Pityriasis Rosea

Husein Oozeerally

Pityriasis rosea

• Originally described by Camille• Melchior Gibert in 1860

• Pityriasis: fine scales• Rosea: rose coloured or pink• Benign Self limiting but associated with

increased miscarriage in first 15 wks of pregnancy

Pityriasis Rosea

• 2 % of OP visits • F>M• Children and young adults (10-35yr) • 0.15% prevalence • No racial variation (lesion colour)• Seasonal outbreaks and climatic variation • Institutional outbreaks

Pityriasis Rosea

• Uncertain cause

• Possible viral trigger– HHV 6 HHV 7– Not contagious

• Life long immunity after outbreak

Initially….

• Prodromal symptoms– Malaise – Headache– Mild constitutional symptoms– Respiratory infection in 69%

Then..

• “Herald patch”– Large (2 - 10cm) – Isolated– Single or multiple– Oval– Pink– Scaly– Central clearing occasionally (mimic tinea)

• Cluster of small oval spots (mimic acne)• Location abdomen (occn armpit)

Images

5 to 10 days later

• Smaller lesion appear on the body

• Trunk (sometimes thighs)

• Occasionally on face, palms and soles– African american boys– Termed inverse pityriasis

Progression

• Small round papules

• > enlarge to1-2cm ovals

• Scaly surface

• Raised or flat

• Hyper or hypo pigmented

• Run along dermatomal lines/ribs giving Christmas tree distribution

4 to 6 weeks

• Begins to fade

• Lasts average 2 - 3 months

Differential

• Viral Exanthems

• Measle like drug eruptions

• Secondary syphilis

• Tinea (KOH test negative)

• Guttate psoriasis

Diagnosis

• Experienced Clinician!!!

• A biopsy of lesion show erthrocytes with dermal papillae and dyskeratotic cells within the dermis

Management

No treatment but…….

Symptom relief from itching

Avoided soap

Oral erythromycin

UVB light (used in the first week)may hasten the disappearance

The END

• Summary– Common– Benign – Self limiting (no tx)

References

• Atlas of Pedistric Physical Diagnosis Zitelli 5 ed

• Emedicine Medscape www