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Durgin JS, Whittington CP, Harrell J, Mervak JE, Smith EH. Clinicopathologic features of pityriasis rosea-like drug eruption secondary to imatinib: A case report and review of the literature. J Cutan Pathol 2024. [PMID: 39021288 DOI: 10.1111/cup.14692] [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: 05/06/2023] [Revised: 06/19/2024] [Accepted: 07/01/2024] [Indexed: 07/20/2024]
Abstract
Pityriasis rosea is an acute, self-limited exanthem that typically occurs in adolescence and young adulthood, classically featuring ovoid erythematous and scaly lesions on the trunk and proximal extremities. While its cause is not definitively known, the classic form of pityriasis rosea may result from the reactivation of latent human herpesvirus (HHV) infections (HHV-6 and HHV-7). Interestingly, drug eruptions that clinically and/or histopathologically resemble pityriasis rosea have also been reported. These pityriasis rosea-like drug eruptions tend to occur at an older age and have a shorter duration than the classic type. As there are different management paradigms, the distinction between classic pityriasis rosea and the mimicking drug eruption is important to recognize. Herein, we report a case of a pityriasis rosea-like drug eruption that occurred in association with imatinib mesylate treatment for chronic myeloid leukemia. We also review the clinicopathologic features of reported cases of pityriasis rosea-like drug eruption, including those due to imatinib. While the clinical morphology of the cutaneous drug-related eruption mimics the lesions seen in classic pityriasis rosea, the presence of unique histopathologic findings, including necrotic keratinocytes, interface dermatitis, and eosinophils, may aid in distinction.
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Affiliation(s)
- Joseph S Durgin
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Carli P Whittington
- Department of Dermatology, Indiana University, Indianapolis, Indiana, USA
- Department of Pathology & Laboratory Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Jane Harrell
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Julie E Mervak
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily H Smith
- Division of Dermatopathology, Department of Dermatology, St. Louis University, St. Louis, Missouri, USA
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2
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Zeng X, Zhou X, Zhang A, Zhu Y, Lu B, Zhu F, Wu M, Lin R. Pityriasis Rosea-Like Eruption following anti-fatigue traditional herbs: Aconitum carmichaelii Debx and Panax Ginseng suspected. BMC Complement Med Ther 2024; 24:248. [PMID: 38951791 PMCID: PMC11218121 DOI: 10.1186/s12906-024-04556-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 06/18/2024] [Indexed: 07/03/2024] Open
Abstract
Traditional herbs have a history of clinical use in anti-fatigue. However, several adverse effects of herbs have been identified. Pityriasis rosea-like eruption (PR-LE) is a rare cutaneous complication of herbs. To the best of our knowledge, there have been few reports of PR-LE following herbs. Here, we described a case of PR-LE that developed 6 days after taking anti-fatigue herbs. After the 17 days of stopping Aconitum carmichaelii Debx and Panax Ginseng, it notably faded. So, when anti-fatigue herbs being authorized for fatigue use, monitoring for potential adverse effects is necessary.
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Affiliation(s)
- Xueyan Zeng
- Department of Traditional Chinese Medicine, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou City, Zhejiang Province, 310007, China
- Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, 310053, China
| | - Xin Zhou
- Department of Traditional Chinese Medicine, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou City, Zhejiang Province, 310007, China
- Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, 310053, China
| | - Aiping Zhang
- Department of Traditional Chinese Medicine, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou City, Zhejiang Province, 310007, China
- Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, 310053, China
| | - Yanqin Zhu
- Department of Traditional Chinese Medicine, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou City, Zhejiang Province, 310007, China
- Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, 310053, China
| | - Bin Lu
- Department of Traditional Chinese Medicine, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou City, Zhejiang Province, 310007, China
- Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, 310053, China
| | - Feiqin Zhu
- Zhuji Fourth People's Hospital, Zhuji city, Zhejiang Province, China
| | - Mengqi Wu
- Department of Traditional Chinese Medicine, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou City, Zhejiang Province, 310007, China
- Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, 310053, China
| | - Riyang Lin
- Department of Traditional Chinese Medicine, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou City, Zhejiang Province, 310007, China.
- Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, 310053, China.
- Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou City, Zhejiang Province, 310007, China.
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3
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Aydin Kurc M, Erfan G, Kaya AD, Gülen D, Oznur M, Yanik ME. Association between Pityriasis Rosea (PR) and HHV-6/HHV-7 Infection: Importance of Sample Selection and Diagnostic Techniques. Diagnostics (Basel) 2024; 14:843. [PMID: 38667488 PMCID: PMC11049655 DOI: 10.3390/diagnostics14080843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/07/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Recent studies have focused on the role of human herpesvirus 6 (HHV-6) and human herpesvirus 7 (HHV-7) in PR etiology with varying results. In our study, with the approach that the discrepancy between the results may be related to the different samples and techniques used, we aimed to clarify the etiology by examining tissue and plasma samples using molecular methods and evaluating the results together with serological parameters. Skin biopsies and plasma samples of twenty-five PR patients were tested to detect HHV-6 and HHV-7 DNA using calibrated quantitative real-time polymerase chain reaction (CQ RT-PCR). IgG and IgM antibodies against HHV-6 and HHV-7 were tested by enzyme-linked immunosorbent assay and indirect immunofluorescence. Of the patient group, 64% were positive for HHV-6 IgG without IgM positivity. HHV-6 DNA was present in seven tissue and ten plasma samples. HHV-7 positivity was 100% and 12% for IgG and IgM antibodies, respectively. HHV-7 DNA was detected in four tissue samples and one plasma sample. Patients with HHV-7 DNA-positive plasma and tissue samples had also HHV-7 IgM antibodies. In conclusion, our results seem to support the role of HHV-6/HHV-7 in the etiology of PR. To clarify the etiology of PR and avoid confusion, the collection of different biological materials simultaneously and the usage of CQ RT-PCR as a diagnostic technique are recommended.
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Affiliation(s)
- Mine Aydin Kurc
- Department of Medical Microbiology, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag 59030, Türkiye;
| | - Gamze Erfan
- Department of Dermatology, Faculty of Medicine, Acıbadem University, Istanbul 34752, Türkiye;
| | - Ayse Demet Kaya
- Department of Medical Microbiology, Faculty of Medicine, Istanbul Okan University, Istanbul 34959, Türkiye;
| | - Dumrul Gülen
- Department of Medical Microbiology, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag 59030, Türkiye;
| | - Meltem Oznur
- Department of Pathology, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag 59030, Türkiye;
| | - Mehmet Emin Yanik
- Clinic of Dermatology, Sancaktepe Region Hospital, Istanbul 34885, Türkiye;
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Lagacé F, D’Aguanno K, Prosty C, Laverde-Saad A, Cattelan L, Ouchene L, Oliel S, Genest G, Doiron P, Richer V, Jfri A, O’Brien E, Lefrançois P, Powell M, Moreau L, Litvinov IV, Muntyanu A, Netchiporouk E. The Role of Sex and Gender in Dermatology - From Pathogenesis to Clinical Implications. J Cutan Med Surg 2023; 27:NP1-NP36. [PMID: 37401812 PMCID: PMC10486181 DOI: 10.1177/12034754231177582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Sex and gender have increasingly been recognized as significant risk factors for many diseases, including dermatological conditions. Historically, sex and gender have often been grouped together as a single risk factor in the scientific literature. However, both may have a distinct impact on disease incidence, prevalence, clinical presentation, severity, therapeutic response, and associated psychological distress. OBJECTIVES AND PROJECT DESCRIPTION The mechanisms that underlie differences in skin diseases between males, females, men, and women remain largely unknown. The specific objectives of this review paper are:To highlight the biological differences between males and females (sex), as well as the sociocultural differences between men and women (gender) and how they impact the integumentary system.To perform a literature review to identify important sex- and gender-related epidemiological and clinical differences for various skin conditions belonging to a range of disease categories and to discuss possible biological and sociocultural factors that could explain the observed differences.To discuss dermatological skin conditions and gender-affirming treatments within the transgender community, a population of individuals who have a gender identity which is different than the gender identity they were assigned at birth. FUTURE IMPACT With the rising number of individuals that identify as non-binary or transgender within our increasingly diverse communities, it is imperative to recognize gender identity, gender, and sex as distinct entities. By doing so, clinicians will be able to better risk-stratify their patients and select treatments that are most aligned with their values. To our knowledge, very few studies have separated sex and gender as two distinct risk factors within the dermatology literature. Our article also has the potential to help guide future prevention strategies that are patient-tailored rather than using a universal approach.
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Affiliation(s)
- François Lagacé
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | | | - Connor Prosty
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Alexandra Laverde-Saad
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Leila Cattelan
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Lydia Ouchene
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Sarah Oliel
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Genevieve Genest
- Division of Allergy and Immunology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Philip Doiron
- Division of Dermatology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Richer
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Abdulhadi Jfri
- Department of Dermatology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Elizabeth O’Brien
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Philippe Lefrançois
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Mathieu Powell
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Linda Moreau
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Ivan V. Litvinov
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Anastasiya Muntyanu
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Elena Netchiporouk
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
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Méndez A, Stevens C, Murina A. From the Cochrane Library: Interventions for Pityriasis Rosea. JMIR DERMATOLOGY 2023; 6:e45388. [PMID: 37632939 PMCID: PMC10335327 DOI: 10.2196/45388] [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: 01/02/2023] [Revised: 05/03/2023] [Accepted: 05/23/2023] [Indexed: 08/28/2023] Open
Affiliation(s)
- Alejandra Méndez
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Carly Stevens
- Department of Dermatology, Tulane University School of Medicine, New Orleans, LA, United States
| | - Andrea Murina
- Department of Dermatology, Tulane University School of Medicine, New Orleans, LA, United States
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6
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Michelerio A, Tchich A, Vassallo C, Brazzelli V. Atypical exanthem with acral involvement in adult patients associated with human herpesvirus 7 active replication: A case series. Front Med (Lausanne) 2023; 10:1144856. [PMID: 37122320 PMCID: PMC10140440 DOI: 10.3389/fmed.2023.1144856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/16/2023] [Indexed: 05/02/2023] Open
Abstract
An "atypical exanthem" (AE) is an eruptive skin eruption that differs in morphology and etiology from classical exanthems and is often a reason for urgent medical evaluation. The most frequent cause of AEs is a viral infection, but an accurate etiology cannot be established basing on the sole clinical features. Human herpesviruses (HHV) have been often suspected as etiologic agents or cofactors in atypical rashes. We performed a retrospective analysis of adult patients presenting an atypical exanthem associated with HHV-7 active replication in our center. The charts of patients were reviewed and the demographic, clinical and laboratory data collected. Nine patients (six males and three females) were included in the study, with a mean age of 43 years for men and of 26 years for women. All patients presented active HHV-7 replication in plasma during the rash, which turned negative after the exanthem resolved. The exanthem displayed a maculopapular pattern involving the trunk, limbs and, notably, the acral regions, in six patients. In three cases the exanthem was confined to only the acral sites. In most cases, there was no fever and the inflammatory indices remained unchanged. Antihistamines, topical and systemic corticosteroids were used as treatment, with excellent symptom control. We propose adding skin manifestation associated with HHV-7 to the concept of atypical exanthems, in particular those localized to the acral regions.
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Affiliation(s)
- Andrea Michelerio
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Adi Tchich
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Camilla Vassallo
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valeria Brazzelli
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- *Correspondence: Valeria Brazzelli,
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Baba K, Baba T, Ogra PL, Okuno T. Overlapping Signs and Symptoms Between Recurrent Varicella and Pityriasis rosea Gibert. Pediatr Infect Dis J 2022; 41:696-701. [PMID: 35763688 DOI: 10.1097/inf.0000000000003601] [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: 11/26/2022]
Abstract
BACKGROUND Pityriasis rosea Gibert (PRG) has features similar to those of common infectious childhood diseases, suggesting a viral cause, but no agent has been identified to date. We describe 4 children with PRG and 2 with recurrent varicella who were studied using photochronography, virology and immunology. METHODS The 6 patients with skin rashes visited our pediatric clinic from April 2012 to May 2016. Photographs of their skin lesions were taken; blood, skin lesions, and/or nasal lavage samples were collected to detect varicella-zoster virus (VZV) DNA and antibodies; and skin tests were carried out to measure cell-mediated immunity to VZV. RESULTS Herald patches were confirmed in 2 of 4 PRG patients. No specimen cultures were positive for infectious VZV. However, VZV-DNA was detected in skin lesions of 3 PRG patients. During the acute phase, 5 patients had IgG antibodies to VZV, and skin-test reactions were positive in 5 patients. CONCLUSIONS IgG antibody titers to VZV at rash onset were high, suggesting that they were already rising at the appearance of the rash and that reinfection with VZV must have occurred during the prodromal stage or several weeks before rash appearance in PRG patients whose immunity had declined below the threshold. Our study suggests a new pathogenesis of PRG that might help to address incongruities of past theories on PRG sites of viral entry and replication, incubation period and variations in the clinical course of PRG from prodrome to healing.
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Affiliation(s)
- Koichi Baba
- From the BABA Pediatric Clinic, Kadoma, Japan
| | - Tomoko Baba
- From the BABA Pediatric Clinic, Kadoma, Japan
| | - Pearay L Ogra
- Department of Pediatrics, State University of New York, Buffalo, New York
| | - Toshiomi Okuno
- Department of Microbiology, Hyogo College of Medicine, Nishinomiya, Japan
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Ciccarese G, Broccolo F, Parodi A, Drago F. Comment on 'Negative SARS-CoV-2 antibodies in patients with positive immunohistochemistry for spike protein in pityriasis rosea-like eruptions'. J Eur Acad Dermatol Venereol 2022; 37:e37-e38. [PMID: 35974703 PMCID: PMC9537982 DOI: 10.1111/jdv.18498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/05/2022] [Indexed: 12/15/2022]
Affiliation(s)
| | - Francesco Broccolo
- Department of Medicine and Surgery, School of MedicineUniversity of Milano‐BicoccaMonzaItaly,Laboratory Cerba HealthcareMilanItaly
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Kim DH, Cho JH, Park SJ, Seo SH, Ahn HH. Impact of COVID-19 on Clinicopathological Spectrum of Pityriasis Rosea in Korea. J Korean Med Sci 2022; 37:e190. [PMID: 35726143 PMCID: PMC9247725 DOI: 10.3346/jkms.2022.37.e190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/16/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pityriasis rosea (PR) is a papulosquamous eruption with generally unknown origin but suspected to be related to viral etiologies. The clinicopathological spectrum of several disorders with viral etiologies has been altered after the coronavirus disease 2019 (COVID-19) pandemic. The author group could experience coherent histological alterations in PR after the COVID-19 pandemic. This study aimed to investigate how the clinicopathological findings of PR were changed after the COVID-19 pandemic. METHODS Patients (n = 11) diagnosed with PR based on the clinical manifestations and skin biopsies between February 2018 and October 2019 and 11 patients in February 2020 and October 2021 were retrospectively analyzed by investigating the medical records. RESULTS The patients with PR during the COVID-19 pandemic demonstrated statistically significant histopathological alterations from classic brisk and dense infiltration pattern to dormant and sparse infiltration and psoriasiform-dominant patterns (P = 0.019). PR was associated with more frequent pruritus during the pandemic period (P = 0.027). CONCLUSION In conclusion, PR demonstrated a significant histopathological alteration with more frequent pruritus during the COVID-19 pandemic. The comparative results about clinicopathological findings of PR will provide a useful reference for dermatologists in the diagnostic process of PR in the COVID-19 pandemic.
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Affiliation(s)
- Dai Hyun Kim
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
- Department of Anatomy, Korea University College of Medicine, Seoul, Korea
| | - Jun Hyuk Cho
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Sung Jin Park
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Soo Hong Seo
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Hyo Hyun Ahn
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea.
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AKYÖN ŞH, GENÇ Y. Pityriasis Rosea After Pfizer-BioNTech Covid-19 Vaccine: A Case Report. TURKISH JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.46310/tjim.1072232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Abstract
Background The increasing number of reports on cutaneous reactions following COVID-19 vaccination has led to growing concerns among certain groups. Objective We reviewed the published reports of cutaneous lesions after COVID-19 vaccination. Methods We conducted a literature search for original and review articles published between January 1, 2020, and September 27, 2021. Results Eleven cutaneous reactions associated with COVID-19 vaccines were determined; the most prevalent reactions were local injection site reactions, delayed local reactions, urticaria, angioedema, and morbilliform eruptions. There were more reports on skin reactions following the administration of messenger RNA-based vaccines than on those following the administration of adenoviral vector or inactivated whole-virus vaccines, in part, due to their higher administration rate. Most reported skin reactions occurred after the first vaccine dose. Limitations A reporting bias could not be excluded, and skin biopsy results were not available for most included individuals. Moreover, given that the included trials focused on vaccine efficacy, there was a lack of details concerning cutaneous reactions and participant information. Conclusion Not all cutaneous reactions observed after COVID-19 vaccination are hypersensitivity reactions. Different cutaneous reactions may reflect underlying immune responses to the vaccines. A large majority of COVID-19 vaccination reactions were mild and self-limiting, and people should be encouraged to complete their vaccination regimen.
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12
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Faizal-Geagea M. Pitiriasis rosada, una reacción exantemática. CASE REPORTS 2021. [DOI: 10.15446/cr.v7n2.95527] [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
Las urgencias dermatológicas son eventos poco frecuentes que puedenser causados por alteraciones agudas de la salud, con o sin afectaciónsistémica, o por enfermedades crónicas cuando se presentan cuadros de agudización.
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13
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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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14
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Yazdanparast T, Yazdani K, Ahmad Nasrollahi S, Izadi Firouzabadi L, Humbert P, Khatami A, Firooz A. Biophysical and ultrasonographic changes in pityriasis rosea compared with uninvolved skin. Int J Womens Dermatol 2021; 7:331-334. [PMID: 34222592 PMCID: PMC8243123 DOI: 10.1016/j.ijwd.2020.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/17/2020] [Accepted: 10/18/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pityriasis rosea (PR) is a common, self-limited, inflammatory papulosquamous skin disease with a possible viral etiology. OBJECTIVE The goal of this study was to evaluate skin biophysical properties in patients with PR compared with uninvolved skin to better understand the pathogenesis of PR. METHODS Stratum corneum hydration, transepidermal water loss, surface friction, pH, sebum, melanin, erythema, temperature, elasticity parameters (R0, R2, R5), thickness, and echodensity of the epidermis and dermis were measured on lesions of classic PR in 21 patients and compared with control sites (average of uninvolved perilesional and symmetrical skin) with a paired t test. RESULTS Stratum corneum hydration (p < .001), R0 (p = .003), R2 (p = .001), R5 (p = .003), and echodensity of the dermis (p = .006) were significantly lower, whereas transepidermal water loss (p = .001), pH (p < .001), and erythema (p < .001) were significantly higher in PR lesions. There was no significant difference in friction index, sebum, melanin content, temperature, thickness of the epidermis and dermis, and echodensity of the epidermis between PR and normal skin. CONCLUSION PR skin is characterized by certain alterations in biophysical properties, which are mostly correlated with histologic changes. These changes may be helpful in early, noninvasive diagnosis of PR.
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Affiliation(s)
- Taraneh Yazdanparast
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Yazdani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saman Ahmad Nasrollahi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Izadi Firouzabadi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Alireza Khatami
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Firooz
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
- Clinical Trial Center, Tehran University of Medical Sciences, Tehran, Iran
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15
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De Medeiros VLS, Monteiro-Neto AU, França DDT, Castelo Branco R, de Miranda Coelho ÉO, Takano DM. Pemphigus Vulgaris After COVID-19: a Case of Induced Autoimmunity. ACTA ACUST UNITED AC 2021; 3:1768-1772. [PMID: 34075351 PMCID: PMC8159521 DOI: 10.1007/s42399-021-00971-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 12/12/2022]
Abstract
Bullae autoimmune diseases can be induced by environmental factors in a genetically susceptible individual, and viruses may be important triggers for this process. Coronavirus disease 2019 (COVID-19) is a multisystemic disease known for developing many types of skin lesions. However, little is known about post-COVID-19 manifestations. A previous healthy male patient, 43 years old, with resistant mediastinal Hodgkin's lymphoma stage II diagnosed in 2019, without treatment at the moment, developed monomorphic flaccid bullae on the trunk 40 days after testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although he had risk factors for IgA and paraneoplastic pemphigus, there were no elements for these diseases. The investigation confirmed a pemphigus vulgaris (PV). PV had a good response to treatment with prednisolone 1 mg/kg per day, and methotrexate 15 mg subcutaneously was added per week. The patient was discharged with oral methotrexate and prednisolone at the same dose. Prednisolone was decreased by 20 mg per day during the follow-up. Viruses such as herpesvirus, cytomegalovirus, and varicela zoster can act as triggers for PV. This process is not immediate after the infection because it depends on the change in antibodies initially produced against the virus that start to identify antigens present in the skin's anchoring structures. SARS-CoV-2 can induce autoimmunity, as seen in Guillán-Barré syndrome and in Kawasaki disease. It is a highly immunogenic virus that is the perfect agent for triggering PV. This case can be considered a cutaneous autoimmune post-COVID-19 manifestation.
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Affiliation(s)
- Vanessa Lucilia Silveira De Medeiros
- Dermatology Clinics, Tropical Medicine Department, Clinics Hospital, Federal University of Pernambuco, Recife, PE Brazil.,Unimed Recife, Unimed Recife III Hospital, Recife, Brazil.,Medical Faculty of Recife, Medical Sciences Center, Federal University of Pernambuco, Recife, PE Brazil
| | | | | | - Rebecca Castelo Branco
- Dermatology Clinics, Tropical Medicine Department, Clinics Hospital, Federal University of Pernambuco, Recife, PE Brazil
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Akdaş E, İlter N, Öğüt B, Erdem Ö. Pityriasis rosea following CoronaVac COVID-19 vaccination: a case report. J Eur Acad Dermatol Venereol 2021; 35:e491-e493. [PMID: 33914958 PMCID: PMC8242459 DOI: 10.1111/jdv.17316] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- E Akdaş
- Department of Dermatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - N İlter
- Department of Dermatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - B Öğüt
- Department of Pathology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ö Erdem
- Department of Pathology, Faculty of Medicine, Gazi University, Ankara, Turkey
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17
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Birlutiu V, Birlutiu RM, Iancu GM. Pityriasis rosea Gibert triggered by SARS-CoV-2 infection: A case report. Medicine (Baltimore) 2021; 100:e25352. [PMID: 33832113 PMCID: PMC8036126 DOI: 10.1097/md.0000000000025352] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 03/11/2021] [Indexed: 01/08/2023] Open
Abstract
RATIONALE Pityriasis rosea Gibert is an erythematous-papulosquamous dermatosis that frequently occurs in young adults. The etiopathogenesis of PR is still unknown, but is frequently associated with episodes of upper respiratory tract infections. It is likely that a new viral trigger of pityriasis rosea is the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). PATIENT CONCERNS We present the case of a female patient in whom the diagnosis of pityriasis rosea led to the investigation and diagnosis of the SARS-CoV-2 infection. The patient presented to the Department of Dermatology for a 3 week duration of an extremely pruritic erythematous-squamous lesion, initially on the trunk and upper limbs, with extension to the lower limbs in the last week and the lesion respected the cephalic extremity, palms, and soles. One week before the rash, respiratory tract infection symptomatology was observed by the patient. At home, she underwent systemic treatment with antihistamines and topical medication with dermatocorticosteroids. The evolution was unfavorable, with the spread of the lesions and the accentuation of the pruritus. DIAGNOSES Considering the actual epidemiological context, we performed a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay from nasal and pharyngeal swabs for coronavirus disease 2019 (COVID-19) to investigate the PR etiology. The patient had a positive RT-PCR result, and was confirmed with SARS-CoV-2 infection. INTERVENTIONS Treatment was initiated with systemic corticosteroid therapy - hydrocortisone hemisuccinate 200 mg/day for 7 days, and loratadine 10 mg 2 times a day. Also, topical medication with dermatocorticosteroids and emollients was associated. OUTCOME Under the treatment that was initiated a partial remission of the lesions after 7 days was observed. LESSONS Our reported case adds to the other findings regarding the association of PR with SARS-CoV-2 infection, in the context of the pandemic, suggesting the need to test patients with PR skin lesions for SARS-CoV-2 infection.
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Affiliation(s)
- Victoria Birlutiu
- Lucian Blaga University of Sibiu, Faculty of Medicine Sibiu, Academic Emergency Hospital Sibiu - Infectious Diseases Clinic, Sibiu
| | - Rares Mircea Birlutiu
- Lucian Blaga University of Sibiu, Faculty of Medicine Sibiu, FOISOR Clinical Hospital of Orthopedics, Traumatology, and Osteoarticular TB Bucharest
| | - Gabriela Mariana Iancu
- Lucian Blaga University of Sibiu, Faculty of Medicine Sibiu, Academic Emergency Hospital Sibiu - Dermatology Clinic, Sibiu, Romania
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18
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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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Veraldi S, Romagnuolo M, Benzecry V. Pityriasis rosea-like eruption revealing COVID-19. Australas J Dermatol 2020; 62:e333-e334. [PMID: 33216971 PMCID: PMC7753512 DOI: 10.1111/ajd.13504] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Stefano Veraldi
- Department of Pathophysiology and Transplantation, Università degli Studi, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Romagnuolo
- Department of Pathophysiology and Transplantation, Università degli Studi, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valentina Benzecry
- Department of Pathophysiology and Transplantation, Università degli Studi, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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20
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Vaccaro M, Marafioti I, Cannavò SP, Ciccarese G, Drago F. Pityriasis rosea during omalizumab treatment for chronic spontaneous urticaria. Dermatol Ther 2020; 33:e14356. [PMID: 33009684 DOI: 10.1111/dth.14356] [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: 09/02/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 11/28/2022]
Abstract
Pityriasis rosea (PR) is an exanthematous disease whose etiology is related to reactivation of herpes human herpesviruses 6 (HHV-6) and 7 (HHV-7). We observed two cases of PR arising during omalizumab therapy for chronic spontaneous urticaria (CSU). Here we report for the first time PR occurring during omalizumab treatment. After PR diagnosis, viral serology was performed. Data in literature about omalizumab mechanism of action, PR and HHV-6/7 infection were analyzed in order to identify possible correlations. In both our cases IgM against HHV-6 and HHV-7 were negative. The first patient presented altered IgG titers for both viruses (1:160 and 1:80, respectively) while only HHV-6 IgG (1:320) were detected in the second patient. From data in literature, we consider it presumable that apoptotic immune cells due to omalizumab immunomodulation could release viral proteins produced from integrated DNA. This could elicit cutaneous cross-reactivity and PR onset. In conclusion, we think there is a link between omalizumab therapy and PR occurring in patients with CSU. Our case history is too small to draw firm conclusions. Data collection of similar cases could be helpful to improve our knowledge.
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Affiliation(s)
- Mario Vaccaro
- Department of Clinical and Experimental Medicine-Dermatology, University of Messina, Messina, Italy
| | - Ilenia Marafioti
- Department of Clinical and Experimental Medicine-Dermatology, University of Messina, Messina, Italy
| | | | - Giulia Ciccarese
- Dermatology Unit, Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Drago
- Dermatology Unit, Ospedale Policlinico San Martino, Genoa, Italy.,DI.S.Sal., Section of Dermatology, University of Genoa, Genoa, Italy
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21
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Daze RP, Dorton D. An Atypical Presentation of Pityriasis Rosea Localized to the Extremities. Cureus 2020; 12:e9765. [PMID: 32944477 PMCID: PMC7489771 DOI: 10.7759/cureus.9765] [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] [Indexed: 11/11/2022] Open
Abstract
Pityriasis rosea (PR) is a benign, self-limiting, papulosquamous disorder characterized by the onset of a herald patch followed by an abrupt eruption of multiple salmon-colored papules and plaques on the trunk and proximal extremities. The individual lesions are often outlined by a collarette of scale and are distributed along the lines of cleavage. While many authors acknowledge an etiologic association with human herpesvirus 6 and human herpesvirus 7, thereby suggesting a viral exanthem, the exact cause remains unclear. While typically demonstrating a truncal predilection, this presentation may be absent in some patients who instead exhibit atypical features and distributions. Various clinical variants include papular, vesicular, purpuric, and eczematoid. The condition rarely manifests without truncal involvement and localized only to the distal extremities. We present a unique case report of a 65-year-old-male with biopsy-proven PR that was localized to his distal extremities with a clinical absence of truncal involvement.
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22
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Chin LD, Parvinnejad N, Haber RM. Pityriasis in dermatology: an updated review. Int J Dermatol 2020; 60:141-158. [PMID: 32783190 DOI: 10.1111/ijd.15097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/30/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022]
Abstract
Dermatology has a very distinctive lexicon. The term pityriasis refers to several dermatologic conditions which all feature scaling of the skin. According to the Merriam-Webster dictionary, the term pityriasis was first used in print in 1684. Although the diseases beginning with the name pityriasis are of diverse causation, they do represent important dermatologic diseases, with some common and others quite rare. It is important for dermatologists to be aware and updated on all pityriasis conditions in dermatology.
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Affiliation(s)
- Laura D Chin
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nikoo Parvinnejad
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Richard M Haber
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
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23
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Sanchez A, Sohier P, Benghanem S, L’Honneur AS, Rozenberg F, Dupin N, Garel B. Digitate Papulosquamous Eruption Associated With Severe Acute Respiratory Syndrome Coronavirus 2 Infection. JAMA Dermatol 2020; 156:819-820. [DOI: 10.1001/jamadermatol.2020.1704] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Adrien Sanchez
- Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Division of Dermatology and Venereology, AP-HP Centre-Université de Paris, Paris, France
| | - Pierre Sohier
- Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Division of Pathology, AP-HP Centre-Université de Paris, Paris, France
| | - Sarah Benghanem
- Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Division of Intensive Care, AP-HP Centre-Université de Paris, France
| | - Anne-Sophie L’Honneur
- Laboratory of Virology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, AP-HP Centre-Université de Paris, Paris, France
| | - Flore Rozenberg
- Laboratory of Virology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, AP-HP Centre-Université de Paris, Paris, France
| | - Nicolas Dupin
- Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Division of Dermatology and Venereology, AP-HP Centre-Université de Paris, Paris, France
| | - Bethsabée Garel
- Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Division of Dermatology and Venereology, AP-HP Centre-Université de Paris, Paris, France
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24
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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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25
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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: 2] [Impact Index Per Article: 0.4] [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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Ghariani Fetoui N, Boussofara L, Gammoudi R, Belajouza C, Ghariani N, Denguezli M. Unilateral pityriasis rosea. Int J Dermatol 2019; 59:e27-e28. [PMID: 31646609 DOI: 10.1111/ijd.14682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 11/26/2022]
Affiliation(s)
| | - Lobna Boussofara
- Department of Dermatology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Rima Gammoudi
- Department of Dermatology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Colandane Belajouza
- Department of Dermatology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Najet Ghariani
- Department of Dermatology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Mohamed Denguezli
- Department of Dermatology, Farhat Hached University Hospital, Sousse, Tunisia.,Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
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28
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Elias M, Patel S, Schwartz RA, Lambert WC. The color of skin: red diseases of the skin, nails, and mucosa. Clin Dermatol 2019; 37:548-560. [PMID: 31896409 DOI: 10.1016/j.clindermatol.2019.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Red color is pervasive in local and systemic skin conditions. It is a color that often reflects variations of dermal blood flow and extends beyond the rubor and calor of inflammation. The pathophysiology of red skin involves remote and local chemical mediators that dilate arteriolar smooth muscle and increase blood flow to superficial vessels and capillary beds. Incident light hits hemoglobin, which preferentially absorbs light of shorter wavelengths, such as blue, and reflects warmer colors. Due to its pervasiveness and consistency, red color is a useful descriptive factor in helping narrow a differential diagnosis. Red skin disorders include a variety of conditions involving endocrine mediators, cardiovascular responses, and the disruption of the skin barrier. An understanding of the blood's role in these disorders equips clinicians to generate differential diagnoses through the lens of pathophysiology. Dermatologists can improve management by considering red skin as part of systemic disease rather than as an isolated incident.
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Affiliation(s)
- Marcus Elias
- Department of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Shreya Patel
- Department of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Robert A Schwartz
- Department of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - W Clark Lambert
- Department of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Pathology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
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Abstract
Dermatologic presentations can quickly become overwhelming for clinicians due to the vast number of causes for these conditions. Characteristics of a rash, such as shape, color, size, and distribution, can significantly narrow the differential diagnosis. A solid framework to organize these presentations is critical for correctly identifying and treating skin issues. The shape of a rash, for instance, can serve as a foundation from which to build complex differential diagnoses. Annular rashes in the pediatric population are common complaints requiring clinical evaluation. This article is the first part of a two-part review that discusses some of the most frequent causes of these annular lesions in the pediatric population. Knowledge of these rashes can drastically improve a physician's ability to manage dermatologic issues. [Pediatr Ann. 2019;48(2):e92-e96.].
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Wang S, Fu L, Du W, Hu J, Zha Y, Wang P. Subsets of T lymphocytes in the lesional skin of pityriasis rosea. An Bras Dermatol 2019; 94:52-55. [PMID: 30726464 PMCID: PMC6360972 DOI: 10.1590/abd1806-4841.20197494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/30/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pityriasis rosea is a common papulosquamous disorder. However, its etiology and pathogenesis remain unclear. OBJECTIVE We investigate the types of inflammatory cells infiltrating the lesional skin of pityriasis rosea and demonstrate whether T-cell-mediated immunity is involved in the pathogenesis of this condition or not. METHODS The biopsies were taken from the lesional skin of 35 cases of patients diagnosed with pityriasis rosea. The specimens were prepared in paraffin sections, then submitted to routine immunohistochemistry procedures using monoclonal antibodies directed against CD3, CD4, CD8, CD20 and CD45RO and horseradish peroxidase-labeled goat anti-human antibodies. The positive sections were determined by the ratio and staining intensity of positive inflammatory cells. RESULTS The mean score of positive CD3, CD4, CD8, and CD45RO staining was respectively 3.74±3.88, 5.67±4.40, 2.94±3.42 and 7.68±4.33 in these pityriasis rosea patients (P<0.001). The percentage of positive staining was 54.29% (19/35), 69.7% (23/33), 40% (14/35) and 79.41% (27/34) (P<0.05). However, the staining of CD20 was negative in all samples. The mean score of CD3 staining in patients with time for remission ≤60 days (4.90±4.21) was higher than that in patients with time for remission >60 days (2.00±2.5) (P<0.05), whereas no statistical difference in the mean score of CD4, CD8 and CD45RO staining was observed. study liMitations: The sample size and the selected monoclonal antibody are limited, so the results reflect only part of the cellular immunity in the pathogenesis of pityriasis rosea. CONCLUSION Our findings support a predominantly T-cell mediated immunity in the development of pityriasis rosea.
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Affiliation(s)
- Shuqin Wang
- Department of Dermatology, 1st Affiliated Hospital, Anhui Medical
University, Hefei, China
- Department of Dermatology, the Anqing Municipal Hospital, Anqing,
China
| | - Liying Fu
- Department of Dermatology, People’s Hospital of Zhengzhou,
Zhengzhou, China
| | - Wenhui Du
- Department of Dermatology, 1st Affiliated Hospital, Anhui Medical
University, Hefei, China
| | - Jun Hu
- Department of Dermatology, the Anqing Municipal Hospital, Anqing,
China
| | - Yongsheng Zha
- Department of Dermatology, the Anqing Municipal Hospital, Anqing,
China
| | - Peiguang Wang
- Department of Dermatology, 1st Affiliated Hospital, Anhui Medical
University, Hefei, China
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Veraldi S, Moltrasio C, Spinelli F, Nazzaro G. Anetodermic lesions following pityriasis rosea and impetigo. GIORN ITAL DERMAT V 2018; 155:697-699. [PMID: 30229641 DOI: 10.23736/s0392-0488.18.06115-1] [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]
Affiliation(s)
- Stefano Veraldi
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy -
| | - Chiara Moltrasio
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Spinelli
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianluca Nazzaro
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 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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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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Horie C, Mizukawa Y, Yamazaki Y, Shiohara T. Varicella zoster virus as a possible trigger for the development of pityriasis lichenoides et varioliformis acuta: retrospective analysis of our institutional cases. Clin Exp Dermatol 2018; 43:703-707. [PMID: 29797478 DOI: 10.1111/ced.13549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2017] [Indexed: 11/30/2022]
Abstract
Although numerous infective agents, including varicella zoster virus (VZV), have been described in association with pityriasis lichenoides et varioliformis acuta (PLEVA) and pityriasis lichenoides chronica (PLC), none has been identified consistently in these lesions. We sought to immunohistochemically identify VZV glycoprotein (g)E antigens in the vascular endothelium in PLEVA and PLC lesions, based on our previous observation that gE was detected in the vascular endothelium and eccrine unit up until 2 months and 2.5, respectively, years after herpes zoster (HZ) infection. In five of the six cases of PLEVA, VZV gE was identified in the endothelial cells and eccrine epithelium, as observed in HZ lesions, whereas VZV gE was detected in only one of seven patients with PLC. None of the patients with PLEVA who had VZV gE-positive vascular endothelial cells had experienced previous episodes of HZ. VZV may be one of the aetiological agents for PLEVA while other aetiological factors could exist in PLC.
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Affiliation(s)
- C Horie
- Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Y Mizukawa
- Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Y Yamazaki
- Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan
| | - T Shiohara
- Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan
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Engelmann I, Ogiez J, Ogiez L, Alidjinou EK, Lazrek M, Dewilde A, Hober D. Relapsing Pityriasis Rosea With HHV-7 Reactivation in an 11-Year-Old Girl. Pediatrics 2018; 141:peds.2017-3179. [PMID: 29674359 DOI: 10.1542/peds.2017-3179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2018] [Indexed: 11/24/2022] Open
Abstract
Pityriasis rosea (PR) usually presents as acute exanthema with oval erythematous-squamous lesions localized on the trunk, arms, and legs with spontaneous remission. We present an unusual case of PR with frequent relapses during a period of 7 years. An 11-year-old white female patient presented with many pruritic erythematous oval lesions on her trunk. A second episode followed 2 years later with several pruritic erythematous lesions on her lower limbs. During the following 5 years, the patient had several relapses per year, with 1 to 3 lesions on changing localizations. PR was diagnosed on the basis of the clinical presentation and detection of human herpesvirus 7 DNA. Spontaneous remission occurred without treatment in each episode. Relapsing PR is a rare form of PR characterized by a lower number of lesions and smaller sized lesions compared with the classic form of PR. Pediatricians should consider the diagnosis of relapsing PR even if only a single or few erythematous lesions are present.
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Affiliation(s)
- Ilka Engelmann
- Laboratoire de Virologie EA3610, University Lille and Faculté de Médecine, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Judith Ogiez
- Laboratoire de Virologie EA3610, University Lille and Faculté de Médecine, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Lucie Ogiez
- Laboratoire de Virologie EA3610, University Lille and Faculté de Médecine, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Enagnon Kazali Alidjinou
- Laboratoire de Virologie EA3610, University Lille and Faculté de Médecine, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Mouna Lazrek
- Laboratoire de Virologie EA3610, University Lille and Faculté de Médecine, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Anny Dewilde
- Laboratoire de Virologie EA3610, University Lille and Faculté de Médecine, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Didier Hober
- Laboratoire de Virologie EA3610, University Lille and Faculté de Médecine, Centre Hospitalier Régional Universitaire de Lille, Lille, France
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Abstract
Pityriasis rosea is a papulosquamous skin disorder that occurs most commonly between the ages of 10 and 35 years. Recurrent pityriasis rosea is rare. We report a patient suffering from recurrent pityriasis rosea, whose etiology may be related to either vaccine-induced stimulation of the immune system, or some rare vaccine component(influenza A [H1N1] vaccine, hepatitis B vaccine). We believe that such a case is unique and it has not been reported previously. The patient was successfully treated with a combination of oral cetirizine, a topical steroid cream, and narrowband-ultraviolet B phototherapy. The symptoms of this disorder should be recognized by dermatologists.
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Affiliation(s)
- Ang Li
- a Department of Dermatology , Qianfoshan Hospital, Shandong University , Jinan , Shandong , People's Republic of China.,b Department of Clinical Medicine , Queen Mary School, Medical School, Nanchang University , Nanchang , Jiangxi , People's Republic of China
| | - Ping Li
- a Department of Dermatology , Qianfoshan Hospital, Shandong University , Jinan , Shandong , People's Republic of China.,c Department of Clinical Medicine , Taishan Medical College , Tai'an , Shandong , People's Republic of China
| | - Yanqiong Li
- a Department of Dermatology , Qianfoshan Hospital, Shandong University , Jinan , Shandong , People's Republic of China.,c Department of Clinical Medicine , Taishan Medical College , Tai'an , Shandong , People's Republic of China
| | - Wenfei Li
- a Department of Dermatology , Qianfoshan Hospital, Shandong University , Jinan , Shandong , People's Republic of China
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Alzahrani NA, AlJasser MI. Geographic tonguelike presentation in a child with pityriasis rosea: Case report and review of oral manifestations of pityriasis rosea. Pediatr Dermatol 2018; 35:e124-e127. [PMID: 29436009 DOI: 10.1111/pde.13417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Oral lesions are rarely reported in patients with pityriasis rosea. We report a case of a 3-year-old boy with clinical evidence of generalized pityriasis rosea who developed asymptomatic oral lesions similar in appearance to geographic tongue. The generalized eruption and tongue lesions resolved simultaneously within 4 weeks. We also review the literature on the oral manifestations of Pityriasis rosea.
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Affiliation(s)
- Nouf A Alzahrani
- Division of Dermatology, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed I AlJasser
- Division of Dermatology, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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39
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Does influenza subtype H1N1 have a place in the etiology of pityriasis rosea? Postepy Dermatol Alergol 2018; 36:164-166. [PMID: 31320848 PMCID: PMC6627266 DOI: 10.5114/ada.2018.73139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 12/28/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Pityriasis rosea (PR) is an acute, inflammatory skin disease of unknown cause. Various infectious agents including viruses have been proposed as causative agents and presence of influenza subtype H1N1 was shown in case reports with PR, but the relation was not conclusive. We hypothesited that there may be a relation between PR and H1N1, since both of them are prevalent in the same period as winter or season transitions. Aim To investigate the effect of the H1N1 virus in PR in this study. Material and methods Twenty-one female and 12 male PR patients who applied to Kırıkkale University Faculty of Medicine Hospital Dermatology Outpatient Clinic were included in the study. Influenza subtype H1N1 IgM and IgG antibodies were detected by enzyme immunoassay (EIA) in sera of patients; tissue biopsy specimens were examined for influenza subtype H1N1 RNA by PCR. Results Seven (23%) of the 33 patients had positive IgM and IgG antibodies. Influenza subtype H1N1 RNA was not detected in the tissue samples of 33 PR patients. Conclusions According to the results of this study, we can say that influenza subtype H1N1 does not play a role in PR etiology.
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Pityriasis rosea in a patient with retrovirus infection: a reply. Postepy Dermatol Alergol 2018; 35:116-117. [PMID: 29599683 PMCID: PMC5872253 DOI: 10.5114/ada.2018.73172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 07/25/2017] [Indexed: 11/17/2022] Open
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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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Ciccarese G, Broccolo F, Rebora A, Parodi A, Drago F. Oropharyngeal lesions in pityriasis rosea. J Am Acad Dermatol 2017; 77:833-837.e4. [DOI: 10.1016/j.jaad.2017.06.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/15/2017] [Accepted: 06/17/2017] [Indexed: 01/21/2023]
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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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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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45
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Halteh P, Lipner SR. A retrospective study on rapid plasma reagin testing in patients with Pityriasis rosea. Int J STD AIDS 2017; 28:1348-1351. [PMID: 28345391 DOI: 10.1177/0956462417702312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pityriasis rosea (PR) is an acute self-limited exanthem characterized by oval erythematous patches with scale and may be difficult to differentiate from secondary syphilis. A rapid plasma reagin (RPR) test can be used to rule in secondary syphilis with high sensitivity and specificity. A retrospective study was performed on patients at Weill Cornell Medicine, who were diagnosed with PR from 2000 to 2016 and also received RPR testing at the time of diagnosis. The objective was to assess the frequency of secondary syphilis when the initial clinical impression was PR. Only 2/142 patients (1.4%) had a reactive RPR test. Based on our results, we advocate that careful social and sexual histories be taken in all patients presenting with atypical PR and syphilis screening performed if risk factors are present.
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Affiliation(s)
- Pierre Halteh
- Department of Dermatology, Weill Cornell Medical College, New York, NY 10021, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medical College, New York, NY 10021, USA
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46
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Drago F, Ciccarese G. Pityriasis Rosea: An Update on Etiopathogenesis and Management of Difficult Aspects - A Reply. Indian J Dermatol 2017; 62:95. [PMID: 28216734 PMCID: PMC5286763 DOI: 10.4103/0019-5154.198042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Francesco Drago
- DISSAL Department of Dermatology, IRCCS AOU San Martino-IST, 16132 Genoa, Italy. E-mail:
| | - Giulia Ciccarese
- DISSAL Department of Dermatology, IRCCS AOU San Martino-IST, 16132 Genoa, Italy. E-mail:
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Badakhsh H, Fadaei F, Badakhsh M, Balouchi A. Atypical Pityriasis Rosea with Unilateral Presentation. J Clin Diagn Res 2017; 10:WD01-WD02. [PMID: 28208986 DOI: 10.7860/jcdr/2016/24915.9101] [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: 10/19/2016] [Accepted: 11/08/2016] [Indexed: 11/24/2022]
Abstract
Pityriasis Rosea (PR) is a common skin disease and characterized by generalized scaly eruptions typically on the trunk and proximal extremities. Atypical presentations of PR are common and can be a diagnostic challenge for clinicians. Here we present a case of a 26-year-old female who presented with a sudden onset of several asymptomatic, erythematous and scaly plaques on her trunk. Plaques sized 0.5-1cm in diameter that were distributed unilaterally (right side) on her chest, back and axilla. Atypical cases of PR are fairly common and less readily recognized. Careful history, clinical evaluation and follow-up are important to avoid misdiagnosis of PR and physicians should be aware of PR variants so that appropriate management and reassurance can be offered. For atypical eruptions without a definite diagnosis, it is safer to consider lesional skin biopsy.
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Affiliation(s)
- Hoda Badakhsh
- Resident, Department of Dermatology, Kerman University of Medical Science , Kerman, Iran
| | - Fahameh Fadaei
- Resident, Department of Dermatology, Kerman University of Medical Science , Kerman, Iran
| | - Mahin Badakhsh
- Lecturer, Department of Midwifery, Zabol University of Medical Science , Zabol, Sistanvbalouchistan, Iran
| | - Abbas Balouchi
- Student, Department of Nursing, Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Science , Tehran, Iran
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Drago F, Ciccarese G, Gasparini G, Cogorno L, Javor S, Toniolo A, Broccolo F. Contemporary infectious exanthems: an update. Future Microbiol 2017; 12:171-193. [DOI: 10.2217/fmb-2016-0147] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
An exanthem is a skin rash that may be associated with mucous membrane eruption, fever or other symptoms. It may develop as manifestation of an infectious disease or as adverse reaction to drugs. Beside the ‘classical exanthems’ commonly occurring in childhood, other exanthems, defined as ‘atypical’ for the different morphology and causal agents, may occur. Among the atypical exanthems with infectious etiology, viral, bacterial, parasitic and helminth infections are implicated. We describe herein etiology and epidemiology of the atypical exanthems caused by infectious agents. In case of exanthem, to make a correct etiological diagnosis is crucial for both the patient and community concerning issues such as time off school, immunizations and risk in pregnancy and immunocompromised individuals.
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Affiliation(s)
- Francesco Drago
- DISSAL Department of Dermatology, IRCCS AOU San Martino-IST, Largo Rosanna Benzi, 10, 16132 Genoa, Italy
| | - Giulia Ciccarese
- DISSAL Department of Dermatology, IRCCS AOU San Martino-IST, Largo Rosanna Benzi, 10, 16132 Genoa, Italy
| | - Giulia Gasparini
- DISSAL Department of Dermatology, IRCCS AOU San Martino-IST, Largo Rosanna Benzi, 10, 16132 Genoa, Italy
| | - Ludovica Cogorno
- DISSAL Department of Dermatology, IRCCS AOU San Martino-IST, Largo Rosanna Benzi, 10, 16132 Genoa, Italy
| | - Sanja Javor
- DISSAL Department of Dermatology, IRCCS AOU San Martino-IST, Largo Rosanna Benzi, 10, 16132 Genoa, Italy
| | - Antonio Toniolo
- Laboratory of Medical Microbiology, Department of Biotechnology & Life Sciences, University of Insubria, Varese, Italy
| | - Francesco Broccolo
- Laboratory of Molecular Microbiology & Virology, School of Medicine, University of Milano-Bicocca, 20900 Monza, Italy
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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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Al Mokadem S, Ghonemy S, Zidan A, Abd El Aleem G. The role of interleukin-22 in pityriasis rosea. Clin Exp Dermatol 2017; 42:30-35. [PMID: 27862158 DOI: 10.1111/ced.12976] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pityriasis rosea (PR) is an exanthematous disease related to reactivation of human herpes virus (HHV) types 6 and 7. The pathogenesis and cytokine profile of PR are still poorly understood.There is a large amount of evidence indicating a viral aetiology for PR. AIM To measure the serum level of interleukin (IL)-22, a cytokine expressed by T helper (Th)17 cells in patients with PR to explore the possible association of IL-22 with the pathogenesis of the disease. METHODS This case-control study enrolled 25 patients with PR (mean ± SD age 20 ± 12 years) and a control group of 25 apparently healthy individuals (mean age 18 ± 12.1 years). Blood samples were collected from both patients and controls to measure serum IL-22. Scoring of PR was performed using the Pityriasis Rosea Severity Score (PRSS). RESULTS There was a statistically significant difference in IL-22 serum level between the patient and control groups. The IL-22 serum level increased with increase in disease severity (PRSS), extent and duration. CONCLUSION Through its proinflammatory cytokines, IL-22 plays a role in the inflammatory process of PR.
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Affiliation(s)
- S Al Mokadem
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - S Ghonemy
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - A Zidan
- Department of Clinical Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - G Abd El Aleem
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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