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Clinical and histopathological findings in pustular psoriaform dermatitis (pityriasis rosea) in pigs.
Three cases of pustular psoriaform dermatitis (pityriasis rosea) in pigs were clinically and histopathologically examined. Grossly, the affected skin was characterized by multiple, circumscribed lesions. Three pigs were the descendants derived from the same Landrace boar. Skin lesions expanded centrifugally to became ring-shaped plaques. There were no abnormal values in hematological and serum biochemical profiles. Histopathologically, the epidermis showed remarkable thickening. The dermal lesions were characterized by a prominent component of superficial and deep perivascular infiltration of eosinophils. Dilatation of microvasculature was accompanied with congested vessels. These results revealed that the etiology of pustular psoriaform dermatitis in pigs was associated with a hereditary predisposition derived from the specific boars. This dermatosis is histopathologically characterized by microcirculatory disturbances with infiltration of abundant eosinophils.
Pityriasis rosea--a virus-induced skin disease? An update.
Pityriasis rosea (PR) is an acute, inflammatory skin disease of unknown cause. Clinical and experimental findings indicate an infectious etiology of PR. Various infectious agents including viruses have been proposed as causative agents and their presence in PR samples has been extensively investigated. Recently, human herpesvirus 7 was linked to PR, but contradictory findings have been reported by various investigators. Here, we describe the features of PR that suggest an infectious cause and review the data from viral studies in PR reported in the literature. In addition, we present a pathogenetic model of PR which may be helpful in planning and evaluating studies for the search of a putative PR-associated virus. Based on the current state of knowledge, none of the known viruses could, so far, be conclusively associated with PR.
Dyskeratotic degeneration of epidermal cells in pityriasis rosea: light and electron microscopic studies.
We studied biopsies from twenty-nine patients with pityriasis rosea. All specimens showed features of subacute or chronic dermatitis as previously reported, but sixteen cases (55%) had dyskeratotic cells within the epidermis. Ultrastructurally, these cells contained an aggregation of tonofilaments, many vacuoles and intracytoplasmic desmosomes. Previously, only non-specific histological changes had been described in pityriasis rosea, but the presence of dyskeratotic cells seems to be a significant feature.
Effect on quality of life in patients with pityriasis rosea: is it associated with rash severity?
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 (gamma(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.
Case clustering in pityriasis rosea: support for role of an infective agent.
One hundred and twenty-six cases of pityriasis rosea seen over two years in north Staffordshire were analysed for clustering in time and space. A statistically significant degree of clustering was found; this was evident among female patients considered separately but not among male patients. The incidence of the condition was higher in patients working in, or attending, educational establishments. These findings support the hypothesis that pityriasis rosea is caused by an infective agent. A search for an infective organism and a transmission mechanism now seems justifiable.
Cytolytic degeneration of keratinocytes adjacent to Langerhans cells in pityriasis rosea (Gibert).
Unique cytolytic degeneration of keratinocytes adjacent to Langerhans cells was observed in five cases of pityriasis rosea (Gilbert). In the cytolytic area, the normal keratinocyte structures were absent except for free ribosomes. In addition, a similar cytolytic part of a keratinocyte was enveloped by the elongated dendrites of the Langerhans cell and was detected within its cytoplasm. The significance of these findings is discussed with respect to anticytoplasmic antibodies in the sera of patients with pityriasis rosea.
Immunohistologic studies in pityriasis rosea. Evidence for cellular immune reaction in the lesional epidermis.
Biopsy specimens of the skin lesions of pityriasis rosea obtained from 15 patients were studied. Characteristic histologic changes were composed of focal intercellular edema, epidermotropism of mononuclear cells often associated with the formation of focal intraepidermal collections of mononuclear cells, and of a perivascular lymphohistiocytic cell infiltration in the superficial dermis. Immunologic analysis using monoclonal antibodies showed that large numbers of lymphoid cells in the perivascular infiltrate reacted with anti-pan-T-cell, anti-helper-inducer subset, and anti-HLA-DR monoclonal antibodies, while the epidermotropic mononuclear cells consisted of helper-inducer cells or suppressor-cytotoxic cells without any predominance pattern. In addition to epidermal Langerhans' cells, some of the dermal infiltrating cells were reactive with monoclonal antibody OKT6. Moreover, there was localized expression of HLA-DR antigen on the keratinocytes. We think that cellular immune reactions are taking place in the lesional epidermis of pityriasis rosea.
Oral lesions in pityriasis rosea.
Oral lesions are not commonly reported with pityriasis rosea (PR). We encountered a patient with clinical and histologic evidence of PR who developed aphthous ulcer-like oral lesions on the buccal mucosa, palate, and tongue. The oral lesions resolved concomitantly with the patient's skin lesions. The previous literature reports a wide variety of oral lesions in association with PR, but few dermatologists, to our knowledge, are aware of such an occurrence.
Collarette scaling in pityriasis rosea demonstrated by digital epiluminescence dermatoscopy.
Collarette scaling is a characteristic sign in pityriasis rosea. The use of digital epiluminescence dermatoscopy is proposed to assist in the recognition of this sign as this technique can magnify the lesions, eliminate other epidermal changes, and demonstrate the morphology and direction of scaling.
Immunological studies of pityriasis rosea (Gibert).
In order to elucidate the immunological mechanism in the pathogenesis of pityriasis rosea, immunofluorescent studies were performed on sera obtained from forty patients with this disease. Antibodies against the cytoplasm of normal human epidermal cells were demonstrated in the sera of all patients. The antibody titer showed a tendency to increase within 3 weeks after onset of secondary eruptions and then to decrease gradually until the period of recovery. The immunoglobulin class was determined to be IgM. Furthermore, by the direct immunofluorescent technique, deposits of IgM in the epidermal cells of skin lesions were demonstrated in 3 of 6 herald lesions and in 1 of 4 secondary eruptions. It is suggested that anti-cytoplasmic antibodies produced by some unknown cause may induce the development of secondary eruptions of this disease.
[Benign familial chronic pemphigus and pityriasis rosea. Clinical aspects and histology of the coexistence of both dermatoses].
We report the course of benign familial pemphigus (Hailey-Hailey disease) in a 45-year-old woman. While this condition was in remission the patient started to suffer from pityriasis rosea. A biopsy of this coexisting dermatosis revealed the typical features of Hailey-Hailey disease (suprabasal acantholysis) and of pityriasis rosea within the same lesion.
Association of pityriasis rosea with human herpesvirus-6 and human herpesvirus-7 in Taipei.
BACKGROUND AND PURPOSE: Pityriasis rosea (PR) is a common papulosquamous skin disease with unknown etiology. The possible relationship of PR with human herpesvirus infection (HHV) has been extensively studied. This study used the polymerase chain reaction (PCR) to investigate the presence of human herpesvirus 6 and 7 (HHV-6 and HHV-7) in 41 PR patients from two hospitals in Northern Taiwan. The epidemiologic features of PR in patients were also studied. METHODS: A total of 41 PR patients (11 males, 30 females) were enrolled in this study from April 1999 to March 2000. PCR of skin biopsy specimens from 24 PR patients was used to identify the existence of HHV-6 and HHV-7. Viral culture from PR biopsy specimens was also performed. Blood from these patients was sampled for Venereal Disease Research Laboratory tests. Skin biopsies from 20 age- and sex-matched controls with other skin diseases were also subjected to PCR study. RESULTS: The ages of the 41 PR patients ranged from 8 to 62 years. An increased incidence (17/41) of PR episodes was observed during the spring. Both HHV-6 and HHV-7 DNA was below the limit of detection in all biopsy specimens from patients and healthy controls. Viral culture for HHV was negative in all patients. CONCLUSION: The epidemiologic features of PR in this series are comparable to other studies except for an exaggerated female predominance (male:female ratio 1:2.7). Our data indicate a lack of association between HHV-6 and HHV-7 infection and PR.
Pityriasis rosea. Viral complement fixation studies.
Eleven patients were seen for pityriasis rosea and underwent acute and convalescent viral complement fixation tests for several respiratory viruses and Mycoplasma. Several patients (6/11) gave a history of antecedent upper respiratory illness; however, no significant rise in titer was seen on any of the complement fixation tests.
Prospective case-control study of chlamydia, legionella and mycoplasma infections in patients with pityriasis rosea.
A double-blind placebo-controlled trial reported the benefit of erythromycin in treating pityriasis rosea (PR), a postulated mechanism being the eradication of bacteria susceptible to erythromycin. The aim of this study was to investigate the association between PR and Chlamydia pneumoniae, C. trachomatis, Legionella longbeachae, L. micdadei, L. pneumophila, and Mycoplasma pneumoniae infections. We recruited 13 patients aged seven to 46 years (mean: 26.8 years) diagnosed to have PR in a primary care setting in 18 months. Lesional histopathology was arranged for atypical cases. Clotted blood was collected at initial presentation and four weeks later. Controls were 13 paired age-and-sex-matched patients requiring blood collection for non-dermatological diseases. Serology tests were performed in parallel but were read "blinded" on the acute and convalescent specimens of patients and the control subjects. The serology profiles were not diagnostic of active infection by any of the bacteria studied for all 13 patients. Two patients had four-fold increase in IgG titres against C. pneumoniae, with IgM being negative. Two patients had IgM detectable against L. pneumophila serotype 6 and M. pneumoniae respectively, with no significant rise of the specific IgG. These patients had no symptom or sign of chest infection. The seroprevalence and IgG titres of the study patients for the bacteria investigated were insignificantly different from those of control subjects. We conclude that the bacteria investigated in this study do not play a significant role in the pathogenesis of PR. We believe that anti-inflammatory and immunomodulatary effects might contribute towards the action of erythromycin, if any, in PR.
Treatment of pityriasis rosea with UV radiation.
Twenty patients with symptomatic and extensive pityriasis rosea were treated with unilateral UV-B phototherapy in a bilateral comparison study. Five consecutive daily erythemogenic exposures resulted in substantially decreased pruritus and extent of disease greater than that on the untreated side in approximately 50% of the patients. Therapy seems to be most beneficial to patients receiving treatment within the first week of the eruption.