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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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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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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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Leung AKC, Lam JM, Leong KF, Hon KL. Pityriasis Rosea: An Updated Review. Curr Pediatr Rev 2021; 17:201-211. [PMID: 32964824 DOI: 10.2174/1573396316666200923161330] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/20/2020] [Accepted: 07/06/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pityriasis rosea is a common acute, self-limited papulosquamous dermatosis that primarily affects children and young adults. The condition and its clinical variants may pose a diagnostic challenge, especially in the absence of the herald patch. OBJECTIVE This article aimed to familiarize pediatricians with clinical manifestations, evaluation, diagnosis, and management of pityriasis rosea. METHODS A search was conducted in March 2020 in Pubmed Clinical Queries using the key term " pityriasis rosea". The search strategy included all clinical trials (including open trials, non-randomized controlled trials, and randomized controlled trials), observational studies, and reviews (including narrative reviews and meta-analyses) published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. RESULTS Pityriasis rosea occurs mainly in individuals between 10 and 35 years of age with a peak during adolescence. Human herpesvirus (HHV)-7 and HHV-6 have been implicated as the causative agents in some patients with pityriasis rosea. A mild prodrome consisting of headaches, fever, malaise, fatigue, anorexia, sore throat, enlarged lymph nodes and arthralgia is present in about 5% of patients. The most common presenting sign, found in approximately 80% of patients, is a "herald" or "mother" patch which is larger and more noticeable than the lesions of the later eruption. A generalized, bilateral, symmetrical eruption develops in approximately 4 to 14 days and continues to erupt in crops over the next 12 to 21 days. Typical lesions are 0.5 to 1 cm, oval or elliptical, dull pink or salmon-colored macules with a delicate collarette of scales at the periphery. The long axes tend to be oriented along the skin lines of cleavage (Langer lines). Lesions on the back may have a characteristic "Christmas tree", whereas lesions on the upper chest may have a V-shaped pattern. There are many conditions that may mimic pityriasis rosea. Pityriasis rosea in the absence of the herald patch and its variants may pose a diagnostic challenge. The typical course is 6 to 8 weeks. In the vast majority of cases, reassurance and symptomatic treatment should suffice. Active intervention may be considered for individuals with severe or recurrent pityriasis rosea and pregnant women with the disease. Treatment options include acyclovir, macrolides (in particular, erythromycin), and ultraviolet phototherapy. If active intervention is needed, there is evidence supporting the use of oral acyclovir to shorten the duration of illness. CONCLUSION Pityriasis rosea is a common, acute, self-limiting exanthematous skin disease that primarily affects children and young adults. The condition is characterized by a "herald patch" after which oval erythematous squamous lesions appear along Langer's lines of cleavage on the trunk and proximal extremities, giving it a "Christmas tree" appearance. The disease presenting in its classical form can easily be diagnosed. Clinical variants of the disease may pose a diagnostic challenge for the general pediatrician. Knowledge of the disease is essential to allow prompt diagnosis and to avoid unnecessary investigations.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences University of British Columbia, Vancouver, British Columbia, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
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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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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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Dermatologic Problems Commonly Seen by the Allergist/Immunologist. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:102-112. [PMID: 31351991 DOI: 10.1016/j.jaip.2019.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 11/23/2022]
Abstract
Allergists/immunologists see a variety of skin disorders, some of which have a known immunologic basis whereas others do not. We review the prevalence, etiology, clinical presentation, and effective and low-cost care of common dermatologic conditions seen in outpatient practices. Conditions discussed include pityriasis alba, seborrheic dermatitis, rosacea, acne, tinea infections, intertrigo, lichen planus, tinea versicolor, lichen simplex chronicus, scabies, pityriasis rosea, keratosis pilaris, and seborrheic keratosis. An understanding of frequently encountered cutaneous diseases and their therapies will help provide immediate access to treatment and improve the experience for both the affected patient and the clinician.
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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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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: 10] [Impact Index Per Article: 1.7] [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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Sonthalia S, Kumar A, Zawar V, Priya A, Yadav P, Srivastava S, Gupta A. Double-blind randomized placebo-controlled trial to evaluate the efficacy and safety of short-course low-dose oral prednisolone in pityriasis rosea. J DERMATOL TREAT 2018; 29:617-622. [PMID: 29363373 DOI: 10.1080/09546634.2018.1430302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of short-course low-dose oral prednisolone in symptomatic pityriasis rosea (PR) of onset <5 days and compare it with placebo. MATERIAL AND METHODS Placebo-controlled randomized double-blind study design with the treatment group receiving tapering doses of oral prednisolone over 2 weeks and the control group receiving a placebo. Outcome measures evaluated were subsidence of patient-perceived pruritus, improvement in rash quantified by a specific score, adverse effects and relapse at 12 weeks. RESULTS The improvement in the pruritus score as well as objective rash score were much better in the prednisolone-treated group. No adverse effects reported in either group. The relapse rate at 12 weeks was much higher in the prednisolone treated group. CONCLUSIONS Oral corticosteroids, even if used in low-dose and for a short tapering course should not be the first line of therapy for PR. The only justified indication may be extensive and highly symptomatic lesions of PR.
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Affiliation(s)
- Sidharth Sonthalia
- a Department of Dermatology & Dermatosurgery , Skinnocence: The Skin Clinic & Research Center , Gurugram , India
| | - Akshy Kumar
- b Department of Dermatology & STD , Kota Medical College , Kota , India
| | - Vijay Zawar
- c Department of Dermatology & Leprosy , Dr Vasantrao Pawar Medical College , Nashik , India
| | - Adity Priya
- d Department of Community Medicine , Hind Institute of Medical Sciences , Lucknow , India
| | - Pravesh Yadav
- e Department of Dermatology & STD , Lady Hardinge Medical College & Associated Hospitals , New Delhi , India
| | - Sakshi Srivastava
- f Department of Dermatology & Plastic Surgery , JAYPEE Hospital , Noida-NCR , India
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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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Urbina F, Das A, Sudy E. Clinical variants of pityriasis rosea. World J Clin Cases 2017; 5:203-211. [PMID: 28685133 PMCID: PMC5480068 DOI: 10.12998/wjcc.v5.i6.203] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 03/21/2017] [Accepted: 04/19/2017] [Indexed: 02/05/2023] Open
Abstract
Pityriasis rosea (PR) is a common erythemato-squamous dermatosis which almost always, is easily diagnosed. Mostly the disease presents in its classical form. However, clinical dermatology is all about variations and PR is not an exception. Variants of the disease in some cases may be troublesome to diagnose and confuse clinicians. Prompt diagnosis and treatment of the condition becomes necessary to avoid unnecessary investigations. We hereby review and illustrate atypical presentations of the disease, including diverse forms of location and morphology of the lesions, the course of the eruption, and its differential diagnoses.
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Oberlin K, Miteva M. SnapshotDx Quiz: April 2017. J Invest Dermatol 2017; 137:e39. [PMID: 30477692 DOI: 10.1016/j.jid.2017.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Kate Oberlin
- Department of Dermatology and Cutaneous Surgery, University of Miami L. Miller School of Medicine, Miami, Florida, USA
| | - Mariya Miteva
- Department of Dermatology and Cutaneous Surgery, University of Miami L. Miller School of Medicine, Miami, Florida, USA.
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Voss V, Mattox A, Guo M. Concurrent pityriasis rosea and Bell's palsy. BMJ Case Rep 2017; 2017:bcr-2016-218069. [PMID: 28115404 DOI: 10.1136/bcr-2016-218069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pityriasis rosea is a dermatological disease with a well-documented clinical appearance, but less is known about causes and treatment. Bell's palsy is a neurological condition leading to acute idiopathic hemifacial paralysis. Recent studies indicate that human herpesvirus (HHV) 6-7 reactivation may be a contributing factor to both conditions. We report a case of the 2 concurrent diagnoses that supports a common contributing factor and suggests further awareness and research into the role HHV 6-7 may play in the aetiology of both conditions.
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Affiliation(s)
- Vanessa Voss
- Saint Louis University, Saint Louis, Missouri, USA
| | - Adam Mattox
- Department of Dermatology, Saint Louis University, Saint Louis, Missouri, USA
| | - Mary Guo
- Department of Dermatology, Saint Louis University, Saint Louis, Missouri, USA
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