Pityriasis Rosea

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.

Adverse cutaneous drug reactions (ACDRs) are common in clinical practice and occur in about 5% of antipsychotic-treated patients. Most ACDRs are benign, but a small percentage of them are serious and life threatening. Pityriasis rosea (PR)-like eruption is a common cutaneous adverse reaction related to many drugs. Clozapine, a complex neurotransmitter receptor-binding in antipsychotic agent, is usually used for treatment-resistant schizophrenia. Clozapine-related ACDRs have been reported frequently, but clozapine-induced PR-like eruption has been reported once in the literature. We report a 54-year-old male patient with chronic schizophrenia who had received clozapine for 28 days and developed generalized skin rashes, high fever, and elevated values in liver function tests. His clozapine was immediately discontinued. He received acute managements with steroid and antihistamine, and his symptoms were relieved after treatment. This case report can be used to remind clinicians of keeping in mind the potential of clozapine-associated ACDRs.

Pityriasis rosea (PR) is a frequently occurring, worldwide self-limiting skin eruption affecting mainly young adults. Its cause remains unknown. However, its occurrence as family or household outbreaks, the very rare occurrence of second attacks and the course of the disease with a primary large lesion followed by secondary dissemination strongly implicate a viral agent . Picornaviruses are small RNA viruses and are the organism most likely to be responsible for this disease since the ultrastructure of PR keratinocytes [2] and cultures of cells inoculated with scale suspensions of PR both demonstrate the presence of picornavirus-like particles . To study the role of picornaviruses in PR pathogenesis, we undertook a study of skin PR specimens using PCR and in situ hybridization (ISH) with consensus probes of picornaviruses.

increase in androgen receptor levels or their distribution between lesional and normal skin. In the present study, the expression of androgen receptors within lesional skin was not increased. Our findings cannot rule out the possibility of an endocrine influence at the microvascular level and we believe that unopposed androgenic stimulation might still contribute to the pathogenesis of rosacea.

Pityriasis rosea is a distinct papulosquamous skin eruption that has been attributed to viral reactivation, certain drug exposures or rarely, vaccination. Herein, we reported a clinicopathlogically typical case of pityriasis rosea that developed after the H1N1 vaccination. With a global H1N1 vaccination program against the pandemic H1N1 influenza, patients should be apprised of the possibility of such rare but benign skin reaction to avoid unnecessary fear. Furthermore, a brief review of the current reported skin adverse events related to the novel H1N1 vaccination in Taiwan is presented here.

Recent controversies on the etiology, diagnosis and treatment have led to increased interest in pityriasis rosea (PR). We review these aspects of the disease. PR is universal. The incidence is around 0.68 per 100 dermatological patients, or 172.2 per 100,000 person-years. The prevalence in people aged between 10 and 29 years is 0.6%. The male to female ratio is around 1: 1.43. Evidence on seasonal variation is conflicting, but there is no evidence that the incidence is dependent on mean air temperature, mean total rainfall, or mean relative humidity. Spatial-temporal and temporal clustering of cases of PR has been reported. The association of PR with human herpesvirus-7 infection is still controversial. Owing to the extreme high sensitivities of sequence-based detection methods such as polymerase chain reaction, novel criteria should be applied to evaluate the evidence. There is no evidence that PR is associated with other viral or bacterial infections. The role of autoimmunity in PR warrants further investigations. Many patients with PR have one or more atypical features. Application of validated diagnostic criteria may be helpful for atypical cases. The efficacy of macrolides, including erythromycin, in PR is still under evaluation. There is no evidence that antiviral agents are effective. The efficacies of ultraviolet radiotherapy and systemic corticosteroids are not well established. In managing a patient with PR, we should concentrate more on how the eruption is affecting the quality of life, i.e. the illness, rather than the extent and severity of the eruption, i.e. the disease.

Pityriasis Rosea (PR) is a self-limiting papulo-squamous disorder characterized in its typical form by sudden onset of a larger scaly plaque (herald plaque), followed by multiple, bilateral smaller scaly lesions of oval or round shape which follow Langer's lines of cleavage on the trunk and proximal parts of extremities.[1] However, not all patients of PR present with typical morphology and distribution. Currently accepted hypothesis that the cause of this disease are human herpesvirus: HHV-6 and HHV-7.
A severe pityriasis rosea during the first 20 weeks of pregnancy may lead to an increased risk of abortion, premature delivery, even fetal demise. Neonatal hypotonia, weak motility, and hyporeactivity were noted
Presented case of 25 year old patient in the first trimester of pregnancy with the typical image of a pityriasis rosea. She was born at the correct time a healthy baby.

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. Conc...

Pityriasis rosea (PR) is a relatively common disease although its aetiology has not yet been identified. It occurs worldwide and there is no racial susceptibility factor. It usually affects teenagers and young adults between 10 and 35 years of age. Typical PR is much easier to diagnose than the rare atypical forms. We report a rare case of vesicular PR in a black woman who had vesicular lesions limited to her palms and soles in addition to regular typical lesions. We devised an efficient oral erythromycin treatment for this patient.

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.

Introduction. Pityriasis rosea (PR) is an exanthematous disease related to human herpesvirus- (HHV-) 6/7 reactivation. The network of mediators involved in recruiting the infiltrating inflammatory cells has never been studied.Object. To investigate the levels of serum cytokines, growth factors, and chemokines in PR and healthy controls in order to elucidate the PR pathogenesis.Materials and Methods. Interleukin- (IL-) 1, IL-6, IL-17, interferon- (IFN-)γ, tumor necrosis factor- (TNF-)α, vascular endothelial growth factor (VEGF), granulocyte colony stimulating factor (G-CSF), and chemokines, CXCL8 (IL-8) and CXCL10 (IP-10), were measured simultaneously by a multiplex assay in early acute PR patients’ sera and healthy controls. Subsequently, sera from PR patients were analysed at 3 different times (0, 15, and 30 days).Results and discussion. Serum levels of IL-17, IFN-γ, VEGF, and IP-10 resulted to be upregulated in PR patients compared to controls. IL-17 has a key role in host defense...

‫ﮔﺮﮔﺎن‬ ‫ﭘﺰﺷﮑﯽ‬ ‫ﻋﻠﻮم‬ ‫داﻧﺸﮕﺎه‬ ‫ﻋﻠﻤﯽ‬ ‫ﻣﺠﻠﻪ‬ / ‫ﺑﻬﺎر‬ 1387 / ‫دوره‬ 10 / ‫ﺷﻤﺎره‬ 1 ) ‫ﭘﯽ‬ ‫درﭘﯽ‬ 25 / ( ‫ﺻﻔﺤﺎت‬ 41 ‫ﺗﺎ‬ 45 ‫ﺗﺤﻘﯿﻘﯽ‬ ‫ﺗ‬ ‫ﺄ‬ ‫ارﯾﺘﺮوﻣﺎﯾﺴﯿﻦ‬ ‫ﺛﯿﺮ‬ ‫درﻣﺎن‬ ‫در‬ ‫ﺑ‬ ‫ﯿ‬ ‫ﻤﺎر‬ ‫ي‬ ‫ﭘ‬ ‫ﯿ‬ ‫روزه‬ ‫ﺘﺮﯾﺎزﯾﺲ‬ ‫آ‬ ) ‫ﭘﻼﺳﺒﻮ‬ ‫ﺑﺎﻟﯿﻨﯽ‬ ‫آزﻣﺎﯾﯽ‬ ‫ﮐﺎر‬ ‫ﯾﮏ‬ -‫دوﺳﻮﮐﻮر‬ ‫ﮐﻨﺘﺮل‬ ( ‫دﻫﻘﺎن‬ ‫ﻣﺤﻤﺪ‬ ‫دﮐﺘﺮ‬ * 1 ‫ﺑﻬﻨﺎم‬ ‫ﻧﺎﺻﺮ‬ ، ‫ﭘﻮر‬ 2 ‫اﻟﺒﺮزي‬ ‫ﻧﺎزﯾﻼ‬ ‫دﮐﺘﺮ‬ ، 3 1 -‫ﮔﺮوه‬ ‫اﺳﺘﺎدﯾﺎر‬ ‫ﺑﯿﻤﺎري‬ ‫آﻣﻮزش‬ ‫ﻫﺎي‬ ‫ﭘﺰﺷﮑ‬ ‫ﻋﻠﻮم‬ ‫داﻧﺸﮕﺎه‬ ‫ﭘﻮﺳﺖ‬ ‫ﯽ‬ ‫ﮔﺮﮔﺎن‬ . 2 -‫آﻣﺎ‬ ‫ارﺷﺪ‬ ‫ﮐﺎرﺷﻨﺎس‬ ‫ز‬ ‫ر‬ ‫ﯾ‬ ‫ﺴﺘ‬ ، ‫ﯽ‬ ‫ﻫ‬ ‫ﻋﻀﻮ‬ ‫ﯿﺄ‬ ‫ﻋﻠﻤ‬ ‫ت‬ ‫ﯽ‬ ‫ﭘﺰﺷﮑ‬ ‫ﻋﻠﻮم‬ ‫داﻧﺸﮕﺎه‬ ‫ﯽ‬ ‫ﮔﺮﮔﺎن‬ . 3 -‫ﮔﺮوه‬ ‫اﺳﺘﺎدﯾﺎر‬ ‫ﻋﺮوق‬ ‫و‬ ‫ﻗﻠﺐ‬ ‫ﭘﺰﺷﮑ‬ ‫ﻋﻠﻮم‬ ‫داﻧﺸﮕﺎه‬ ‫ﯽ‬ ‫ﮔﺮﮔﺎن‬ .

A number of quantitative models including linear discriminant analysis, logistic regression, k nearest neighbor, kernel density, recursive partitioning, and neural networks are being used in medical diagnostic support systems to assist human decision-makers in disease diagnosis. This research investigates the decision accuracy of neural network models for the differential diagnosis of six erythamatous-squamous diseases. Conditions where a hierarchical neural network model can increase diagnostic accuracy by partitioning the decision domain into subtasks that are easier to learn are specifically addressed. Self-organizing maps (SOM) are used to portray the 34 feature variables in a two dimensional plot that maintains topological ordering. The SOM identifies five inconsistent cases that are likely sources of error for the quantitative decision models; the lower bound for the diagnostic decision error based on five errors is 0.0140. The traditional application of the quantitative models cited above results in diagnostic error levels substantially greater than this target level. A two-stage hierarchical neural network is designed by combining a multilayer perceptron first stage and a mixture-of-experts second stage. The second stage mixture-of-experts neural network learns a subtask of the diagnostic decision, the discrimination between seborrheic dermatitis and pityriasis rosea. The diagnostic accuracy of the two stage neural network approaches the target performance established from the SOM with an error rate of 0.0159.

Introduction: Pityriasis rosea is an acute and self-limited exanthem first 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, a health worker, attended the emergency room due to the onset of symptoms that began 20 days earlier with the appearance of punctiform lesions 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. ...

Pityriasis rosea, a self-limited exanthematous disease of unknown etiology, is a fairly common exanthem encountered by dermatology nurses and nurse practitioners. Their special roles in diagnosis, symptomatic relief, care for patients with atypical rash, patient education, and counseling are described.

Background It is unknown how the quality of life (QOL) is affected in patients with pityriasis rosea (PR), and whether it is related to rash severity. Methods We constructed a valid and reliable Cantonese version of the Dermatology Life Quality Index (DLQI). We recruited patients with PR, with atopic dermatitis and with acne vulgaris, and controls of the same sex and comparable age. We applied the DLQI and the Pityriasis Rosea Severity Score (PRSS) to the patients with PR, the DLQI and the SCORing Atopic Dermatitis Index (SCORAD) to the controls with atopic dermatitis, and the DLQI and the Leeds Acne Grading System (LAGS) to the controls with acne vulgaris. Results Total DLQI scores of the 22 patients with PR (mean: 6.36, SD: 5.79) were significantly lower than those of the 22 controls with atopic dermatitis (mean: 12.00, SD: 5.38) (P = 0.021), but were insignificantly different from those of the 22 controls with acne vulgaris (mean: 6.86, SD: 4.53) (P = 0.57). Correlation between the total DLQI and PRSS scores was weak (γ s = +0.19) and insignificant (P = 0.40). All six DLQI parameters were insignificantly correlated with the PRSS scores. In contrast, the total DLQI scores and most of the DLQI parameters were strongly correlated with the rash severity scores for the control subjects. Significantly more patients with PR have concerns regarding disease etiology and infectivity. Conclusions The QOL of the patients with PR was significantly less affected than that for the patients with atopic dermatitis, but was insignificantly different from the patients with acne vulgaris. Unlike atopic dermatitis and acne vulgaris, the effects on the QOL in PR are insignificantly correlated with rash severity. These results bear important implications on clinical management.

To examine the proposed association between pityriasis rosea and human herpesvirus 7 (HHV-7). A retrospective cross-sectional survey. University medical center in Switzerland. Thirteen patients with pityriasis rosea and 14 persons with normal skin (control subjects). Detection of HHV-7-specific DNA sequences and antigen (85-kd phosphoprotein [pp85]) by nested polymerase chain reaction and immunohistochemical analysis, respectively. Human herpesvirus 7 DNA sequences and expression of the HHV-7-specific immunodominant pp85 antigen were found in 1 (8%) of 13 lesional skin biopsy specimens of pityriasis rosea. The prevalence of HHV-7 DNA sequences and antigens is even slightly lower in lesional skin of patients with pityriasis rosea than in clinically and morphologically normal skin of 14 control persons, in 2 of whom (14%) HHV-7 DNA sequences and antigens could be detected. The low detection rate of HHV-7 DNA sequences and antigens argues strongly against a causative role for HHV-7 in the pathogenesis of pityriasis rosea.