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Current Pediatric Reviews 2021Pityriasis rosea is a common acute, self-limited papulosquamous dermatosis that primarily affects children and young adults. The condition and its clinical variants may... (Review)
Review
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.
Topics: Adolescent; Anti-Bacterial Agents; Child; Female; Humans; Pityriasis Rosea; Pregnancy; Young Adult
PubMed: 32964824
DOI: 10.2174/1573396316666200923161330 -
American Family Physician Jan 2018Pityriasis rosea is a common self-limiting rash that usually starts with a herald patch on the trunk and progresses along the Langer lines to a generalized rash over the...
Pityriasis rosea is a common self-limiting rash that usually starts with a herald patch on the trunk and progresses along the Langer lines to a generalized rash over the trunk and limbs. The diagnosis is based on clinical and physical examination findings. The herald patch is an erythematous lesion with an elevated border and depressed center. The generalized rash usually presents two weeks after the herald patch. Patients can develop general malaise, fatigue, nausea, headaches, joint pain, enlarged lymph nodes, fever, and sore throat before or during the course of the rash. The differential diagnosis includes secondary syphilis, seborrheic dermatitis, nummular eczema, pityriasis lichenoides chronica, tinea corporis, viral exanthems, lichen planus, and pityriasis rosea-like eruption associated with certain medications. Treatment is aimed at controlling symptoms and consists of corticosteroids or antihistamines. In some cases, acyclovir can be used to treat symptoms and reduce the length of disease. Ultraviolet phototherapy can also be considered for severe cases. Pityriasis rosea during pregnancy has been linked to spontaneous abortions.
Topics: Anti-Bacterial Agents; Diagnosis, Differential; Eczema; Exanthema; Family Practice; Female; Humans; Male; Physical Examination; Pityriasis Rosea; Skin
PubMed: 29365241
DOI: No ID Found -
BMJ (Clinical Research Ed.) Oct 2015
Review
Topics: Child; Drug Eruptions; Female; Humans; Pityriasis Rosea; Pregnancy; Pregnancy Complications; Randomized Controlled Trials as Topic; Recurrence; Referral and Consultation; Remission, Spontaneous
PubMed: 26514823
DOI: 10.1136/bmj.h5233 -
Journal of the American Academy of... Dec 2021
Topics: Adult; Female; Gestational Age; Herpesvirus 6, Human; Herpesvirus 7, Human; Humans; Pityriasis Rosea; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Skin; Young Adult
PubMed: 34624414
DOI: 10.1016/j.jaad.2021.09.059 -
Cutis Oct 1995
Review
Topics: Adolescent; Adult; Child, Preschool; Diagnosis, Differential; Humans; Pityriasis Rosea; Prognosis
PubMed: 8575217
DOI: No ID Found -
The Israel Medical Association Journal... Aug 2022
Topics: Diagnosis, Differential; Humans; Pityriasis Rosea; Skin
PubMed: 35972001
DOI: No ID Found -
Journal Der Deutschen Dermatologischen... Jul 2022Pityriasis rosea (PR), a common skin disease in young adults, may adversely affects the course of pregnancy and the unborn child. (Review)
Review
BACKGROUND AND OBJECTIVE
Pityriasis rosea (PR), a common skin disease in young adults, may adversely affects the course of pregnancy and the unborn child.
PATIENTS AND METHODS
Data from forty-six pregnant women with PR seen in the dermatological university clinic between 2003 and 2018 were analyzed and compared with patient data (n = 53) from previously published studies to determine the incidence and risk factors for an unfavorable pregnancy outcome after PR infection.
RESULTS
Unfavorable pregnancy outcomes (defined as miscarriage, preterm delivery before week 37 of gestation, or birth weight < 2,500 g) were significantly less frequent in our study population than in a pooled cohort obtained from previously published studies (10.9 % vs. 39.6 %; P = 0.0012). Analysis of pooled data from our study and from previous studies revealed that the week of pregnancy at onset of PR was inversely associated with an unfavorable outcome (odds ratio [OR] = 0.937; 95 % CI 0.883 to 0.993). In addition, duration of PR (OR = 1.432; 95 % CI 1.129 to 1.827), additional extracutaneous symptoms (OR = 4.112; 95 % CI 1.580 to 10.23), and widespread rash distribution (OR 5.203, 95 % CI 1.702 to 14.89) were directly associated with unfavorable outcome.
CONCLUSION
In most cases, PR does not influence pregnancy or birth outcomes.
Topics: Cohort Studies; Female; Humans; Incidence; Infant, Newborn; Pityriasis Rosea; Pregnancy; Pregnancy Complications; Risk Factors; Young Adult
PubMed: 35616213
DOI: 10.1111/ddg.14763 -
American Family Physician Jan 2018
Topics: Eczema; Health Promotion; Humans; Patient Education as Topic; Pityriasis Rosea
PubMed: 29365248
DOI: No ID Found -
JAMA Dermatology Dec 2018
Topics: Humans; Pityriasis Rosea; Skin
PubMed: 30383122
DOI: 10.1001/jamadermatol.2018.3290 -
American Family Physician Jan 2004Pityriasis rosea is a common, acute exanthem of uncertain etiology. Viral and bacterial causes have been sought, but convincing answers have not yet been found.... (Review)
Review
Pityriasis rosea is a common, acute exanthem of uncertain etiology. Viral and bacterial causes have been sought, but convincing answers have not yet been found. Pityriasis rosea typically affects children and young adults. It is characterized by an initial herald patch, followed by the development of a diffuse papulosquamous rash. The herald patch often is misdiagnosed as eczema. Pityriasis rosea is difficult to identify until the appearance of characteristic smaller secondary lesions that follow Langer's lines (cleavage lines). Several medications can cause a rash similar to pityriasis rosea, and several diseases, including secondary syphilis, are included in the differential diagnosis. One small controlled trial reported faster clearing of the exanthem with the use of erythromycin, but the mechanism of effect is unknown. Resolution of the rash may be hastened by ultraviolet light therapy but not without the risk of hyperpigmentation. Topical or systemic steroids and antihistamines often are used to relieve itching.
Topics: Adult; Age Distribution; Anti-Inflammatory Agents; Biopsy; Child; Diagnosis, Differential; Female; Histamine H1 Antagonists; Humans; Incidence; Male; Pityriasis Rosea; Seasons; Sex Distribution; Ultraviolet Therapy
PubMed: 14727822
DOI: No ID Found