Pityriasis Rosea

Pityriasis rosea (PR) is an acute self-limiting, papulosquamous inflammatory disease of uncertain etiology, characterized by multiple erythematous scaly patches over the back and trunk along the cleavage lines.
  • Mild constitutional symptoms. Mild pruritus.
  • Occasionally they are multiple and seen in 50% cases.
  • Wide spread pink papules
  • Appear 5-15 days after herald patch.
  • Vesicular, pustules and purpuric lesions are also seen.
  • These symptoms usually persist for 6-8weeks.
  • Spontaneously resolve. Heal with hypo/hyperpigmentation.
  • Inverse PR –lesions are seen in the axilla and inguinal areas.
  • Congestion of oral mucosa, nose.
  • Face, palms and soles usually spared.
  • The precise cause is not known.
  • Probably viral infections – HHV-7 &HHV-6 play a role.
  • Some drugs – Metronidazole, gold, barbiturates, clonidine, captopril, isotretinoin, imatinib can cause PR like eruption.
  • Cell mediated immunity may be involved with a presence of activated CD4 + / HLA – DR+ in the epidermal and dermal infiltrate in association with Langerhans cells(CD1a+).
  • Commonly seen in children and young adults (35 years).
  • Slight female predominance.
  • No racial predilection
  • Worldwide
  • Seasonal variations – peak in the spring and fall.

How is it diagnosed?

  • Initial lesion is a solitary skin to pink colored oval patch with collarette of scales.
  • It appears on the trunk and less often on the neck.
  • It is known as “Herald patch” or “Mother patch”. Papular lesions coalesce to form multiple pink colored oval patches with collarette scales.
  • Along the lines of cleavage on the posterior trunk and back.
  • Resemble “Christmas tree pattern”.

How is it treated?

  • Self-limiting condition
  • Counseling and reassurance
  • Anti-pruritic lotions
  • Topical medium potency corticosteroids
  • NBUVB therapy for 5-10 days
  • Natural sunlight
  • Oral antihistamines
  • Erythromycin –25-40 mg/kg/day in four divided doses for 14 days
  • Acyclovir 800 mg five times daily is also effective
  • Systemic steroids in severe cases

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