PITYRIASIS ROSEA
 
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PITYRIASIS ROSEA

 

DEFINITION:

A cutaneous disorder characterized by a herald patch preceding a widespread symmetrical papular eruption.

EPIDEMIOLOGY:

  • incidence: ?
  • age of onset:
    • peak age 15-40 years
  • risk factors:
    • F > M

PATHOGENESIS:

1. Background

  • a mild inflammatory exanthem of unknown etiology
  • a viral etiology has been suggested but is unproven
  • may be a pityriasis rosea-like rash as a reaction to:
    • arsenicals, barbiturates, bismuth, captopril, clonidine, gold, hydrochloride
  • papular pityriasis rosea is an uncommon variant presenting in black children less than 5 years of age
  • a prodrome of mild constitutional symptoms may precede the onset of the rash (fever, malaise, pharyngitis, arthralgia, headache)

CLINICAL FEATURES:

1. Cutaneous Manifestations

1. Herald or Mother Patch

  • a solitary round or oval pink lesion with a raised border and fine adherent scales around the margin
  • may persist for a week or more then involutes as the suc-ceeding lesions begin to appear
  • usually found on the trunk but may occur anywhere
  • vary from 1-10 cm. in diameter

2. Pityriasis Rosea

  • appears 5-10 days after the appearance of the Herald Patch
  • round or oval, slightly raised, salmon-coloured papular & macular lesions
  • usually <1 cm. in diameter with the long axis of each lesion aligned with the cutaneous cleavage line giving a Christmas-tree pattern
  • at first each lesion is discrete but then may become confluent
  • each lesion is covered with a fine scale which initially gives the skin a crinkly appearance but then desquamates leaving a collarette scale around each lesion
  • usually generalized affecting chiefly the trunk but may be located to certain areas (neck, axillae, proximal limbs, groin, thighs) and rarely to others (eyelids, scalp, penis, mucous membranes)
  • lasts from 3-8 weeks then disappears spontaneously

INVESTIGATIONS:

1. Skin Biopsy

  • mild inflammatory changes (i.e., edema) of the dermis and epidermis
  • mild acanthosis, focal parakeratosis, spongiosis

MANAGEMENT:

1. Pityriasis Rosea

  • ultraviolet B (UVB) therapy
  • bland emollients to scales

2. Pruritis

  • lubricating lotion with menthol and phenol
  • nonfluorinated topical corticosteroid lotions or creams
  • oral antihistamines

 

 

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