Pityriasis Rosea: An Updated Review.

BACKGROUND: Pityriasis rosea is a common acute, self-limited papulosquamous dermatosis that primarily affects children and young adults. The condition and its clinical variants may pose a diagnostic challenge, especially in the absence of the herald patch. OBJECTIVE: This article aimed to familiarize pediatricians with clinical manifestations, evaluation, diagnosis, and management of pityriasis rosea. METHODS: A search was conducted in March 2020 in Pubmed Clinical Queries using the key term " pityriasis rosea". The search strategy included all clinical trials (including open trials, non-randomized controlled trials, and randomized controlled trials), observational studies, and reviews (including narrative reviews and meta-analyses) published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. RESULTS: Pityriasis rosea occurs mainly in individuals between 10 and 35 years of age with a peak during adolescence. Human herpesvirus (HHV)-7 and HHV-6 have been implicated as the causative agents in some patients with pityriasis rosea. A mild prodrome consisting of headaches, fever, malaise, fatigue, anorexia, sore throat, enlarged lymph nodes and arthralgia is present in about 5% of patients. The most common presenting sign, found in approximately 80% of patients, is a "herald" or "mother" patch which is larger and more noticeable than the lesions of the later eruption. A generalized, bilateral, symmetrical eruption develops in approximately 4 to 14 days and continues to erupt in crops over the next 12 to 21 days. Typical lesions are 0.5 to 1 cm, oval or elliptical, dull pink or salmon-colored macules with a delicate collarette of scales at the periphery. The long axes tend to be oriented along the skin lines of cleavage (Langer lines). Lesions on the back may have a characteristic "Christmas tree", whereas lesions on the upper chest may have a V-shaped pattern. There are many conditions that may mimic pityriasis rosea. Pityriasis rosea in the absence of the herald patch and its variants may pose a diagnostic challenge. The typical course is 6 to 8 weeks. In the vast majority of cases, reassurance and symptomatic treatment should suffice. Active intervention may be considered for individuals with severe or recurrent pityriasis rosea and pregnant women with the disease. Treatment options include acyclovir, macrolides (in particular, erythromycin), and ultraviolet phototherapy. If active intervention is needed, there is evidence supporting the use of oral acyclovir to shorten the duration of illness. CONCLUSION: Pityriasis rosea is a common, acute, self-limiting exanthematous skin disease that primarily affects children and young adults. The condition is characterized by a "herald patch" after which oval erythematous squamous lesions appear along Langer's lines of cleavage on the trunk and proximal extremities, giving it a "Christmas tree" appearance. The disease presenting in its classical form can easily be diagnosed. Clinical variants of the disease may pose a diagnostic challenge for the general pediatrician. Knowledge of the disease is essential to allow prompt diagnosis and to avoid unnecessary investigations.

Unique clinical presentations of pityriasis rosea: aphthous ulcers, vesicles and inverse distribution of lesions.

Pityriasis Rosea (PR) is a common skin disorderencountered in daily practice. Although its etiologyhas not been established, there has been widespreadresearch into possibilities. The lack of its characteristicmanifestations, specifically the herald patch andtruncal involvement, can lead to pitfalls in diagnosis.Whereas other conditions in the differential diagnosisshould be considered, PR can at times also manifest inan atypical manner. We wish to illustrate three casesof PR including those that presented with aphthousulcers, vesicles, and an inverse pattern.

Itch Management in Childhood.

Itch in children is a very common symptom and is mainly related to a skin disease rather than an underlying systemic disorder. The most common dermatoses include atopic dermatitis, contact dermatitis, insect bites, scabies, and pediculosis capitis. There are specific diagnostic patterns which require the evaluation of a careful history and dermatological examination. For dermatological treatment, we have to consider that children, especially infants, show differences in physiology and pathophysiology, and also in pharmacokinetics and pharmacodynamics compared with adults.

Concurrence of lichen striatus and localised pityriasis rosea: Cutaneous mosaicism.

Cutaneous mosaicism has always been an intriguing subject. A 15-year-old boy presented to us with a unilateral band of lesions of pityriasis rosea and lichen striatus. The case is discussed in the light of the concept of genetic mosaicism.

Treatments for pityriasis rosea.

Pityriasis rosea is a common skin disorder in children and young adults. It is a self-limiting disease with symptoms that are typically mild and tolerable. Consequently, the best treatment remains the one followed so far by generations of dermatologists: reassuring the patient and letting the condition go away on its own. However, there are times when treatment is recommended. In this paper, we review the available treatments for this skin disease.

An update on pityriasis rosea and other similar childhood exanthems.

PURPOSE OF REVIEW: Pityriasis rosea is a common skin condition seen in children and adults. Whereas pityriasis rosea is a benign condition, it is important to distinguish it from other childhood exanthems. RECENT FINDINGS: Pityriasis rosea can present in a variety of manners. Most often a herald patch precedes the generalized eruption, although this is not always the case. Pityriasis rosea may lead to undesirable outcomes when affecting pregnant women. Guttate psoriasis, secondary syphilis, cutaneous lupus erythematosus, capillaritis, pityriasis versicolor, nummular eczema, and cutaneous T-cell lymphoma are important to consider in the differential diagnosis of pityriasis rosea. SUMMARY: Pityriasis rosea is self-limiting, usually lasting 1-3 months. Treatment may be considered in certain cases, although there is a paucity of medical studies supporting any definitive treatment. However, treatment may be warranted for other conditions that mimic pityriasis rosea.

Interventions for pityriasis rosea.

BACKGROUND: Pityriasis rosea is a scaly rash that mainly affects young adults. It can be very itchy but most people recover within 2 to 12 weeks. OBJECTIVES: To assess the effects of interventions for pityriasis rosea. SEARCH STRATEGY: We searched the Cochrane Skin Group Specialised Register (December 2004), the Cochrane Central Register of Controlled Clinical Trials in The Cochrane Library (Issue 4, 2004), MEDLINE (1966 to January 2005), EMBASE (1976 to January 2005), LILACS (1982 to January 2005), BIOSIS Preview (1980 to June 2002), and ongoing trials databases. We scanned bibliographies of published studies, abstracts from dermatology conference proceedings, corresponded with trialists and contacted the pharmaceutical industry. SELECTION CRITERIA: Randomised controlled trials evaluating interventions for pityriasis rosea. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. We contacted study authors to retrieve missing data. MAIN RESULTS: Three trials involving 148 people were included. One poor quality trial (23 people), compared intravenous glycyrrhizin and intravenous procaine. It found no significant difference between the two interventions for treating symptoms and rash. One fair quality trial (85 people), compared the oral antihistamine dexchlorpheniramine (4 mg), the oral steroid betamethasone (500 mcg), and a combination of betamethasone (250 mcg) and dexchlorpheniramine (2 mg). It found no significant difference in itch resolution at two weeks, as rated by the participants, between dexchlorpheniramine and betamethasone, and the combination of dexchlorpheniramine and betamethasone. However, both dexchlorpheniramine and betamethasone alone seem to be better at clearing rash than the combination of dexchlorpheniramine and betamethasone. These interventions were not compared with placebo. The small good quality trial (40 people) that compared oral erythromycin and placebo found that erythromycin was more effective than placebo in terms of rash improvement, as rated by the trialists, after two weeks (RR 13.00; 95% CI 1.91 to 88.64). It was also more effective in decreasing the itch score (difference of 3.95 points, 95% CI 3.37 to 4.53). No serious adverse effects were reported for the interventions. Two out of 17 people on oral erythromycin and 1 out of 17 on placebo reported minor gastrointestinal upset. AUTHORS' CONCLUSIONS: We found inadequate evidence for efficacy for most treatments for pityriasis rosea. Oral erythromycin may be effective in treating the rash and decreasing the itch. However, this result should be treated with caution since it comes from only one small RCT. More research is necessary to evaluate the efficacy of erythromycin and other treatments.

La medicina tradicional en el tratamiento de la pitiriasis rosada de Gilbert Recidivante / Traditional medicine in the treatment of Recurrent pityriasis rosea of Gilbert

La Pitiriasis Rosada es una entidad que se puede ver en cualquier edad, pero más frecuente entre los 15 y 35 años, de etiología no precisada, aunque existen hipótesis que abogan por su posible causa viral. Se señalan diversas formas clínicas, que evolucionan aún sin tratamiento de 6 a 14 semanas, no obstante un porcentaje de las mismas presentan recidivas molestas para el paciente, que en ocasiones se convierten en causa de duda diagnóstica. Hasta hace algún tiempo esta forma clínica no era muy observada, aumentando su incidencia en la actualidad, por lo que nos decidimos a realizar un estudio descriptivo prospectivo, para evaluar la eficacia del tratamiento acupuntural, por lo que se seleccionaron diferentes puntos, aplicándose en los pacientes con diagnóstico clínico- histopatológico de la entidad. Se resalta que no se encuentran reportes de este tipo de tratamiento en la literatura revisada, lo que se estima constituye la novedad de este trabajo, además de la evolución favorable de la totalidad de los casos que se incluyeron en el estudio, por lo que se recomienda continuar esta investigación elevando la casuística(AU)

Pityriasis rosea is an entity that can be seen at any age but it is more frequently observed between 15 to 35 years of age. Although its etiology is not already established, there are hypotheses about possible viral causes. Different clinical forms may have a positive evolution without any treatment from 6 to 14 weeks, however, sometimes they can produce recurrences which cause some pain in patients and may create difficulties for diagnosis. No longer ago this clinical form was not very observed, but nowadays the number of cases has increased and for that reason, a descriptive and prospective study was carried out. It aim to evaluate the efficacy of an acupuncture treatment for patients with clinical and histopatological diagnosis of the entity. Reports of this kind of treatment were not found in a bibliographical review, so we may believe about the possible novelty of this work. The fact that the whole cases of this study had a favourable evolution may be an indication to continue the research with more cases(AU)