Pityriasis rosea. Viral complement fixation studies

A case of Pityriasis rosea concurrent with the novel influenza A (H1N1) infection

Pityriasis rosea is a common skin disease with a self-limiting course. Multiple etiologies including viruses, bacteria, and fungi have been investigated in an attempt to confirm a casual association. Pityriasis rosea has not been associated with influenza virus, but has been associated with herpes simplex virus types 6 and 7. We encountered a case of a proven pandemic H1N1 infection associated with a clincopathological diagnosis of pityriasis rosea. We conclude that influenza A (H1N1) virus could either be a primary cause of pityriasis rosea or a trigger for reactivation of other viral causes.

The role of human herpesvirus 6, human herpesvirus 7, Epstein-Barr virus and cytomegalovirus in the aetiology of pityriasis rosea

AIM

To identify the role of human herpesvirus 6 (HHV-6), HHV-7, Epstein-Barr virus (EBV) and cytomegalovirus (CMV) in the pathogenesis of pityriasis rosea (PR).

MATERIAL

Polymerase chain reaction with specific primers for HHV-6 and HHV-7 DNA sequences was performed on the blood and tissue samples of 25 patients with PR and on the blood samples of age- and sex-matched healthy controls. HHV-6, EBV, CMV immunoglobulin M (IgM) and IgG were analysed by enzyme-linked immunosorbent assay, HHV-7 IgM and IgG were analysed by indirect immunofluorescence on the serum samples of the study population. In the patient group, the values were studied 2 weeks later again (second control).

RESULTS

There were no differences between the first and second controls of the patients and healthy subjects regarding HHV-6 IgM, HHV-7 IgM, CMV IgM, EBV IgM results. There were significant differences between the first [HHV-6 DNA (2 of 25), HHV-7 DNA (6 of 25)] and second control [HHV-6 DNA (1 of 25), HHV-7 DNA (11 of 25)] of the patients for the blood samples in favour of HHV-7. PR patients showed higher amounts of HHV-6 and HHV-7 DNA positivity when compared with that of healthy subjects. HHV-7 seemed to be more important regarding tissue samples [HHV-6 DNA (7 of 25), HHV-7 DNA (12 of 25) first control, HHV-6 DNA (6 of 25), HHV-7 DNA (12 of 25) second control] as well as blood samples.

CONCLUSION

Though our results failed to support a causal relationship among EBV, CMV and PR, they indicated a possible role for HHV-6 and especially HHV-7 in a group of Turkish patients but other aetiological factors may exist.

The detection of human herpesvirus-8 DNA in plasma and peripheral blood mononuclear cells in adult patients with pityriasis rosea by polymerase chain reaction

BACKGROUND

Herpesvirus-like particles have been reported to be detectable by electron microscopy in lesional biopsy of patients with pityriasis rosea (PR). We report a study investigating the association of PR with human herpesvirus-8 (HHV-8) infection.

METHODS

Our setting is a teaching clinic affiliated to a university. We recruited eight patients aged 28-47 years (mean: 34.5 years) diagnosed with PR during a one-year period. We collected acute blood specimens at presentation and convalescent blood specimens three to four weeks later. We also collected skin scrapings from the herald patch where present and from truncal secondary lesions.

RESULTS

We detected HHV-8 DNA by a nested PCR (polymerase chain reaction) targeting, respectively, a 233-bp and a 160-bp fragment of ORF 26. PCR for HHV-8 DNA was negative in the peripheral blood mononuclear cells and plasma of acute and convalescent specimens of all patients, and negative in all skin scrapings. We detected anti-HHV-8 IgG and IgM antibodies by the indirect immunofluorescence. Four patients had IgG antibodies against HHV-8, but with no significant rise of titre. None were positive for anti-HHV-8 IgM antibody.

CONCLUSION

We conclude that PR is not associated with HHV-8 infection.

Epidemiological study of human herpesvirus-6 and human herpesvirus-7 in pityriasis rosea

BACKGROUND

Pityriasis rosea (PR) is a common papulosquamous skin disorder that is suspected to have an infectious aetiology.

OBJECTIVES

We aimed to study the role of human herpesvirus (HHV)-7 and HHV-6 in the pathogenesis of PR.

METHODS

We performed seroepidemiological studies (indirect immunofluorescence test) and polymerase chain reaction (PCR) analysis for HHV-6 and HHV-7 in patients with PR. Seventy-two serum samples and 37 samples of peripheral blood mononuclear cells (PBMC) from 44 patients with PR were obtained. Twenty-five patients with other skin disorders such as drug eruption, urticaria or herpes zoster were studied as controls in the PCR analysis.

RESULTS

HHV-7 DNA was detected in 13 of 30 (43%) samples of PBMC of the patients with PR and 14 of 25 (56%) samples of PBMC of controls. HHV-6 DNA was detected in six of 29 (21%) patients with PR and nine of 23 (39%) controls. Thus there was no difference in the prevalence of HHV-6 or HHV-7 in PBMC between patients with PR and those with other skin disorders. In the seroepidemiological study, two cases of at least a fourfold rise in titre and five cases of a fourfold decrease in titre to HHV-7 antibody, and two cases of a fourfold rise in titre and two cases of a fourfold decrease in titre to HHV-6 antibody, were observed in 24 patients with PR. This seroepidemiological study revealed antibody responses consistent with active infection in several PR patients, but the greater proportion of the patients had no definite increase in the antibody titres.

CONCLUSIONS

We conclude that HHV-7 and HHV-6 may play a part in some patients with PR, but that other causative agents may exist. Further analyses are needed to determine the causative agents of PR.

Pityriasis rosea Gibert: detection of Legionella micdadei antibodies in patients

Some epidemiological and clinical characteristics of Pityriasis rosea Gibert has led us to hypothesize that this disease may be the clinical manifestation of an infection caused by legionellas. We have thus tested the sera of 36 patients ill with Pityriasis rosea and 19 controls for Legionella pneumophila serogroup 1-6 and Legionella micdadei antibodies. These, who had the same age and sex distribution as study patients, were receiving treatment for other diseases in the same ward. Also tested were 200 sera from the voluntary blood donors from the same region as study patients. Legionella micdadei antibodies were detected in 12 (33.3%) Pityriasis rosea cases and in one (5.2%) control. They were significantly more common in Pityriasis rosea cases than in either controls or voluntary blood donor population. The findings to date encourage continued research into the causative relationship between the Legionella micddadei infection and the onset of Pityriasis rosea Gibert.

Pityriasis rosea. An immunologic study

Some immunologic studies were carried out for 31 patients with pityriasis rosea. Normal levels of serum IgG and IgA but higher levels of IgM were obtained. Serum C3 values were decreased while C4 values were normal. B lymphocytes showed no difference from the controls, whereas T-cell counts were significantly lower in the patients. The migration inhibition indices were higher in the patients than the controls. Direct immunofluorescence tests were negative in the studied three cases. The possible implication of a viral infection in the production of the reported changes was discussed.

Pityriasis rosea update: 1986

Pityriasis rosea is a common self-limited dermatologic disorder. It appears to be a nonspecific cutaneous reaction pattern with a large number of causes. Current evidence indicates that a cell-mediated immune mechanism may be important in its pathogenesis.

Pityriasis rosea in the Sudan

Pityriasis rosea presents in the Sudan with the same picture as it does in other countries of Africa. The seasonal incidence is highest in the cold, dry months. The erythematous or rosea picture seen in whites is never encountered in blacks. The term pityriasis rosea may not be descriptive of the disease as it presents in black and brown skins.

Papulosquamous diseases: a review

Papulosquamous diseases are a heterogeneous group of disorders whose etiology primarily is unknown. The nosology of these disorders is based on a descriptive morphology of clinical lesions characterized by scaly papules and plaques. The major entities in this group include psoriasis, parapsoriasis (including pityriasis lichenoides et varioliformis acuta), lichen planus, lichen nitidus, lichen striatus, pityriasis rosea, pityriasis rubra pilaris, seborrheic dermatitis, and the Gianotti-Crosti syndrome. Many other conditions may become papulosquamous and should be considered in the differential diagnosis.

Recent upper respiratory tract infection and pityriasis rosea: a case-control study of 249 matched pairs

A sample of 249 patients was drawn from an original population of 939 patients with pityriasis rosea identified in an earlier population-based study of pityriasis rosea in Rochester, Minnesota. A control was selected for each case, matched for age, sex, and year of diagnosis. Comparison was made with regard to recent immunization, history of atopy, and recent infection. A statistically significant number of patients had experienced recent upper respiratory tract infection (P less than 0.005). The association between recent infection and pityriasis rosea is discussed.

Pityriasis rosea in children. A review

Pityriasis rosea is a common disorder of unknown etiology that may simulate a number of other dermatologic entities. Secondary syphilis should always be ruled out, particularly in adolescents. Pruritus occurs more frequently than is generally appreciated. The herald patch may not always be present. Secondary lesions occasionally occur distal to the elbows and knees and on the face. Over the more proximal parts of the body the secondary lesions will characteristically align themselves with the long axis following the skin lines of cleavage. The natural course is that of spontaneous resolution within 6 to 8 weeks. Sequelae are rare and usually medically insignificant. Management with oral antipruritics and/or topical steroids may be necessary to relieve the itching.