Pityriasis rosea in children. A review

Childhood pityriasis rosea

Pityriasis rosea (PR) is an acute, self-limiting papulosquamous disorder of unknown etiology. Published studies of childhood PR are scarce and most are reviews. The aim of this study was to determine the demographic and clinical features of childhood PR.

Pityriasis rosea: an update with a critical appraisal of its possible herpesviral etiology

Pityriasis rosea is an acute, self-healing exanthem characterized by oval erythematous-squamous lesions of the trunk and limbs, that usually spares face, scalp, palms, and soles. Constitutional symptoms, which have the character of true prodromes; clinical features, which resemble those of the known exanthems; and many epidemiologic data all suggest an infectious origin. A host of infectious agents have been incriminated, but, recently, human herpesvirus 6 and 7 have been extensively studied. The goal of this review is to outline the epidemiologic, clinical, histologic, and ultrastructural features of pityriasis rosea, but mainly to stress its possible human herpesvirus nature. In addition, clues have been added to help the reader to go through the complex subtleties of the virologic investigation.

Phenotypical characteristics of the immune cells in allergic contact dermatitis, atopic dermatitis and pityriasis rosea

Allergic contact dermatitis (ACD) is a cell-mediated, delayed type IV immunologic reaction. Atopic dermatitis (AD) is a chronic inflammatory skin disease that results from a complex interaction between immunologic, genetic, and environmental factors. Pityriasis rosea (PR) is a self-limited eruption of unknown etiology. Immune cell infiltrate is a constant feature in the inflammatory skin diseases. Here, we performed phenotypical characterization of the immune cells in ACD, AD and PR (ten cases each). We performed immunohistochemical stains for B cells (CD20), T cells (CD3), histiocytes (CD68) and T cells with cytotoxic activity (granzyme-B). The data were compared with findings in 20 specimens of normal skin. The results were scored as mean values of positively stained immune cells. Immunohistochemistry showed significantly high counts of immune cells in lesional skin (ACD, AD and PR) compared to the normal one (p < 0.05). In the lesional skin, the immune cells were composed predominantly of CD3(+) T lymphocytes and CD68(+) cells (histiocytes). Some of the CD3(+) cells were granzyme B(+). The counts of some immune cells (CD3(+) and CD68(+)) were high in ACD compared to AD and PR. The counts of CD20(+) and granzyme B(+) cells were high in PR compared to ACD and AD. However, these differences did not reach the level of statistical significance. The present data describe the profile of the immune cell infiltrate in AD, ACD and PR. The cell-mediated immunity seems to have critical role in the development of these lesions.

Atypical presentations of pityriasis rosea: case presentations

Atypical cases of pityriasis rosea (PR) are fairly common and less readily recognized than typical eruptions. We present four patients for whom we believe atypical PR is the most likely diagnosis. A 33-year-old man had purpuric lesions bilaterally on the legs with classical rash on the trunk. A 28-year-old woman had intensely pruritic and urticarial lesions. A 10-year-old girl had hundreds of small papular lesions 1-3 mm in size. A pregnant woman aged 26 had oral haemorrhagic ulcers with classical PR eruption on her trunk. The oral ulcers erupted and remitted at the same time as the generalized eruption. We reviewed the literature and proposed a classification based on rash morphology, rash size, rash distribution, number of lesions, site of lesions, severity of symptoms and course of the eruption. We believe that it is difficult to make a clear division to define typical and atypical PR, and that it is important not to ascribe any unusual or atypical skin eruption with PR unless other dermatoses have been excluded.

Quality of life in children with pityriasis rosea: a prospective case control study

Our aim was to investigate the effects on quality of life of pityriasis rosea (PR) in children and the concerns of their parents. We recruited all children ages 5-16 years with a diagnosis of PR in a primary care setting over a period of 30 months. Controls were the next child of the same sex and comparable age consulting for atopic dermatitis or for conditions unrelated to the skin. Information on parental concerns was also gathered. Ten children with PR and 20 control subjects were recruited. Total Children's Dermatology Life Quality Index (CDLQI) scores of children with PR (mean 3.50; 95% confidence interval [CI] 2.66-4.34) were significantly lower than those of children with atopic dermatitis (mean 7.70; 95% CI 5.59-9.81). Children with PR had significantly lower scores for symptoms and feelings, personal relationships, and sleep. Total CDLQI scores of children with PR were significantly higher than those of children with no active skin problem (mean 0.30; 95% CI -0.18 to 0.78). Significantly more parents of children with PR had concerns regarding the etiology, infectivity, relapse, and complications or dangers of the disease. We concluded that quality of life (QOL) of children with PR is significantly less affected than that of children with atopic dermatitis and significantly more affected than in children with no active skin problem. The major concerns of parents of children with PR are the etiology, infectivity, relapse, and complications or dangers. These results have important implications on whether active intervention is worthwhile for this disease.