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