. We can no longer apply Koch's postulates to establish cause-effect relationships. Biological properties of some viruses including lifelong latent infection, asymptomatic shedding, and endogenous reactivation render virological results on various body tissues difficult to interpret. We might not be able to confirm or refute viral causes for these rashes in the near future. Owing to the relatively small number of patients, virological and epidemiology studies, and treatment trials usually recruit few study and control subjects. This leads to low statistical powers and thus results have little clinical significance. Moreover, studies with few patients are less likely to be accepted by mainstream dermatology journals, leading to publication bias. Aggregation of data by meta-analyses on many studies each with a small number of patients can theoretically elevate the power of the results. Techniques are also in place to compensate for publication bias. However, these are not currently feasible owing to different inclusion and exclusion criteria in clinical studies and treatment trials. The diagnoses of these rashes are based on clinical assessment. Investigations only serve to exclude important differential diagnoses. A wide spectrum of clinical features is seen, and clinical features can vary across different populations. The terminologies used to define these rashes are confusing, and even more so are the atypical forms and variants. Previously reported virological and epidemiological results for these rashes are conflicting in many aspects. The cause of such incongruence is unknown, but low homogeneity during diagnosis and subject recruitment might be one of the factors leading to these incongruent results. The establishment and proper validation of diagnostic criteria will facilitate clinical diagnosis, hasten recruitment into clinical studies, and allow results of different studies to be directly compared with each another. Meta-analyses and systematic reviews would be more valid. Diagnostic criteria also streamline clinical audits and surveillance of these diseases from community perspectives. However, over-dependence on diagnostic criteria in the face of conflicting clinical features is a potential pitfall. Clinical acumen and the experience of the clinicians cannot be replaced by diagnostic criteria. Diagnostic criteria should be validated and re-validated in response to the ever-changing manifestations of these intriguing rashes. We advocate the establishment and validation of diagnostic criteria of these rashes. We also encourage the ongoing conduction of studies with a small number of patients. However, for a wider purpose, these studies should recruit homogenous patient groups with a view towards future data aggregation.
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Affiliation(s)
- Antonio Chuh
- School of Public Health, The Chinese University of Hong Kong and The Prince of Wales Hospital, Hong Kong
| | | | - Michelle Law
- School of Public Health, The Chinese University of Hong Kong and The Prince of Wales Hospital, Hong Kong
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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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Osawa A, Haruna K, Okumura K, Taneda K, Mizuno Y, Suga Y. Pityriasis rosea showing unilateral localization. J Dermatol 2010; 38:607-9. [PMID: 21352292 DOI: 10.1111/j.1346-8138.2010.01044.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Parija M, Thappa DM. Study of role of streptococcal throat infection in pityriasis rosea. Indian J Dermatol 2010; 53:171-3. [PMID: 19882027 PMCID: PMC2763755 DOI: 10.4103/0019-5154.44787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Pityriasis rosea is a common, acute exanthem of uncertain etiology. The exact cause of pityriasis rosea is not known but various hypotheses have been postulated incriminating infective agents such as viruses, bacteria, spirochete and noninfective etiologies such as atopy and autoimmune causes have also been investigated. Aim: We undertook a study to investigate the role of Streptococcus haemolyticus in the causation of pityriasis rosea and study the levels of C-reactive protein (CRP) and ASLO titer in patients with pityriasis rosea. Materials and Methods: The study included 20 patients with pityriasis rosea attending the outpatient dermatology department at JIPMER hospital during the period from June to December 2004. Corresponding number of age- and sex-matched controls were chosen from amongst healthy individuals and patients attending skin OPD with dermatological disorders other than pityriasis rosea. Results: On analyzing the data collected from 20 cases of pityriasis rosea, the average age was found to be 15.3 years and ranged from 5 years to 30 years. The male to female ratio was found to be 1.5:1. The average duration of illness was 14.5 days (median) and 29.3 days (mean). CRP was negative in all the cases as well as the controls. ASLO titer was found to be raised in 2 (10%) cases, while it remained below the critical value in all the controls. On comparing the cases and controls, the raised ASLO titer in the cases was found to be not statistically significant (p = 0.147). From the throat swab culture, Streptococcus haemolyticus was isolated from only one case and none of the controls. This finding was not statistically significant (p = 0.310). Conclusion: As per the findings of the present study, we arrived at conclusion that there is no association between streptococcus pharyngitis and pityriasis rosea.
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Affiliation(s)
- Madhuri Parija
- Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry - 605 006, India
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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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Neoh CY, Tan AWH, Mohamed K, Sun YJ, Tan SH. Characterization of the inflammatory cell infiltrate in herald patches and fully developed eruptions of pityriasis rosea. Clin Exp Dermatol 2009; 35:300-4. [PMID: 19663842 DOI: 10.1111/j.1365-2230.2009.03469.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pityriasis rosea (PR) is a common cutaneous papulosquamous disorder affecting young adults. Previous studies have suggested possibilities of a viral aetiology and the involvement of cell-mediated immunity, but these remain unproven to date. AIM To elucidate the possible pathomechanisms in PR by characterizing the inflammatory cellular infiltrate in herald patches and fully developed PR eruptions. METHODS In total, 12 biopsy specimens from 6 patients diagnosed with PR were examined. For each patient, biopsies were taken from both a herald patch and a secondary patch. Specimens were processed for histopathological examination and immunohistochemical staining with a large panel of monoclonal antibodies. RESULTS Histopathologically, all specimens showed epidermal changes such as parakeratosis, orthokeratosis, epidermal hyperplasia and spongiosis. Less common results included epidermal exocytosis and focal parakeratosis. In all biopsies, the dermal infiltrate of lymphocytes stained positively for monoclonal antibodies specific for T cells. The ratio of the CD4+ (helper) vs. CD8+ (cytotoxic) T cells in the dermal infiltrate was increased in most specimens. Increased staining for Langerhans cells was seen within the dermis of lesional skin. There were no marked differences found in histopathology and immunohistochemistry between the herald patch and secondary lesions. Overall, there was a lack of natural killer cell and B-cell activities in PR lesions. CONCLUSIONS Our results support a predominantly T-cell mediated immunity in the development of PR.
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Affiliation(s)
- C Y Neoh
- Department of Dermatology, National Skin Centre, Singapore, Singapore.
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Martínez-Casimiro L, Pérez-Ferriols A. Pitiriasis rosada: una presentación atípica. Semergen 2009. [DOI: 10.1016/s1138-3593(09)71876-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Pitiríase rósea é doença inflamatória aguda da pele, que regride espontaneamente, normalmente sem deixar seqüelas, em período que varia de quatro a oito semanas. Clinicamente é caracterizada pelo aparecimento de típicas lesões eritêmato-pápulo-escamosas. Atinge todas as idades, embora seja mais comumente observada entre 10 e 35 anos. Apesar de exaustivas pesquisas, sua etiologia ainda permanece desconhecida. São discutidos alguns aspectos epidemiológicos, anatomoclínicos, diagnósticos diferenciais, doenças associadas, com ênfase no tratamento e etiologia da doença.
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Affiliation(s)
| | - Délio Delmaestro
- Universidade Federal do Espírito Santo; Universidade Federal do Espírito Santo, Brasil
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Chuh AAT, Chan PKS, Lee A. The detection of human herpesvirus-8 DNA in plasma and peripheral blood mononuclear cells in adult patients with pityriasis rosea by polymerase chain reaction. J Eur Acad Dermatol Venereol 2006; 20:667-71. [PMID: 16836493 DOI: 10.1111/j.1468-3083.2006.01569.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Herpesvirus-like particles have been reported to be detectable by electron microscopy in lesional biopsy of patients with pityriasis rosea (PR). We report a study investigating the association of PR with human herpesvirus-8 (HHV-8) infection. METHODS Our setting is a teaching clinic affiliated to a university. We recruited eight patients aged 28-47 years (mean: 34.5 years) diagnosed with PR during a one-year period. We collected acute blood specimens at presentation and convalescent blood specimens three to four weeks later. We also collected skin scrapings from the herald patch where present and from truncal secondary lesions. RESULTS We detected HHV-8 DNA by a nested PCR (polymerase chain reaction) targeting, respectively, a 233-bp and a 160-bp fragment of ORF 26. PCR for HHV-8 DNA was negative in the peripheral blood mononuclear cells and plasma of acute and convalescent specimens of all patients, and negative in all skin scrapings. We detected anti-HHV-8 IgG and IgM antibodies by the indirect immunofluorescence. Four patients had IgG antibodies against HHV-8, but with no significant rise of titre. None were positive for anti-HHV-8 IgM antibody. CONCLUSION We conclude that PR is not associated with HHV-8 infection.
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Affiliation(s)
- A A T Chuh
- Department of Community and Family Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
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Miranda SMB, Porto LC, Pontes LFS, Filgueira AL. Correlation between HLA and pityriasis rosea susceptibility in Brazilian blacks. J Eur Acad Dermatol Venereol 2006; 20:21-6. [PMID: 16405603 DOI: 10.1111/j.1468-3083.2005.01320.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The human leucocyte antigen (HLA) has been related to susceptibility factors in several diseases. This study aimed to determine the potential genetic susceptibility of patients with pityriasis rosea (PR) through HLA molecular typing analysis. METHODS The method of choice was polymerase chain reaction with sequence-specific primers (PCR-SSP) using low-resolution typing kits, with determination of the alleles class I (HLA-A, HLA-B and HLA-C) and class II (HLA-DRB1, DRB3, DRB4, DRB5 and DQB1) performed in 30 Afro-Brazilian PR-diagnosed patients and 45 healthy individuals as the control group (PR-C). RESULTS Analysis of the HLA typing results showed that the relative risk (RR) of 4.00 [95% confidence interval (95% CI) 1.20-13.28, two-tailed P = 0.018] for allele HLA-DQB1*04 class II, detected in 33.3% of PR patients, was significant. By contrast, in the control group only 11.1% of subjects had that allele. Three out of six B*51 alleles and three out of six B*53 alleles detected in PR patients were found, together with the allele DQB1*04. CONCLUSION We suggest that alleles DQB1*04 may be involved in the genetic susceptibility of PR based on the significant predominance of those alleles observed in the black PR patients. We also recommend that more studies are conducted on populations of other ethnic origins, preferentially with higher resolution techniques of DNA typing.
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Affiliation(s)
- S M B Miranda
- Department of Dermatology, Clinical Hospital, Vitória, Brazil.
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Affiliation(s)
- Lenis M González
- Dermatology and Pediatrics - New Jersey Medical School, Newark, NJ 07103-2714, USA
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Broccolo F, Drago F, Careddu AM, Foglieni C, Turbino L, Cocuzza CE, Gelmetti C, Lusso P, Rebora AE, Malnati MS. Additional evidence that pityriasis rosea is associated with reactivation of human herpesvirus-6 and -7. Ann Dermatol 2005; 24:360-2. [PMID: 22879725 PMCID: PMC3412250 DOI: 10.5021/ad.2012.24.3.360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 08/29/2011] [Accepted: 08/30/2011] [Indexed: 12/11/2022] Open
Abstract
To elucidate the role of human herpesvirus (HHV)-6 and -7 (HHV-7) in pityriasis rosea (PR), we measured their DNA load in plasma, peripheral blood mononuclear cells (PBMC), and tissues using a calibrated quantitative real-time PCR assay. We also studied HHV-6- and HHV-7-specific antigens in skin by immunohistochemistry and anti-HHV-7 neutralizing activity using a syncytia-inhibition test. Plasma and PBMC were obtained from 31 PR patients (14 children, 17 adults), 12 patients with other dermatites, and 36 blood donors. Skin biopsies were obtained from 15 adults with PR and 12 with other dermatites. HHV-6 and HHV-7 DNA were detected in 17% and in 39% of PR plasmas, respectively, but in no controls. HHV-7 viremia was associated with a higher PBMC load and, in adults, with systemic symptoms. HHV-7, but not HHV-6, levels in PBMC were higher in PR patients than in controls. HHV-6 and HHV-7 antigens were found only in PR skin (17% and 67% of patients analyzed, respectively), indicating a productive infection. Syncytia-neutralizing antibodies were found in PR patients and controls, but their titers were lower in patients with HHV-7 viremia. These data confirm the causal association between PR and active HHV-7 or, to a lesser extent, HHV-6 infection.
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Affiliation(s)
- Francesco Broccolo
- Unit of Human Virology, DIBIT San Raffaele Scientific Institute, Milan, Italy
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Chuh AAT, Lee A, Chan PKS. Pityriasis rosea in pregnancy - specific diagnostic implications and management considerations. Aust N Z J Obstet Gynaecol 2005; 45:252-3. [PMID: 15904457 DOI: 10.1111/j.1479-828x.2005.00399.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Antonio A T Chuh
- Department of Community and Family Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
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Miranda SB, Lupi O, Lucas E. Vesicular pityriasis rosea: response to erythromycin treatment. J Eur Acad Dermatol Venereol 2005; 18:622-5. [PMID: 15324412 DOI: 10.1111/j.1468-3083.2004.01021.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pityriasis rosea (PR) is a relatively common disease although its aetiology has not yet been identified. It occurs worldwide and there is no racial susceptibility factor. It usually affects teenagers and young adults between 10 and 35 years of age. Typical PR is much easier to diagnose than the rare atypical forms. We report a rare case of vesicular PR in a black woman who had vesicular lesions limited to her palms and soles in addition to regular typical lesions. We devised an efficient oral erythromycin treatment for this patient.
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Affiliation(s)
- S B Miranda
- Dermatology Department, Clinical Hospital of Federal University/UFES, Vitória, Brazil.
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Garcia-F-Villalta MJ, Hernández-Nuñez A, Córdoba S, Fernández-Herrera J, García-Díez A. Atypical pityriasis rosea and Hodgkin's disease+. J Eur Acad Dermatol Venereol 2004; 18:81-2. [PMID: 14678538 DOI: 10.1111/j.1468-3083.2004.00610.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pityriasis rosea (PR)-like eruptions have been associated with several neoplasms and drugs. These eruptions may be atypical. To date, the association of Hodgkin's disease with PR-like eruptions has rarely been reported. We report a 37-year-old patient with clinical lesions of PR-like, systemic symptoms and lymphadenopathies, who was subsequently diagnosed with Hodgkin's disease.
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Affiliation(s)
- M J Garcia-F-Villalta
- Department of Dermatology, Hospital Universitario de La Princesa, C/Diego de León n° 62, Madrid 28006, Spain
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36
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Karnath B, Hussain N, Bevin M. Pityriasis rosea. Appearance and distribution of macules aid diagnosis. Postgrad Med 2003; 113:93-4, 97. [PMID: 12764899 DOI: 10.3810/pgm.2003.05.1420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 40-year-old man presented with a 1-week history of a diffuse pruritic rash. The patient denied having had fever, chills, or a recent respiratory infection. He could not recall having an initial patch. Physical examination revealed numerous small, scaly patches on his trunk (figure 1). The rash spared the palms of his hands and soles of his feet as well as the distal extremities.
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Affiliation(s)
- Bernard Karnath
- Department of Internal Medicine, University of Texas Medical Branch at Galveston, 301 University Blvd, 4,174 John Sealy Annex, Galveston, TX 77555-0566, USA.
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Carbia SG, Chain M, Dei-Cas I, Hochman A, Lagodín C, Devés A, Woscoff A. Pitiríase rósea purpúrica: relato de caso e revisão da literatura. An Bras Dermatol 2003. [DOI: 10.1590/s0365-05962003000200010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A pitiríase rósea purpúrica constitui doença rara e 10 casos foram publicados na Europa e EUA. O quadro clínico cutâneo é a forma hemorrágica ou purpúrica com variável descamação marginal. Relata-se o caso de um homem de 25 anos de idade com lesões na região escapular. A revisão da literatura enfatiza o diagnóstico diferencial das lesões purpúricas. Segundo Lilacs e Medline, não foram relatados casos na literatura latino-americana.
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Affiliation(s)
- Engin Sezer
- Department of Dermatology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
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Pitiriasis rosada eritrodérmica. ACTAS DERMO-SIFILIOGRAFICAS 2003. [DOI: 10.1016/s0001-7310(03)76701-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Watanabe T, Kawamura T, Jacob SE, Aquilino EA, Orenstein JM, Black JB, Blauvelt A. Pityriasis rosea is associated with systemic active infection with both human herpesvirus-7 and human herpesvirus-6. J Invest Dermatol 2002; 119:793-7. [PMID: 12406322 DOI: 10.1046/j.1523-1747.2002.00200.x] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pityriasis rosea is a common skin disease that has been suspected to have a viral etiology. We performed nested polymerase chain reaction to detect human herpesvirus-7, human herpesvirus-6, and cytomegalovirus DNA in lesional skin, nonlesional skin, peripheral blood mononuclear cells, serum, and saliva samples isolated from 14 pityriasis rosea patients. Viral mRNA expression and virion visualization within lesional skin were studied by in situ hybridization and transmission electron microscopy, respectively. By nested polymerase chain reaction, human herpesvirus-7 DNA was present in lesional skin (93%), nonlesional skin (86%), saliva (100%), peripheral blood mononuclear cells (83%), and serum (100%) samples, whereas human herpesvirus-6 DNA was detected in lesional skin (86%), nonlesional skin (79%), saliva (80%), peripheral blood mononuclear cells (83%), and serum (88%) samples. By contrast, cytomegalovirus DNA was not detected in these tissues. Control samples from 12 healthy volunteers and 10 psoriasis patients demonstrated rare positivity for either human herpesvirus-7 or human herpesvirus-6 DNA in skin or serum. By in situ hybridization, infiltrating mononuclear cells expressing human herpesvirus-7 and human herpesvirus-6 mRNA were identified in perivascular and periappendageal areas in 100% and 75% pityriasis rosea skin lesions, respectively, compared to herpesviral mRNA positivity in only 13% normal skin and psoriasis skin controls. Transmission electron microscopy failed to reveal herpesviral virions in pityriasis rosea lesional skin. Nested polymerase chain reaction and in situ hybridization enabled detection of human herpesvirus-7 and human herpesvirus-6 in skin and other tissues isolated from patients with pityriasis rosea. These results suggest that pityriasis rosea is associated with systemic active infection with both human herpesvirus-7 and human herpesvirus-6.
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Affiliation(s)
- Takahiro Watanabe
- Dermatology Branch and Division of Cancer Treatment and Diagnosis, Center for Cancer Research, National Cancer Institute, Howard Hughes Medical Institute, NIH Medical Research Scholar Program, Bethesda, Maryland, USA
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Abstract
BACKGROUND Clinical presentation, immunologic, light microscopic, and electron microscopic studies suggest a viral etiology for pityriasis rosea (PR). OBJECTIVE To evaluate whether human herpesvirus 7 (HHV-7) is an etiologic factor for PR. PATIENTS AND METHODS Twenty-one PR patients (12 female, nine male) aged between 12 and 52 years, whose diagnoses were confirmed clinically and histopathologically, were included in the study. The duration of the disease was questioned. Tissue samples of 5-mm punch biopsy material were collected from the patients and from six healthy volunteers (three female, three male) as the controls. Nested polymerase chain reaction (PCR) with specific primers for HHV-7 DNA sequences (OPERON technologies Inc., HV-7S/HV-8A external sences and HV-10S/HV11A internal sences) was performed on each tissue sample. Polymerase chain reaction products were analyzed by electrophoresis on 2% agarose gels. After molecular weight markers (Haphi174) had been placed and visualized on an ultraviolet transilluminator, the gels were immersed and photographs were taken. RESULTS The mean age was 29.86 +/- 11.77 for the PR patients and 25.33 +/- 11.69 for the controls. The mean duration of the disease was 16.28 +/- 15.74 days. Human herpesvirus 7 DNA sequences were detected in six of the PR patients (28.57%). The mean duration of the disease was calculated as 11.67 +/- 9.85 for the HHV-7-positive patients (patient nos. 3, 4, 5, 7, 8, 9) and 18.13 +/- 17.05 for the HHV-7-negative patients, and there was no statistically significant differences in either of the groups (U = 29.5, W = 50.5, P = 0.2241, using the Mann-Whitney U and Wilcoxon's rank sum W-tests). Nested PCR was negative for HHV-7 in all of the specimens from the controls. There was no statistically significant difference for the presence of HHV-7 DNA sequence between the PR patients and the controls (P = 0.2843, Fisher's exact two-tail analysis test). CONCLUSION Our results failed to support a possible role for HHV-7 in the pathogenesis of PR.
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Affiliation(s)
- Ayse A Karabulut
- Department of Dermatology, Ankara Education and Research Hospital, Refik Saydam Hifzisihha Institute, Ministry of Health, Turkey
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Offidani A, Pritelli E, Simonetti O, Cellini A, Giornetta L, Bossi G. Pityriasis rosea associated with herpesvirus 7 DNA. J Eur Acad Dermatol Venereol 2000; 14:313-4. [PMID: 11204526 DOI: 10.1046/j.1468-3083.2000.00050.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Harman M, Aytekin S, Akdeniz S, Inalöz HS. An epidemiological study of pityriasis rosea in the Eastern Anatolia. Eur J Epidemiol 1998; 14:495-7. [PMID: 9744683 DOI: 10.1023/a:1007412330146] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The purpose of this study was to investigate the epidemiological features of pityriasis rosea (PR) in the Eastern Anatolia, Turkey. Three hundred ninety-one patients (214 females, 177 males) with PR seen during the years 1992-1995 were analyzed for annual incidence among dermatologic outpatients, sex, age, and distribution by month and year. The average annual incidence was 0.75 per 100 dermatologic patients. PR was reported to be slightly more common in women by margin of 1.2:1.0. Eighty-seven percent of the cases were between the ages of 10 and 39 years, with a peak in the 20-29 age group. The incidence of the disease was much higher in the rainy and snowy months. No declining incidence was observed over the years. Changes in incidence from year to year, though not great, were statistically significant.
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Affiliation(s)
- M Harman
- Department of Dermatology & Venerology, Faculty of Medicine, University of Dicle, Diyarbakir, Turkey
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Abstract
A large proportion of children seen by primary care pediatricians involve problems related to the skin. In this chapter, the importance of history and, particularly, physical examination in the diagnosis of various skin disorders is discussed. The ability to describe a rash using proper terminology will help narrow the differential and enable one to communicate what is seen to other physicians. The various primary and secondary lesions that may be present will be described along with various dermatoses as examples. Four common skin disorders that often fool the primary care physician are also discussed.
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Affiliation(s)
- A J Pomeranz
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA
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English JC, Laws RA, Keough GC, Wilde JL, Foley JP, Elston DM. Dermatoses of the glans penis and prepuce. J Am Acad Dermatol 1997; 37:1-24; quiz 25-6. [PMID: 9216519 DOI: 10.1016/s0190-9622(97)70207-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A wide range of infectious, neoplastic, and inflammatory dermatoses can affect the glans penis or prepuce. Some are unique to the genitalia. Other more common dermatoses may have a unique appearance when they involve genital skin and mucosa. A thorough understanding of regional anatomy and a systematic diagnostic approach are helpful in the management of a refractory penile dermatosis. We review embryology and regional anatomy, drug-induced eruptions, allergic and irritant dermatitis, infection, neoplasia, and traumatic and inflammatory dermatoses as they relate to the glans and prepuce. Our discussion focuses on the clinical features, office laboratory studies, and histopathologic findings that assist in diagnosis and treatment.
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Affiliation(s)
- J C English
- Department of Dermatology, Brooke Army Medical Center, Texas, USA
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McCuaig CC, Russo P, Powell J, Pedneault L, Lebel P, Marcoux D. Unilateral laterothoracic exanthem. A clinicopathologic study of forty-eight patients. J Am Acad Dermatol 1996; 34:979-84. [PMID: 8647991 DOI: 10.1016/s0190-9622(96)90275-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Four years ago, we began seeing young children with an unusual, predominantly unilateral, morbilliform and eczematous, self-limited cutaneous eruption. It appeared to correspond to unilateral laterothoracic exanthem (ULE) reported from France and to an eruption described as "a new papular erythema of childhood" in the United States. OBJECTIVE We conducted a prospective study of ULE to define its clinical evolution, pathology, and therapy. In addition, we performed epidemiologic and microbiologic investigations in an attempt to determine the cause of ULE. METHOD We studied 48 children with ULE. In some patients, blood, urine, stool, as well as skin biopsy specimens were analyzed. RESULTS ULE is a morbilliform, eczematous eruption that often begins close to the axilla and spreads to become bilateral, although it usually retains a unilateral predominance. Patients' mean age at onset is 24.3 months, with a female predominance (2:1) and mean duration of 5 weeks, followed by spontaneous resolution that may or may not be improved with topical corticosteroids. It is characterized by a unique eccrine lymphocytic infiltration. Although signs of infection were reported by most patients, no one infectious agent was identified. No significant epidemiologic factor was found. CONCLUSION ULE, in young children, is a self-limited morbilliform and scarlatiniform eruption that may represent a specific skin reaction to one or more infectious agents.
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Affiliation(s)
- C C McCuaig
- Department of Pediatrics, Hôpital Sainte-Justine, Montreal, Quebec, Canada
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47
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Abstract
Skin diseases are an essential part of primary care medicine. Most dermatologic care is delivered in an outpatient setting. The initial evaluation is usually performed by the primary care physician. Women account for nearly 60% of all visits for dermatologic complaints.
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Affiliation(s)
- V S Nanda
- Department of Dermatology, University of California, Irvine, USA
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Van Durme DJ, Brozena SJ. Common Dermatoses. Fam Med 1994. [DOI: 10.1007/978-1-4757-4005-9_117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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