Pityriasis Rosea in Kaduna, North-West Nigeria: A 20-Year Experience.

BACKGROUND: Pityriasis rosea (PR) is an acute, self-limiting papulosquamous skin disease which predominantly affects children and young adults. Pityriasis rosea appears to be more common in West Africa. Reports about PR from northern Nigeria are few. OBJECTIVES: To present the relative prevalence, demographic and clinical characteristics of PR. METHODS: We conducted a retrospective review of records of consecutive patients attending two dermatology clinics in Kaduna, North-West Nigeria between September 2001 and November 2021. RESULTS: Of 39,037 patients, 922 (2.4%) presented with PR: Median age was 15 years (range 3 months to 63 years) and 24% < 10 years, 60% < 18 years, 87% < 30% years. 62% were female. In patients < 20 years, males were significantly more in number than females (69.6% vs. 60.9%, P = 0.007) while in those >20 years, females were more in number (39.1% vs. 30.4%, P = 0.007). The mean duration of disease at presentation was 14 days (range 1 - 240 days). Majority (60%) were seen during the rainy season. A herald patch was present in 67.8%, usually occurring 7 days before the main rash. The trunk was affected by the main rash in 94% while the neck and face were affected in 19.2% and 23.6%, respectively. Itching was reported by 80%. The classic disease constituted 80.2%. Oral involvement was rare. CONCLUSION: Pityriasis rosea is a common disease in Kaduna. It mostly affects children, adolescents and young adults. Clinical presentation is typical in the majority of patients. Rarely an atypical disease occurs. Oral involvement was rare.

CONTEXTE: Le pityriasis rosé (PR) est une dermatose papulosquameuse aiguë spontanément résolutive qui touche principalement les enfants et les jeunes adultes. Le pityriasis rosea semble être plus courant en Afrique de l'Ouest. Les rapports sur la RP du nord du Nigeria sont peu nombreux. OBJECTIFS: Présenter la prévalence relative, les caractéristiques démographiques et cliniques de la RP. METHODES: Nous avons effectué un examen rétrospectif des dossiers de patients consécutifs fréquentant deux cliniques de dermatologie à Kaduna, dans le nord-ouest du Nigeria, entre septembre 2001 et novembre 2021. RESULTATS: Sur 39 037 patients, 922 (2,4 %) ont présenté une RP : l'âge médian était de 15 ans (intervalle de 3 mois à 63 ans) et 24 % < 10 ans, 60 % < 18 ans, 87 % < 30 % ans. 62 % étaient des femmes. Chez les patients de < 20 ans, les hommes étaient significativement plus nombreux que les femmes (69,6 % contre 60,9 %, P = 0,007) tandis que chez ceux de > 20 ans, les femmes étaient plus nombreuses (39,1 % contre 30,4 %, P = 0,007) . La durée moyenne de la maladie au moment de la présentation était de 14 jours (fourchette de 1 à 240 jours). La majorité (60%) ont été observées pendant la saison des pluies. Un patch annonciateur était présent chez 67,8%, survenant généralement 7 jours avant l'éruption principale. Le tronc était touché par l'éruption principale dans 94 % tandis que le cou et le visage étaient touchés dans 19,2 % et 23,6 %, respectivement. Des démangeaisons ont été signalées par 80 %. La maladie classique constituait 80,2 %. L'atteinte orale était rare. CONCLUSION: Le pityriasis rosé est une maladie courante à Kaduna. Elle touche principalement les enfants, les adolescents et les jeunes adultes. La présentation clinique est typique chez la majorité des patients. Rarement une maladie atypique survient. L'atteinte orale était rare. Mots clés: Pityriasis rosé, Kaduna-Nigeria, Épidémiologie, Présentation clinique, Africains.

Manifestation of pityriasis rosea and pityriasis rosea-like eruptions after Covid-19 vaccine: A systematic review.

BACKGROUND: After introducing Covid-19 vaccines, a few side effects were reported, pityriasis rosea being one of them. Therefore, this study will systematically review its manifestation afteradministration. METHODS: Databases were searched, covering a timeline from December 1, 2019 to February 28, 2022. Data were independently extracted and accessed for bias. SPSS statistical software version 25 was used for appropriate inferential statistics. RESULTS: Thirty-one studies were included for data extraction after screening following the eligibility criteria. A total of 111 people were identified to have developed pityriasis rosea or pityriasis rosea-like eruptions after vaccination, out of which 36 (55.38%) were female. The average age of incidence was calculated to be 44.92 years, and 63 (62.37%) people presented after administration of the first dose. It was found popularly in the trunk area, either asymptomatically or with mild symptoms. Meantime the onset, was 8.58 days, and meantime it took to recover, was 6.44 weeks. CONCLUSION: The association between pityriasis rosea and pityriasis rosea-like eruptions after Covid-19 vaccines was established, but given the scarcity of studies, there is a need to conduct different clinical trials to confirm this association further and study the etiology and mechanism of the disease.

Cutaneous reactions after COVID-19 vaccination in Turkey: A multicenter study.

OBJECTIVES: In this study covering all of Turkey, we aimed to define cutaneous and systemic adverse reactions in our patient population after COVID-19 vaccination with the Sinovac/CoronaVac (inactivated SARS-CoV-2) and Pfizer/BioNTech (BNT162b2) vaccines. METHODS: This prospective, cross-sectional study included individuals presenting to the dermatology or emergency outpatient clinics of a total of 19 centers after having been vaccinated with the COVID-19 vaccines. Systemic, local injection site, and non-local cutaneous reactions after vaccination were identified, and their rates were determined. RESULTS: Of the 2290 individuals vaccinated between April 15 and July 15, 2021, 2097 (91.6%) received the CoronaVac vaccine and 183 (8%) BioNTech. Systemic reactions were observed at a rate of 31.0% after the first CoronaVac dose, 31.1% after the second CoronaVac dose, 46.4% after the first BioNTech dose, and 46.2% after the second BioNTech dose. Local injection site reactions were detected at a rate of 35.6% after the first CoronaVac dose, 35.7% after the second CoronaVac dose, 86.9% after the first BioNTech dose, and 94.1% after the second BioNTech dose. A total of 133 non-local cutaneous reactions were identified after the CoronaVac vaccine (2.9% after the first dose and 3.5% after the second dose), with the most common being urticaria/angioedema, pityriasis rosea, herpes zoster, and maculopapular rash. After BioNTech, 39 non-local cutaneous reactions were observed to have developed (24.8% after the first dose and 5% after the second dose), and the most common were herpes zoster, delayed large local reaction, pityriasis rosea, and urticaria/angioedema in order of frequency. Existing autoimmune diseases were triggered in 2.1% of the patients vaccinated with CoronaVac and 8.2% of those vaccinated with BioNTech. CONCLUSIONS: There are no comprehensive data on cutaneous adverse reactions specific to the CoronaVac vaccine. We determined the frequency of adverse reactions from the dermatologist's point of view after CoronaVac and BioNTech vaccination and identified a wide spectrum of non-local cutaneous reactions. Our data show that CoronaVac is associated with less harmful reactions while BioNTech may result in more serious reactions, such as herpes zoster, anaphylaxis, and triggering of autoimmunity. However, most of these reactions were self-limiting or required little therapeutic intervention.

Coronavirus disease 2019 and pityriasis rosea: A review of the immunological connection.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is characterized by the activation of a cytokine storm derived from an excess release of cytokine (interleukin [IL]-6, interferon [IFN] I, C-X-C motif chemokine ligand [CXCL]10, tumor necrosis factor [TNF]-α, macrophage inflammatory protein [MIP]1) due to an uncontrolled immune activation. There has been a fivefold increase in the number of cases of pityriasis rosea during the SARS-CoV-2 pandemic. Using the keywords "pityriasis" and "COVID-19", we carried out a PubMed search, including all articles in the English language published until November 2021. We aimed to investigate the possible connection between SARS-CoV-2 and pityriasis rosea (PR). Pityriasis could be considered an immunological disease due to the involvement of cytokines and chemokines. Our analysis yielded 65 articles of which 53 were not considered; the others (n = 12) concerning the association between PR and COVID-19 were included in our study. We suggest two mechanisms underlying the involvement of the skin in viral infections: (i) viruses directly affecting the skin and/or inducing host immune response thus causing cutaneous manifestations; and (ii) viruses as a possible inducer of the reactivation of another virus. The first mechanism is probably related to a release of pro-inflammatory cytokine and infection-related biomarkers; in the second, several pathways could be involved in the reactivation of other latent viruses (human herpesviruses 6 and 7), such as a cytokine-cytokine receptor interaction, the Janus kinase-signal transducer and activator of transcription signaling pathway, and the IL-17 signaling pathway. We thus believe that a cytokine storm could be directly or indirectly responsible for a cutaneous manifestation. More investigations are needed to find specific pathways involved and thus confirm our speculations.

Molecular study of recent virus and its relationship to Pityriasis rosea.

BACKGROUND: A new type of coronavirus family severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that has been detected in individuals with several clinical symptoms named COVID-19, was recognized as a pandemic on March 11, 2020. Numerous researches have been conducted on the manifestations of a skin disease related to COVID-19, i.e., rashes or Pityriasis rosea (PR), vascular markings, and pimple-like lesions. AIM: This study aims to find out if the Coronavirus can affect the PR development, which also can be considered as a trigger and symptom for other types of infections. MATERIAL AND METHODS: This study is a case series describing the dermatological findings related to COVID-19 in the Thi-Qar Governorate. Samples were taken from inpatients, outpatients, and from the emergency unit of Al Hussein Teaching Hospital, and inwards of Al-Shefaa' Isolation Hospital. The study has been done over a 4 month period (June-September, 2020.). RESULTS: Around 19 patients, 10 females (52.6%) and 9 males (47.4%), who were infected with Coronavirus and were suffering from PR, are included in this study. The distribution of patients according to the incidence of PR in typical and anomalous manners were 77.9% and 21.1% respectively. The highest percentage of the incidence of PR was in moderate COVID-19 (84.2%), while it was around 15.8% in mild COVID-19. There was no significant statistical difference in the mean age distribution according to gender, while there was a significant statistical difference according to PR and COVID-19 class. More studies are needed to evaluate whether or not these lesions are associated with the virus. CONCLUSION: The PR was one of the dermatological finding of COVID-19 that did not have a clear role in the distribution of the disease according to the background of the patients, and also the severity of COVID-19. It can be triggered by COVID-19 and be completely cured with the clearance of the disease. RECOMMENDATION: An accurate robust cutaneous documentation related to COVID-19 is required to improve the knowledge of the disease as well as its epidemiology.

Overlapping Signs and Symptoms Between Recurrent Varicella and Pityriasis rosea Gibert.

BACKGROUND: Pityriasis rosea Gibert (PRG) has features similar to those of common infectious childhood diseases, suggesting a viral cause, but no agent has been identified to date. We describe 4 children with PRG and 2 with recurrent varicella who were studied using photochronography, virology and immunology. METHODS: The 6 patients with skin rashes visited our pediatric clinic from April 2012 to May 2016. Photographs of their skin lesions were taken; blood, skin lesions, and/or nasal lavage samples were collected to detect varicella-zoster virus (VZV) DNA and antibodies; and skin tests were carried out to measure cell-mediated immunity to VZV. RESULTS: Herald patches were confirmed in 2 of 4 PRG patients. No specimen cultures were positive for infectious VZV. However, VZV-DNA was detected in skin lesions of 3 PRG patients. During the acute phase, 5 patients had IgG antibodies to VZV, and skin-test reactions were positive in 5 patients. CONCLUSIONS: IgG antibody titers to VZV at rash onset were high, suggesting that they were already rising at the appearance of the rash and that reinfection with VZV must have occurred during the prodromal stage or several weeks before rash appearance in PRG patients whose immunity had declined below the threshold. Our study suggests a new pathogenesis of PRG that might help to address incongruities of past theories on PRG sites of viral entry and replication, incubation period and variations in the clinical course of PRG from prodrome to healing.

Impact of COVID-19 on Clinicopathological Spectrum of Pityriasis Rosea in Korea.

BACKGROUND: Pityriasis rosea (PR) is a papulosquamous eruption with generally unknown origin but suspected to be related to viral etiologies. The clinicopathological spectrum of several disorders with viral etiologies has been altered after the coronavirus disease 2019 (COVID-19) pandemic. The author group could experience coherent histological alterations in PR after the COVID-19 pandemic. This study aimed to investigate how the clinicopathological findings of PR were changed after the COVID-19 pandemic. METHODS: Patients (n = 11) diagnosed with PR based on the clinical manifestations and skin biopsies between February 2018 and October 2019 and 11 patients in February 2020 and October 2021 were retrospectively analyzed by investigating the medical records. RESULTS: The patients with PR during the COVID-19 pandemic demonstrated statistically significant histopathological alterations from classic brisk and dense infiltration pattern to dormant and sparse infiltration and psoriasiform-dominant patterns (P = 0.019). PR was associated with more frequent pruritus during the pandemic period (P = 0.027). CONCLUSION: In conclusion, PR demonstrated a significant histopathological alteration with more frequent pruritus during the COVID-19 pandemic. The comparative results about clinicopathological findings of PR will provide a useful reference for dermatologists in the diagnostic process of PR in the COVID-19 pandemic.

Pityriasis rosea in pregnancy: A case series and literature review.

BACKGROUND AND OBJECTIVE: Pityriasis rosea (PR), a common skin disease in young adults, may adversely affects the course of pregnancy and the unborn child. PATIENTS AND METHODS: Data from forty-six pregnant women with PR seen in the dermatological university clinic between 2003 and 2018 were analyzed and compared with patient data (n = 53) from previously published studies to determine the incidence and risk factors for an unfavorable pregnancy outcome after PR infection. RESULTS: Unfavorable pregnancy outcomes (defined as miscarriage, preterm delivery before week 37 of gestation, or birth weight < 2,500 g) were significantly less frequent in our study population than in a pooled cohort obtained from previously published studies (10.9 % vs. 39.6 %; P = 0.0012). Analysis of pooled data from our study and from previous studies revealed that the week of pregnancy at onset of PR was inversely associated with an unfavorable outcome (odds ratio [OR] = 0.937; 95 % CI 0.883 to 0.993). In addition, duration of PR (OR = 1.432; 95 % CI 1.129 to 1.827), additional extracutaneous symptoms (OR = 4.112; 95 % CI 1.580 to 10.23), and widespread rash distribution (OR 5.203, 95 % CI 1.702 to 14.89) were directly associated with unfavorable outcome. CONCLUSION: In most cases, PR does not influence pregnancy or birth outcomes.