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PubMed2004

Pityriasis rosea--evidence for and against an infectious aetiology.

Pityriasis rosea, first named as such in 1860, probably holds the longest record for an exanthem suspected to be associated with an infection but for which an exact cause has not been found. The distinctly programmed clinical course, the lack of recurrence for most patients, and the presence of temporal case clustering provide the strongest evidence to support an infectious aetiology. Further support comes from seasonal variation and the association with respiratory tract infections, the unfavourable social and economic background of cases, and a history in some cases of contact with patients with pityriasis rosea. The apparent therapeutic efficacy of several treatment modalities does not provide strong evidence for or against an infectious aetiology. The roles of human herpesvirus 7 and to a lesser extent human herpesvirus 6 remain controversial. There exists reasonable evidence that pityriasis rosea is not associated with cytomegalovirus, Epstein-Barr virus, parvovirus B19, picornavirus, influenza and parainfluenza viruses, Legionella spp., Mycoplasma spp. and Chlamydia spp. infections. Evidence is also unsubstantiated as yet for alternative aetiological hypotheses such as autoimmunity, atopy, and genetic predisposition.

Bacterial Infections↗

PubMed2002

Pityriasis rosea is associated with systemic active infection with both human herpesvirus-7 and human herpesvirus-6.

Pityriasis rosea is a common skin disease that has been suspected to have a viral etiology. We performed nested polymerase chain reaction to detect human herpesvirus-7, human herpesvirus-6, and cytomegalovirus DNA in lesional skin, nonlesional skin, peripheral blood mononuclear cells, serum, and saliva samples isolated from 14 pityriasis rosea patients. Viral mRNA expression and virion visualization within lesional skin were studied by in situ hybridization and transmission electron microscopy, respectively. By nested polymerase chain reaction, human herpesvirus-7 DNA was present in lesional skin (93%), nonlesional skin (86%), saliva (100%), peripheral blood mononuclear cells (83%), and serum (100%) samples, whereas human herpesvirus-6 DNA was detected in lesional skin (86%), nonlesional skin (79%), saliva (80%), peripheral blood mononuclear cells (83%), and serum (88%) samples. By contrast, cytomegalovirus DNA was not detected in these tissues. Control samples from 12 healthy volunteers and 10 psoriasis patients demonstrated rare positivity for either human herpesvirus-7 or human herpesvirus-6 DNA in skin or serum. By in situ hybridization, infiltrating mononuclear cells expressing human herpesvirus-7 and human herpesvirus-6 mRNA were identified in perivascular and periappendageal areas in 100% and 75% pityriasis rosea skin lesions, respectively, compared to herpesviral mRNA positivity in only 13% normal skin and psoriasis skin controls. Transmission electron microscopy failed to reveal herpesviral virions in pityriasis rosea lesional skin. Nested polymerase chain reaction and in situ hybridization enabled detection of human herpesvirus-7 and human herpesvirus-6 in skin and other tissues isolated from patients with pityriasis rosea. These results suggest that pityriasis rosea is associated with systemic active infection with both human herpesvirus-7 and human herpesvirus-6.

Adolescent↗

PubMed1999

Pityriasis rosea is not associated with human herpesvirus 7.

OBJECTIVE: To examine the proposed association between pityriasis rosea and human herpesvirus 7 (HHV-7). DESIGN: A retrospective cross-sectional survey. SETTING: University medical center in Switzerland. PATIENTS: Thirteen patients with pityriasis rosea and 14 persons with normal skin (control subjects). MAIN OUTCOME MEASURES: Detection of HHV-7-specific DNA sequences and antigen (85-kd phosphoprotein [pp85]) by nested polymerase chain reaction and immunohistochemical analysis, respectively. RESULTS: 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. CONCLUSION: 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.

Adolescent↗

PubMed1995

Pityriasis rosea Gibert: detection of Legionella micdadei antibodies in patients.

Some epidemiological and clinical characteristics of Pityriasis rosea Gibert has led us to hypothesize that this disease may be the clinical manifestation of an infection caused by legionellas. We have thus tested the sera of 36 patients ill with Pityriasis rosea and 19 controls for Legionella pneumophila serogroup 1-6 and Legionella micdadei antibodies. These, who had the same age and sex distribution as study patients, were receiving treatment for other diseases in the same ward. Also tested were 200 sera from the voluntary blood donors from the same region as study patients. Legionella micdadei antibodies were detected in 12 (33.3%) Pityriasis rosea cases and in one (5.2%) control. They were significantly more common in Pityriasis rosea cases than in either controls or voluntary blood donor population. The findings to date encourage continued research into the causative relationship between the Legionella micddadei infection and the onset of Pityriasis rosea Gibert.

Antibodies, Bacterial↗

PubMedDate not supplied

Human herpesvirus 6 and 7 DNA in peripheral blood leucocytes and plasma in patients with pityriasis rosea by polymerase chain reaction: a prospective case control study.

An association between pityriasis rosea and human herpesvirus 7 (HHV-7) has been reported but remains controversial. The purpose of the present study was to investigate the association between HHV-6 and HHV-7 with pityriasis rosea. Fifteen patients aged 6-54 years with a diagnosis of pityriasis rosea and 15 age-matched controls were recruited. None of the patients had HHV-6 or HHV-7 DNA detected by polymerase chain reaction in the acute or convalescent plasma specimen. In the acute peripheral blood leucocytes specimen, 3 patients and one control had RHV-6 DNA detected (p=0.299; NS), while 7 patients and 5 controls had HHV-7 DNA (p=0.355; NS). Antibody to HHV-6 was detected in the acute specimen of 13 patients and 13 controls, while antibody to HHV-7 was found in all 15 of patients and controls. We thus found no evidence of recent HHV-6 or HHV-7 infection in patients with a diagnosis of pityriasis rosea.

Adolescent↗

PubMed2001

[Pityriasis rosea in secondary schools in Ouagadougou, Burkina Faso].

BACKGROUND: Pityriasis rosea is a spontaneously regressive benign erythematous squamous dermatosis. A better understanding of this condition in developing countries would be useful. PATIENTS AND METHODS: We conducted a cross section study based on one-day surveys in Ouagadougou, Burkina Faso, secondary schools. The stratified cluster sampling method described by Henderson was used. Six thousand pupils were examined to collect epidemiology and clinical data and to determine the presence of complications and results of complementary explorations performed. RESULTS: Thirty-six cases of pityriasis rosea were observed (0.6 p. 100). Prevalence was higher in children from an unfavorable social and economic background. A typical eruption was often observed with classical localizations and morphology in 86.1 p. 100 of the cases. Pruritus was often observed with an inaugural lesion (61.1 p. 100) predominantly on the upper limbs (54.6 p. 100) and the trunk (31.8 p. 100) measuring 1 to 3 cm. A typical second eruption was found in most cases, situated on the trunk (75 p. 100), distal portions of the limbs (64.4 p. 100), proximal portions of the limbs (33.3 p. 100) and the neck (30.5 p. 100). The eruption evolved for 1 week to 1 month in most cases (61 p. 100). In 55.5 p. 100 of the cases, therapeutic abstention was the rule. Secondary treatment-related complications occurred in 38.9 p. 100 of the cases. Stool studies generally demonstrate ameba cysts. Syphilis serology was negative. DISCUSSION: Our sampling technique in the secondary school setting provided a representative sample of the urban population of African cities. This work demonstrated the variability of prevalence by social and economic conditions and is in favor of an infections cause, demonstrating several similar features with other series reported in the literature. Generally, a stool study is not necessary and syphilis serology is negative in typical cases. Health care workers should be more aware of pityriasis rosea in order to avoid poorly adapted treatment.

Adolescent↗

PubMed1983

Failure to detect immune complexes in the secondary stage of pityriasis rosea.

Thirty-three patients with pityriasis rosea were studied with regard to the possible presence of circulating and cutaneously deposited immune complexes. The levels of circulating immune complexes, determined by a solid-phase C1q-binding assay, were not different from those of healthy control individuals. The levels were similar in samples obtained during the initial and during the remission stages of the disease. Cutaneous deposits of immunoglobulin and/or complement were found in only 5 of 33 patients. This study does not support of concept that circulating immune complexes are important for the development of the secondary skin lesions in pityriasis rosea.

Adolescent↗

PubMed2006

Use of high-dose acyclovir in pityriasis rosea.

BACKGROUND: The association of human herpesvirus 6 (HHV-6) and HHV-7 with pityriasis rosea suggests that systemic drugs directed against HHV may hasten recovery of patients with pityriasis rosea. OBJECTIVE: The purpose of this study was to verify the efficacy of oral acyclovir in the treatment of pityriasis rosea. METHODS: Eighty-seven consecutive patients were treated for 1 week with either oral acyclovir (800 mg 5 times daily) or placebo. In all patients, the time of lesion clearing and the number of new lesions appearing during treatment were recorded. RESULTS: On the 14th day of treatment, 79% of treated patients fully regressed compared with 4% of the placebo group. The lesions cleared in 18.5 days in treated patients and in 37.9 days in the placebo group. Clearance was achieved in 17.2 days in patients treated in the first week from onset and in 19.7 days in the patients treated later. On the 7th day, there were significantly fewer new lesions in patients treated in the first week than in those treated later. LIMITATIONS: This trial was neither randomized nor double blind. Objectivity was achieved by counting the lesions. CONCLUSION: Acyclovir may be effective in the treatment of pityriasis rosea, especially in patients treated in the first week from onset, when replicative viral activity of HHV is probably very high.

Acyclovir↗

PubMed2002

Atypical pityriasis rosea or psoriasis guttata? Early examination is the key to a correct diagnosis.

Pityriasis rosea is a self-limited, mild, inflammatory skin disease characterized by scaly lesions, possibly due to an unidentified infectious agent. It may occur at any age, but is seen most frequently in young adults. This paper reports a patient who presented with a skin condition which was initially diagnosed as pityriasis rosea; however, due to the persistence and change in appearance of the lesions, the diagnosis was later altered to psoriasis guttata. Changes in pityriasis rosea lesions over the course of the disease may make a correct diagnosis difficult, unless the patient is seen during the early stages of lesion formation. The final diagnosis in this case was of the rare variant known as pityriasis rosea irritata. This case highlights the importance of an excellent patient history in order to correctly diagnose the disease.

Adult↗

PubMed2003

Case clustering in pityriasis rosea: a multicenter epidemiologic study in primary care settings in Hong Kong.

OBJECTIVES: To investigate the epidemiology of pityriasis rosea in primary care settings in Hong Kong and to analyze for temporal clustering. DESIGN: Retrospective epidemiologic study. SETTING: Six primary care teaching practices affiliated with a university. Patients Forty-one patients with pityriasis rosea, 564 patients with atopic dermatitis (negative control condition), and 35 patients with scabies (positive control condition). METHODS: We retrieved all records of patients with pityriasis rosea, atopic dermatitis, or scabies diagnosed in 3 years. We analyzed temporal clustering by a method based on a regression model. RESULTS: The monthly incidence of pityriasis rosea is negatively but insignificantly correlated with mean air temperature (gamma s = -0.41, P =.19) and mean total rainfall (gamma s = -0.34, P =.27). Three statistically significant clusters with 7, 6, and 7 cases were identified (P =.03), occurring in the second coldest month in the year (February), the second hottest month (July), and a temperate month (April), respectively. For atopic dermatitis (negative control condition), the nonclustering regression model was selected by Akaike information criteria. For scabies (positive control condition), 1 cluster of 20 cases was detected (P =.03). CONCLUSIONS: Significant temporal clustering independent of seasonal variation occurred in our series of patients with pityriasis rosea. This may be indicative of an infectious cause.

Adolescent↗

PubMed1980

[Idiopathic eruptive macular pigmentation following pityriasis rosea. Presentation of two cases (author's transl)].

We describe two cases of acquired hyperpigmented macular eruption following pityriasis rosea. This condition is characterized by an eruption of discrete grayish macules on the trunk. On the back, the lesion are oval and their long axis follows the cutaneous liners. Similar features have been described by Runtova. The clinical type of this pigmented eruption is quite comparable to the cases recently described by Degos, Civatte and Belaïch under the title of "idiopathic eruptive macular pigmentation". Sometimes the "idiopathic" character of this pigmented eruption may be lacking, when a retrospective diagnosis of lichen planus or pityriasis rosea can be made. We think that the pigmentogenes pityriasis rosea should be included in the group of atypical pityriasis rosea. A survey of the literature allows to recognize some identical cases formerly reported under various titles. All these cases should be grouped together under the title of pigmentogenes pityriasis rosea.

Adult↗

PubMed2004

Atypical pityriasis rosea and Hodgkin's disease.

Pityriasis rosea (PR)-like eruptions have been associated with several neoplasms and drugs. These eruptions may be atypical. To date, the association of Hodgkin's disease with PR-like eruptions has rarely been reported. We report a 37-year-old patient with clinical lesions of PR-like, systemic symptoms and lymphadenopathies, who was subsequently diagnosed with Hodgkin's disease.

Adult↗

PubMed2004

Vesicular pityriasis rosea: response to erythromycin treatment.

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.

Administration, Oral↗

PubMed2002

Human herpes virus-like particles in pityriasis rosea lesions: an electron microscopy study.

BACKGROUND: In a previous study we detected virions with electron microscopy features of human herpes viruses in the supernatant of cocultured mononuclear cells from patients with acute pityriasis rosea. Because of their morphology and of polymerase chain reaction studies, we ascribed them to human herpes virus 7. OBJECTIVE: To find such virions in the lesional skin of pityriasis rosea patients. METHODS: Skin specimens from lesions of 21 patients with acute pityriasis rosea were examined by elecron microscopy. RESULTS: In 15 (71%) patients, human herpes virus particles in various stages of morphogenesis were detected. Mature enveloped virions appeared as typical human herpes virus virions, measuring about 160-200 nm in diameter and containing an electrodense cylindrical core, a capsid, an envelope with typical spikes and a very distinct tegument layer between the capsid and the envelope. They were very similar to those we reported in the supernatant of co-cultured circulating mononuclear cells from patients with pityriasis rosea. CONCLUSION: Our results confirm our previous findings and provides further evidence of a viral etiology for pityriasis rosea.

Herpesvirus 7, Human↗

PubMed1980

Pityriasis rosea in Nigerians.

One hundred thirty-eight Nigerian patients with pityriasis rosea were studied. Patients with the condition constituting 2.4% of all patients seen in two skin clinics in Northern Nigeria in a period of over three years. The proportional rate of pityriasis rosea parallels figures from other African studies, and is higher than values obtained in European series. Pyriasis rosea in Nigerians appears to be more florid and has a greater tendency to overstep the classic boundaries of distribution on the body, to affect the face and involve the oral cavity. The sex and age distribution was similar to European series, although some lowering of the age of onset of the condition was observed. No relationship between the frequency of pityriasis rosea and season was found.

Adolescent↗

PubMed1992

Tongue and cheek: oral lesions in pityriasis rosea.

Fifty-one consecutive patients with clinical findings and history consistent with pityriasis rosea underwent a complete oral examination to search for any concomitant oral lesions. One case was omitted from the statistical analysis because the results of a rapid plasma reagin test were positive. Of the fifty remaining cases, eight patients (16 percent) were noted to have various oral lesions, all of which were asymptomatic. These findings suggest that the actual incidence of oral lesions in pityriasis rosea may be higher than previously reported. A complete oral examination in a patient presenting with a papulosquamous eruption may be helpful in ascertaining the diagnosis of pityriasis rosea.

Adolescent↗

PubMed2005

Temporal case clustering in pityriasis rosea: a regression analysis on 1379 patients in Minnesota, kuwait, and diyarbakir, Turkey.

OBJECTIVE: To detect temporal case clustering in patients with pityriasis rosea in different geographic locations. DESIGN: Regression analysis of dates on which 1379 patients were diagnosed as having pityriasis rosea in 3 different geographic locations. The control data consisted of dates of diagnosis of patients with psoriasis in the same settings. SETTING: Dermatology clinics in Kuwait, Minnesota, and Diyarbakir, Turkey.Patients Patients with pityriasis rosea and psoriasis seeking care in the clinics. RESULTS: Three significant positive clusters (P = .005, P =.001, and P =.01, respectively) and 1 significant negative cluster (P<.001) were detected in these series of patients. No cluster was detected in 2 corresponding series of patients with psoriasis in Kuwait and Turkey. CONCLUSION: Temporal case clustering exists in pityriasis rosea.

Adolescent↗

PubMed1987

Pityriasis rosea in Lagos.

A recent 5-year period study of the incidence of pityriasis rosea among dermatologic outpatients was conducted at the Lagos University Teaching Hospital. Three hundred fifty-two patients with pityriasis rosea were seen. The average annual incidence was 4.8 per 100 dermatologic patients. Women predominated by a margin of 1.2:1.0. More than 91% of the patients were between the ages of 5 and 35 years, with a peak at ages 10-14. The incidence of the disease was significantly higher in the early part of the rainy season. No declining incidence was observed over the years. A blood picture of a leukopenia with relative lymphocytosis was observed early in the disease. Ampicillin, when consumed after the onset of the eruption, made the patient with pityriasis rosea clinically worse.

Adolescent↗