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.

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.

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.

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.

Pigmented purpuric dermatosis: Ten years of experience in a tertiary hospital and awareness of mycosis fungoides in differential diagnosis.

BACKGROUND: Pigmented purpuric dermatoses (PPD) can clinically mimic many diseases. Histopathology provides a definitive diagnosis. The aim of the study is to reveal the features of patients with PPD and to determine the disease frequency in the differential diagnosis, especially mycosis fungoides (MF). METHODS: We retrospectively reviewed records of patients with PPD admitted to our hospital from January 2010 to May 2019. We studied the histopathological features of 127 patients, and performed pattern analysis on cases with a confirmed histopathologic diagnosis of PPD. Among the cases presenting with clinical features of PPD, but displaying different histopathological diagnoses, we focused on MF and tried to clarify the features of PPD-like MF. RESULTS: Overall, 389 patients were admitted to our hospital with PPD symptoms. Of them, 262 patients were diagnosed clinically and a histopathological examination was performed in 127 patients. Of 127, 87 were diagnosed with PPD, and in the remaining 40, non-specific features (9.4%), vasculitis (6.2%), pityriasis rosea (4.7%), MF (3.9%), suspected-MF (1.5%), and other dermatoses (%5.5) were detected. The biopsy findings of two patients showed PPD, but during follow-up, the diagnosis of MF was established. CONCLUSIONS: MF should be included in the differential diagnosis of PPD cases presenting with longstanding and widespread involvement.

Pityriasis rosea: elucidation of environmental factors in modulated autoagressive etiology and dengue virus infection.

INTRODUCTION: A retrospective epidemiological study was conducted to study seasonal variation in the incidence of pityriasis rosea (PR) and its temporal association with various meteorological variables, and dengue virus infection. METHODS: The study was conducted at a tertiary referral center in Guwahati, Assam, India. We searched for and retrieved all medical records of patients diagnosed with PR by dermatologists from December 1st, 2014 to July 31st, 2017. The diagnosis was made only if the patient fulfilled at least three out of the following four clinical features: 1) herald patch, 2) peripheral collaret scales, 3) predominant truncal and proximal limb distribution of the lesions, and 4) orientation of lesions along the lines of cleavage. For each visit by every patient, we retrieved data for the monthly mean air temperature, mean total rainfall, and mean relative humidity. PR patients that had dengue fever with NS1 antigen and/or IgM/IgG antibody positivity were studied along with healthy controls. RESULTS: Overall, PR occurred more frequently in the colder months and months with less rainfall. However, these associations were insignificant (p = 0.23, R = -0.38, and R = -0.55, respectively). Upon further examination of the data, we found that the monthly incidence of PR was significantly lower in March and April than the other months during the study period (F = 8.31, p = 0.002). A statistically significant higher incidence was detected in September, November, and December (p < 0.01 for 2014 and 2017, but not in the 2016 seasonal cohort) and also in January and February (p < 0.05 for 2016 and 2017). Interestingly, a retrospective history of dengue fever emerged as a significant correlate. CONCLUSIONS: In our setting, there was significant temporal clustering and seasonal variation among patients with PR. The incidence of dengue fever is significantly correlated with PR.

Pityriasis Rosea during Pregnancy: Major and Minor Alarming Signs.

BACKGROUND: Pityriasis rosea (PR) is a self-limiting exanthematous disease associated with human herpesvirus (HHV)-6 and/or HHV-7 reactivation. In pregnant women, PR may be associated with pregnancy complications. OBJECTIVE: To determine relevant risk factors in the development of negative pregnancy outcome in PR. METHODS: Between 2005 and 2017 at the Department of Dermatology, University of Genoa, we recruited 76 women who developed PR during pregnancy. In 60 patients without known risk factors for intrauterine fetal death (30 with pregnancy complications and 30 without) we analyzed the pregnancy week of PR onset, presence of enanthem and of constitutional symptoms, PR body surface area involvement, age, and in 50 patients (20 with pregnancy complications and 30 without), the viral load of HHV-6 and HHV-7 (copies/mL). RESULTS: In logistic regression analysis, early onset of PR (p = 0.0017) and enanthem (p = 0.0392) proved to be significantly associated with pregnancy complications. HHV-6 viral load (copies/mL) (p < 0.0001), constitutional symptoms (p < 0.001), and PR body surface area involvement (p < 0.004) were also significantly associated with pregnancy complications. CONCLUSION: The onset of PR before week 15 and enanthem may be considered major risk factors that should alarm the dermatologist. Constitutional symptoms and involvement of > 50% of the body area may be considered minor risk factors.

Oropharyngeal lesions in pityriasis rosea.

BACKGROUND: Pityriasis rosea (PR) is an exanthematous disease associated with the endogenous systemic reactivation of human herpesvirus-6 (HHV-6) and human herpesvirus-7 (HHV-7). Oropharyngeal lesions may be associated with the exanthema, but anecdotal evidence suggests that few dermatologists are aware of their occurrence. OBJECTIVE: Classifying oropharyngeal lesions in PR, establishing their prevalence, and assessing their possible association with different PR forms. METHODS: The records of all PR cases diagnosed in the Dermatology Clinic of Genoa University between 2003 and 2016 were retrospectively reviewed to examine sex and age of the patients, PR type, presence of enanthema, systemic symptoms, specific anti-HHV-6 and or HHV-7 serology, and HHV-6 and/or HHV-7 DNA loads. RESULTS: The oropharyngeal mucosa was carefully examined in 527 patients with PR. Painless oropharyngeal lesions were observed in 149 patients with PR (28%) and classified as erythematomacular, macular and papular, erythematovesicular, and petechial lesions. The petechial and macular and papular patterns were those most frequently observed. There was no statistically significant difference in the levels of HHV-6 and HHV-7 viremia in the plasma of patients with enanthema and those without. LIMITATIONS: Because this was a retrospective study, biopsies on mucosal lesions were not performed. CONCLUSION: Our findings showed that enanthemas are frequently associated with forms of PR different from the classic form.

Seasonal variations in dermatologic and dermatopathologic diagnoses: a retrospective 15-year analysis of dermatopathologic data.

BACKGROUND: Certain dermatologic conditions are known to show seasonal variations in frequency, the reasons for which are unclear but in some cases may be attributable to changes in ambient weather conditions. OBJECTIVES: The current study was conducted to determine whether seasonal trends might exist for dermatologic conditions including erythema multiforme, guttate psoriasis, erythema dyschromicum perstans (ashy dermatosis), pityriasis lichenoides, and pityriasis rosea. METHODS: Data were derived from a 15-year retrospective review of electronic records from a large dermatopathology laboratory located in the mid-Atlantic region of the USA. Numbers of diagnoses per month and "per season" were determined. Pairwise comparisons of seasonal data were made using two-sample t-tests with significance set at P ≤ 0.05. RESULTS: Perniosis (chilblains) was significantly more common in winter and spring (P = 0.001). Hand, foot, and mouth disease was statistically more prevalent in summer and autumn (P = 0.028). Erythema multiforme was most common in spring and summer (P = 0.004). Grover's disease was most common in winter and spring (P = 0.000039). Guttate psoriasis was non-significantly more common in winter and spring (P = 0.076). No statistically significant seasonal variation was found for erythema dyschromicum perstans (P = 0.899), pityriasis rosea (P = 0.727), or pityriasis lichenoides (P = 0.366). CONCLUSIONS: This study found statistically significant seasonal trends for several dermatologic conditions. The study was primarily epidemiologic and was not intended to address histopathologic differences that might underlie the seasonal variations observed. However, further investigation of seasonal differences in the histopathology of erythema multiforme may prove interesting.

Is There a Link between Human Herpesvirus Infection and Toll-like Receptors in the Pathogenesis of Pityriasis Rosea? A Case-control Study.

Human herpesvirus (HHV) 6 and 7 are involved in the pathogenesis of pityriasis rosea (PR). Our aim was to evaluate the role of the innate immune response in PR through the detection of Toll-like receptors (TLR) 2, 3, 4, 7, 8, and 9 expression in the skin of affected patients and to detect the possibility of being induced by HHV-6 and/or HHV-7 viral coexistence in these patients. Twenty-four patients with PR and 24 healthy controls were included in this case-control study. Biopsy was obtained from the PR lesion and from the healthy skin of controls for detection of HHV-6 and 7 as well as TLRs 2, 3, 4, 7, 8, and 9 gene expression using real-time polymerase chain reaction (PCR). Significantly elevated expression of all studied TLRs and significantly higher viral load of HHV-6 and 7 in PR cases were detected. A significant higher expression of TLR2 and 4 in HHV-7 positive cases and a significant positive correlation between TLR9 and HHV-7 viral load were documented. HHV6 and 7 may also be involved in the pathogenesis of PR via TLR pathways.

Relapsing pityriasis rosea.

To assess the prevalence of relapses of pityriasis rosea (PR), a retrospective cohort study investigated all PR cases diagnosed in Genoa between 2000 and 2013 and followed them up to today. Of 570 cases, 21 (3.7%) relapsed. Most of them had a single episode, but 4 had two episodes and 2 had three episodes. The herald patch was always absent, size and number of the lesions were reduced, and duration was shorter than that of the primary episodes. Constitutional symptoms were present, though less severe than in the primary eruption. Most recurrences occurred within 1 year (16/21, 76.2%). Men outnumbered women and the mean age of the relapsing patients (20.3 years) was higher than that for the primary episode. A pathogenetic hypothesis is provided: since PR is associated with reactivation of human herpesvirus 6/7, a parallelism with other typical reactivating human herpesviruses (varicella zoster virus and Epstein-Barr virus) has been established.

A clinicoepidemiological study of pityriasis rosea in South India.

Pityriasis rosea is an acute self-limiting papulosquamous skin disorder of unknown etiology. Although pityriasis rosea is a common dermatologic disorder, information regarding the epidemiology of the disease in India is limited because of inadequate studies. The incidence and presentation of pityriasis rosea varies from one geographical region to another. The objective was to study the various clinical patterns of the disease and epidemiologic factors influencing its occurrence. A cross-sectional study on the clinicoepidemiologic pattern of pityriasis rosea was conducted. A detailed history of illness regarding onset, evolution, duration, symptoms, systemic features, recurrence, history of contact, and associated factors such as socioeconomic status, history of drug intake, and use of new clothing, along with epidemiologic data, was recorded in the performa. The age of the patients ranged from 3 to 47 (mean 20.32) years. Incidence of pityriasis rosea was highest among patients aged 11 to 20 years followed by those 21 to 30 years. There was a male preponderance. Seasonal variation was not evident. History of using new garments or old garments, unwashed for an extended period was elicited in 23% of cases. The average interval of onset of lesions and presentation to physician was 14.45 days. Pruritus was a common symptom (70%). Of 73 patients, 67 had herald patch. The clinical features of most of the cases were in accordance with the classical pattern of pityriasis rosea.

Pityriasis rosea and herpesviruses: facts and controversies.

Pityriasis rosea is an acute exanthem with many clinical and epidemiologic features of an infectious disease. To date, human herpesvirus (HHV)-6 and HHV-7 appear to be the most indicted culprits, and the evidence in favor of this hypothesis and the controversial results produced elsewhere are discussed. The complex pathophysiology of HHV-6 and HHV-7 infection, their diffusion in the population at large, the difficulties of understanding whether the infection is still latent or is clinically manifest, and well as whether pityriasis rosea depends on a reinfection or on a viral reactivation, all make the issue extremely difficult to study and understand.