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Khadiri O, Kaoua R, Aboudourib M, Amal S, Hocar O. An atypical form of pediatric pityriasis rosea of the diaper area: Pityriasis marginata et circinata of Vidal. Arch Pediatr 2024; 31:340-343. [PMID: 38789377 DOI: 10.1016/j.arcped.2024.02.003] [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: 07/31/2023] [Revised: 12/09/2023] [Accepted: 02/11/2024] [Indexed: 05/26/2024]
Abstract
Pityriasis rosea is a common, self-limited disease which in its typical form should not raise diagnostic doubts. Nevertheless, its atypical presentations can be a challenge for the clinician, and hence it is important to be aware of them. Recognition of these forms may enable a correct diagnosis to be made and avoid unnecessary procedures. We present two patients for whom we believe atypical PR was the most likely the diagnosis.
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Affiliation(s)
- Omayma Khadiri
- Department of Dermatology and Venereology, Mohammed VI University Hospital Center, Bioscience and Health Laboratory, Cadi Ayyad University, FMPM Marrakech, Morocco.
| | - Rim Kaoua
- Department of Dermatology and Venereology, Mohammed VI University Hospital Center, Bioscience and Health Laboratory, Cadi Ayyad University, FMPM Marrakech, Morocco
| | - Maryam Aboudourib
- Department of Dermatology and Venereology, Mohammed VI University Hospital Center, Bioscience and Health Laboratory, Cadi Ayyad University, FMPM Marrakech, Morocco
| | - Said Amal
- Department of Dermatology and Venereology, Mohammed VI University Hospital Center, Bioscience and Health Laboratory, Cadi Ayyad University, FMPM Marrakech, Morocco
| | - Ouafa Hocar
- Department of Dermatology and Venereology, Mohammed VI University Hospital Center, Bioscience and Health Laboratory, Cadi Ayyad University, FMPM Marrakech, Morocco
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Okoji UK, Agim NG, Heath CR. Features of Common Skin Disorders in Pediatric Patients with Skin of Color. Dermatol Clin 2022; 40:83-93. [PMID: 34799038 DOI: 10.1016/j.det.2021.09.002] [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] [Indexed: 11/03/2022]
Abstract
Many dermatologic conditions common in the pediatric population may have unique presentations in skin of color or occur with greater incidence. This may be due to ethnic origin, socioeconomic factors, or other influences. Awareness of the potential variations in skin of color may enhance prompt diagnosis, appropriate treatment, and/or reassurance as indicated.
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Affiliation(s)
- Uchenna K Okoji
- Drexel University College of Medicine, 2900 West Queen Lane, Philadelphia, PA 19129, USA
| | - Nnenna G Agim
- University of Texas Southwestern, 2350 North Stemmons Freeway, Dallas, TX 75220, USA
| | - Candrice R Heath
- Lewis Katz School of Medicine, Temple University, 3401 North Broad Street, 5-OPB Dermatology, Philadelphia, PA 19140, USA.
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Fölster-Holst R. Infectious exanthemas in childhood. J Dtsch Dermatol Ges 2021; 18:1128-1155. [PMID: 33112060 DOI: 10.1111/ddg.14301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/09/2020] [Indexed: 12/15/2022]
Abstract
Most childhood exanthemas are harmless. However, recognizing serious diseases with life-threatening complications at an early stage is important for the timely initiation of adequate therapy. This requires knowledge of the specific patterns of the exanthema, obtained from the medical history and the clinic, including the patient's general condition and physical examination. In unclear cases, additional diagnostic measures are undertaken, such as blood tests and smears (cutaneous, mucocutaneous). Viruses are the most common cause of childhood exanthemas. New variants of infectious agents, improved diagnostics and stays in tropical and subtropical countries have expanded the spectrum of infectious exanthemas.
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Affiliation(s)
- Regina Fölster-Holst
- Dermatology, Venereology, Allergology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
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Leung AKC, Lam JM, Leong KF, Hon KL. Pityriasis Rosea: An Updated Review. Curr Pediatr Rev 2021; 17:201-211. [PMID: 32964824 DOI: 10.2174/1573396316666200923161330] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/20/2020] [Accepted: 07/06/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pityriasis rosea is a common acute, self-limited papulosquamous dermatosis that primarily affects children and young adults. The condition and its clinical variants may pose a diagnostic challenge, especially in the absence of the herald patch. OBJECTIVE This article aimed to familiarize pediatricians with clinical manifestations, evaluation, diagnosis, and management of pityriasis rosea. METHODS A search was conducted in March 2020 in Pubmed Clinical Queries using the key term " pityriasis rosea". The search strategy included all clinical trials (including open trials, non-randomized controlled trials, and randomized controlled trials), observational studies, and reviews (including narrative reviews and meta-analyses) published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. RESULTS Pityriasis rosea occurs mainly in individuals between 10 and 35 years of age with a peak during adolescence. Human herpesvirus (HHV)-7 and HHV-6 have been implicated as the causative agents in some patients with pityriasis rosea. A mild prodrome consisting of headaches, fever, malaise, fatigue, anorexia, sore throat, enlarged lymph nodes and arthralgia is present in about 5% of patients. The most common presenting sign, found in approximately 80% of patients, is a "herald" or "mother" patch which is larger and more noticeable than the lesions of the later eruption. A generalized, bilateral, symmetrical eruption develops in approximately 4 to 14 days and continues to erupt in crops over the next 12 to 21 days. Typical lesions are 0.5 to 1 cm, oval or elliptical, dull pink or salmon-colored macules with a delicate collarette of scales at the periphery. The long axes tend to be oriented along the skin lines of cleavage (Langer lines). Lesions on the back may have a characteristic "Christmas tree", whereas lesions on the upper chest may have a V-shaped pattern. There are many conditions that may mimic pityriasis rosea. Pityriasis rosea in the absence of the herald patch and its variants may pose a diagnostic challenge. The typical course is 6 to 8 weeks. In the vast majority of cases, reassurance and symptomatic treatment should suffice. Active intervention may be considered for individuals with severe or recurrent pityriasis rosea and pregnant women with the disease. Treatment options include acyclovir, macrolides (in particular, erythromycin), and ultraviolet phototherapy. If active intervention is needed, there is evidence supporting the use of oral acyclovir to shorten the duration of illness. CONCLUSION Pityriasis rosea is a common, acute, self-limiting exanthematous skin disease that primarily affects children and young adults. The condition is characterized by a "herald patch" after which oval erythematous squamous lesions appear along Langer's lines of cleavage on the trunk and proximal extremities, giving it a "Christmas tree" appearance. The disease presenting in its classical form can easily be diagnosed. Clinical variants of the disease may pose a diagnostic challenge for the general pediatrician. Knowledge of the disease is essential to allow prompt diagnosis and to avoid unnecessary investigations.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences University of British Columbia, Vancouver, British Columbia, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
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Fölster-Holst R. Infektiöse Exantheme im Kindesalter. J Dtsch Dermatol Ges 2020; 18:1128-1157. [PMID: 33112074 DOI: 10.1111/ddg.14301_g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/10/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Regina Fölster-Holst
- Dermatologie, Venerologie, Allergologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Kiel
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Eshtiaghi P, Weinstein M. Where in the World Did You Get That Rash? Pediatr Rev 2020; 41:184-195. [PMID: 32238547 DOI: 10.1542/pir.2018-0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Panteha Eshtiaghi
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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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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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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Efficacy and Safety of Indigo Naturalis in Combination with Narrow-Band Ultraviolet B for Treatment of Pityriasis Rosea: A Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:6816981. [PMID: 29770152 PMCID: PMC5892283 DOI: 10.1155/2018/6816981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/22/2017] [Accepted: 12/03/2017] [Indexed: 11/29/2022]
Abstract
Pityriasis rosea (PR), a skin rash, causes substantial discomfort in patients. There is a lack of effective therapies for PR. A combination of ultraviolet irradiation and indigo naturalis treatment has been shown to be a safe and effective regime for control of PR; however, the data have been largely inconsistent. Tis meta-analysis further evaluated the efficacy and safety of this combination in patients with PR. The PubMed, Embase, Cochrane Library, CNKI, VIP, and Wan Fang databases were searched for relevant RCTs of this combination therapy in patients with PR. A total of eight studies with a combined study population of 688 patients published between January 2006 and March 2016 were eligible for this meta-analysis. The RevMan 5.3 software was used for the meta-analysis. The regimen of compound indigo naturalis plus NB-UVB showed much better control of PR as compared to that achieved with use of compound indigo naturalis or NB-UVB alone in terms of cure rate or effective rate. However, no significant difference was observed between the two with respect to incidence of adverse effects. The analysis was affected by publication bias as revealed by funnel plot analysis. Further studies with large sample sizes are required to confirm our findings.
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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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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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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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Fu LY, Xu CC, Zheng XD, Chen G, Zhu J, Wang PG. Association of HLA-DQB1*03:03 with pityriasis rosea in Chinese patients. Clin Exp Dermatol 2017; 43:389-392. [PMID: 29222811 DOI: 10.1111/ced.13313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2017] [Indexed: 11/30/2022]
Affiliation(s)
- L.-Y. Fu
- Department of Dermatology; No.1 affiliated hospital and Key Laboratory of Dermatology; Ministry of Education; Anhui Medical University; Hefei China
| | - C.-C. Xu
- Department of Dermatology; No.1 affiliated hospital and Key Laboratory of Dermatology; Ministry of Education; Anhui Medical University; Hefei China
| | - X.-D. Zheng
- Department of Dermatology; No.1 affiliated hospital and Key Laboratory of Dermatology; Ministry of Education; Anhui Medical University; Hefei China
| | - G. Chen
- Department of Dermatology; No.1 affiliated hospital and Key Laboratory of Dermatology; Ministry of Education; Anhui Medical University; Hefei China
| | - J. Zhu
- Department of Dermatology; No.1 affiliated hospital and Key Laboratory of Dermatology; Ministry of Education; Anhui Medical University; Hefei China
| | - P.-G. Wang
- Department of Dermatology; No.1 affiliated hospital and Key Laboratory of Dermatology; Ministry of Education; Anhui Medical University; Hefei China
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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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El-Ela MA, El-Komy M, Hay RA, Hegazy R, Sharobim A, Rashed L, Amr K. Higher Expression of Toll-like Receptors 3, 7, 8, and 9 in Pityriasis Rosea. J Pathol Transl Med 2017; 51:148-151. [PMID: 28192646 PMCID: PMC5357755 DOI: 10.4132/jptm.2016.09.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/05/2016] [Accepted: 09/07/2016] [Indexed: 11/29/2022] Open
Abstract
Background Pityriasis rosea (PR) is a common papulosquamous skin disease in which an infective agent may be implicated. Toll-like receptors (TLRs) play an important role in immune responses and in the pathophysiology of inflammatory skin diseases. Our aim was to determine the possible roles of TLRs 3, 7, 8, and 9 in the pathogenesis of PR. Methods Twenty-four PR patients and 24 healthy individuals (as controls) were included in this case control study. All recruits were subjected to routine laboratory investigations. Biopsies were obtained from one active PR lesion and from healthy skin of controls for the detection of TLR 3, 7, 8, and 9 gene expression using real-time polymerase chain reaction. Results This study included 24 patients (8 females and 16 males) with active PR lesions, with a mean age of 28.62 years. Twenty four healthy age- and sex-matched individuals were included as controls (8 females and 16 males, with a mean age of 30.83 years). The results of the routine laboratory tests revealed no significant differences between both groups. Significantly elevated expression of all studied TLRs were detected in PR patients relative to healthy controls (p < .001). Conclusions TLRs 3, 7, 8, and 9 might be involved in the pathogenesis of PR.
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Affiliation(s)
- Mostafa Abou El-Ela
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed El-Komy
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rania Abdel Hay
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab Hegazy
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amin Sharobim
- Department of Dermatology, National Research Center (NRC), Cairo University, Cairo, Egypt
| | - Laila Rashed
- Department of Clinical Biochemistry, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Khalda Amr
- Department of Molecular Genetics, National Research Center (NRC), Cairo University, Cairo, Egypt
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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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Kilinc F, Akbas A, Sener S, Aktaş A. Atypical pityriasis rosea: clinical evaluation of 27 patients. Cutan Ocul Toxicol 2016; 36:157-162. [PMID: 27558764 DOI: 10.1080/15569527.2016.1225217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pityriasis rosea (PR) is a common, acute, self-limiting inflammatory skin disease. It can easily be recognized with its typical clinical presentation. However, unusual clinic presentations can cause difficulty in diagnosis. Up to now, not many atypical forms are reported. OBJECTIVE To determine the clinical characteristics of patients with atypical pityriasis rosea. METHODS A total of 27 cases, diagnosed as atypical PR by clinical and/or histopathological examination and applied to the outpatient clinic of dermatology department between the years 2007 and 2015 were analyzed retrospectively. RESULTS The ages of patients ranged from 2 to 59 years. Of these patients, 15 (55.6%) were male and 12 (44.4%) were female. The male-to-female ratio was 5-4. Five patients had papular, four patients had purpuric, three patients had vesicular, two patients had follicular, one patient had erythema multiforme-like and one patient had eczematous drug-induced atypical form of pityriasis rosea. There were 12 cases of localized, two cases of segmental pityriasis rosea. Four of the localized forms also had atypical morphology. Histopathological evaluation was required for diagnosis in 12 (44.4%) patients. CONCLUSIONS PR can appear in many different uncommon forms. Localization and skin rush can be misleading and diagnosis can be compelling.
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Affiliation(s)
- Fadime Kilinc
- a Ataturk Training and Research Hospital , Department of Dermatology , Ankara , Turkey
| | - Ayse Akbas
- a Ataturk Training and Research Hospital , Department of Dermatology , Ankara , Turkey
| | - Sertac Sener
- a Ataturk Training and Research Hospital , Department of Dermatology , Ankara , Turkey
| | - Akın Aktaş
- b Yildirim Beyazit University, Medical Faculty , Department of Dermatology , Ankara , Turkey
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Drago F, Ciccarese G, Rebora A, Broccolo F, Parodi A. Pityriasis Rosea: A Comprehensive Classification. Dermatology 2016; 232:431-7. [PMID: 27096928 DOI: 10.1159/000445375] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/29/2016] [Indexed: 12/13/2022] Open
Abstract
Pityriasis rosea (PR) is an acute, self-limiting exanthematous disease associated with the endogenous systemic reactivation of human herpesvirus (HHV)-6 and/or HHV-7. The disease typically begins with a single, erythematous plaque followed by a secondary eruption with lesions on the cleavage lines of the trunk (configuration of a 'Christmas tree'). The duration may vary from 2 weeks to a few months. Besides the typical presentation of PR, atypical forms have been described. The previous classifications of PR are mainly based on its atypical morphological features rather than on the pathogenetic mechanisms that underlie the different presentations of the disease. Notably, most of the morphologically atypical forms follow a course amenable to the classic form. The classification that we propose, taking into account the pathogenesis, clinical features, and course of the disease, is easy and intuitive and may be helpful in identifying the atypical forms of PR in order to avoid misdiagnosis and establish the best treatment options. Finally, this classification provides indications for managing potentially harmful forms of PR (such as PR in pregnancy) and PR-like eruptions.
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Affiliation(s)
- Francesco Drago
- DISSAL, Department of Dermatology, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
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