Pitiriasis rosada de Gibert en paciente de raza negra / Pityriasis rosea Gibert in a black patient

Los cambios poblacionales, los movimientos migratorios y el aumento de adopciones han condicionado la aparición de nuevas patologías en nuestras consultas, así como presentaciones diferentes de las patologías más habituales. Presentamos las imágenes y la revisión bibliográfica de un caso de pitiriasis rosada de Gibert en una paciente de cuatro años de raza negra (AU)

Population changes, migration and increasing number of adoptions have conditioned the emergence of new diseases in our consultations, as well as different forms of the most common diseases. We present the images and the medical literature review of a case of pityriasis rosea Gibert in a black four years old patient (AU)

Pityriasis rosea--evidence for and against an infectious aetiology.

Pityriasis rosea, first named as such in 1860, probably holds the longest record for an exanthem suspected to be associated with an infection but for which an exact cause has not been found. The distinctly programmed clinical course, the lack of recurrence for most patients, and the presence of temporal case clustering provide the strongest evidence to support an infectious aetiology. Further support comes from seasonal variation and the association with respiratory tract infections, the unfavourable social and economic background of cases, and a history in some cases of contact with patients with pityriasis rosea. The apparent therapeutic efficacy of several treatment modalities does not provide strong evidence for or against an infectious aetiology. The roles of human herpesvirus 7 and to a lesser extent human herpesvirus 6 remain controversial. There exists reasonable evidence that pityriasis rosea is not associated with cytomegalovirus, Epstein-Barr virus, parvovirus B19, picornavirus, influenza and parainfluenza viruses, Legionella spp., Mycoplasma spp. and Chlamydia spp. infections. Evidence is also unsubstantiated as yet for alternative aetiological hypotheses such as autoimmunity, atopy, and genetic predisposition.

Prospective case-control study of chlamydia, legionella and mycoplasma infections in patients with pityriasis rosea.

A double-blind placebo-controlled trial reported the benefit of erythromycin in treating pityriasis rosea (PR), a postulated mechanism being the eradication of bacteria susceptible to erythromycin. The aim of this study was to investigate the association between PR and Chlamydia pneumoniae, C. trachomatis, Legionella longbeachae, L. micdadei, L. pneumophila, and Mycoplasma pneumoniae infections. We recruited 13 patients aged seven to 46 years (mean: 26.8 years) diagnosed to have PR in a primary care setting in 18 months. Lesional histopathology was arranged for atypical cases. Clotted blood was collected at initial presentation and four weeks later. Controls were 13 paired age-and-sex-matched patients requiring blood collection for non-dermatological diseases. Serology tests were performed in parallel but were read "blinded" on the acute and convalescent specimens of patients and the control subjects. The serology profiles were not diagnostic of active infection by any of the bacteria studied for all 13 patients. Two patients had four-fold increase in IgG titres against C. pneumoniae, with IgM being negative. Two patients had IgM detectable against L. pneumophila serotype 6 and M. pneumoniae respectively, with no significant rise of the specific IgG. These patients had no symptom or sign of chest infection. The seroprevalence and IgG titres of the study patients for the bacteria investigated were insignificantly different from those of control subjects. We conclude that the bacteria investigated in this study do not play a significant role in the pathogenesis of PR. We believe that anti-inflammatory and immunomodulatary effects might contribute towards the action of erythromycin, if any, in PR.

Pityriasis rosea Gibert: detection of Legionella micdadei antibodies in patients.

Some epidemiological and clinical characteristics of Pityriasis rosea Gibert has led us to hypothesize that this disease may be the clinical manifestation of an infection caused by legionellas. We have thus tested the sera of 36 patients ill with Pityriasis rosea and 19 controls for Legionella pneumophila serogroup 1-6 and Legionella micdadei antibodies. These, who had the same age and sex distribution as study patients, were receiving treatment for other diseases in the same ward. Also tested were 200 sera from the voluntary blood donors from the same region as study patients. Legionella micdadei antibodies were detected in 12 (33.3%) Pityriasis rosea cases and in one (5.2%) control. They were significantly more common in Pityriasis rosea cases than in either controls or voluntary blood donor population. The findings to date encourage continued research into the causative relationship between the Legionella micddadei infection and the onset of Pityriasis rosea Gibert.