The diagnostic criteria of pityriasis rosea and Gianotti-Crosti syndrome - a protocol to establish diagnostic criteria of skin diseases

Atypical pityriasis rosea in a young Colombian woman. Case report

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.

The Serum Immunoglobulin E Level: Is There a Relationship With the Clinical Course of the Gianotti-Crosti Syndrome?

Background: Gianotti Crosti syndrome (GCS) is a self-healing condition with a spontaneous resolution in 2-6 weeks but, even if rarely, recurrent episodes have been reported. Objective: The aim of this observational study is to investigate serum Immunoglobulin E (IgE) level in children with GCS, evaluating if there is a relationship between IgE level and clinical course of the disease. Methods: Children with GCS diagnosed at a tertiary care children's university hospital between June 2018 and November 2019 were prospectively enrolled. Demographic, clinical and hematochemical data of children investigated were collected. In particular, IgE level were investigated at symptoms onset and, if available, at the following blood tests. Patients were divided in 2 groups on the bases of the clinical course: children with a chronic relapsing course and children who did not present any relapse. Results: Among 29 patients enrolled in this study, 14 (48.3%) children had a chronic relapsing course and 15 (51.7%) did not present any relapse. A statistically significant difference was present considering the length of the disease: 210 days (IQR: 161.25-255) for patients with a chronic relapsing course compared to 40 days (IQR: 30-75) for the other group (p < 0.0001). About the median IgE level in the 2 groups, a value about 10 time higher was found in children with chronic course compared to the other group (1,144 vs. 116 U/mL) with a statistically significant difference (p < 0.0001). Conclusion: Despite the study limitations, a significant correlation between higher IgE levels and chronic-relapsing course of the GCS can be assumed.

Occult Hepatitis B Virus Infections (Often with Human Herpesvirus 7 Co-Infection) Detected in Pityriasis rosea Patients: A Pilot Study

Background

The etiopathogenesis of Pityriasis rosea (PR), a papulo-squamous skin disease, remains elusive and hypothesized to be caused primarily by human herpesvirus (HHV) 6 or 7 or immune dysfunction.

Aims

The recent increasing incidences of hepatitis B virus (HBV) infections, including asymptomatic occult HBV infections (OBIs), in a densely populated city in India, prompted us to investigate whether PR patients (from varied socioeconomic and immune status) harbor the underlying HBV infections. These cases were also investigated for HHV 6 and 7 infections.

Materials and Methods

DNA from ethylenediaminetetraacetic acid blood samples from PR-diagnosed individuals (n = 13; mostly young adults) and healthy controls (n = 11) were subjected to virus gene-specific polymerase chain reactions (PCRs) for HBV and HHV 6 and 7. PCR products of expected length, when observed, were sequenced (bidirectional) using overlapping primers. Sequences were identified by NCBI BLAST and analyzed by multiple sequence alignment and phylogenetic studies. The blood samples were tested for HBsAg by EIA.

Results

In 5/13 PR samples, only HBV DNA (4/5 being HBsAg negative) was detected, providing first-time evidence that PR may be manifested in asymptomatic HBV carriers. 6/13 cases were HHV 7 (not HHV 6) DNA positive, providing confirmatory molecular genetic evidence for the first time of PR association with HHV 7 from India. Surprisingly, 5/6 HHV 7-positive PR cases were also HBV positive. Overall, 10/13 PR samples showed evidence of HBV infection. 8/13 were OBI, harboring at least one OBI-signature S protein mutation. All healthy controls were HBsAg EIA and PCR negative.

Conclusions

77% of PR patients presented the evidence of underlying HBV infection (genotype D2), suggestive of horizontal HBV transmission. This warrants for mass HBV vaccination. PR patients should be tested for underlying virus infections for appropriate therapy and management.

Pityriasis Rosea, Gianotti-Crosti Syndrome, Asymmetric Periflexural Exanthem, Papular-Purpuric Gloves and Socks Syndrome, Eruptive Pseudoangiomatosis, and Eruptive Hypomelanosis: Do Their Epidemiological Data Substantiate Infectious Etiologies?

Many clinical and laboratory-based studies have been reported for skin rashes which may be due to viral infections, namely pityriasis rosea (PR), Gianotti-Crosti syndrome (GCS), asymmetric periflexural exanthem/unilateral laterothoracic exanthem (APE/ULE), papular-purpuric gloves and socks syndrome (PPGSS), and eruptive pseudo-angiomatosis (EP). Eruptive hypomelanosis (EH) is a newly discovered paraviral rash. Novel tools are now available to investigate the epidemiology of these rashes. To retrieve epidemiological data of these exanthema and analyze whether such substantiates or refutes infectious etiologies. We searched for articles published over the last 60 years and indexed by PubMed database. We then analyzed them for universality, demography, concurrent patients, temporal and spatial-temporal clustering, mini-epidemics, epidemics, and other clinical and geographical associations. Based on our criteria, we selected 55, 60, 29, 36, 20, and 4 articles for PR, GCS, APE/ULE, PPGSS, EP, and EH respectively. Universality or multiple-continental reports are found for all exanthema except EH. The ages of patients are compatible with infectious causes for PR, GCS, APE/ULE, and EH. Concurrent patients are reported for all. Significant patient clustering is demonstrated for PR and GCS. Mini-epidemics and epidemics have been reported for GCS, EP, and EH. The current epidemiological data supports, to a moderate extent, that PR, GCS, and APE could be caused by infectious agents. Support for PPGSS is marginal. Epidemiological evidences for infectious origins for EP and EH are inadequate. There might be growing epidemiological evidence to substantiate or to refute our findings in the future.