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PubMed1992

Atypical manifestations of pityriasis lichenoides chronica: development into paraneoplasia and non-Hodgkin lymphomas of the skin.

Three patients with atypical courses and manifestations of pityriasis lichenoides chronica (PLC) are presented. The first patient is a 21-year-old white woman who showed a good response of her PLC lesions as well as her reactive oligoarthritis to repeated PUVA treatments combined with oral prednisone during 1 year. The effect of the treatment then decreased. The patient developed a low-grade malignant lymphoma of the lung. When the lymphoma of the lung improved after chemotherapy, the PLC eruptions improved, too. The second patient is a 41-year-old man, whose Hodgkin's disease stage IVa was successfully treated by chemotherapy and radiotherapy in 1984. In 1987 he showed PLC lesions which responded well to PUVA therapy, later also in combination with etretinate. Until 1988 repeated skin biopsies revealed a non-specific eczematous pattern. In 1989 the recalcitrant PLC eruptions finally revealed a pleomorphic non-Hodgkin lymphoma of the skin with medium-sized cells. The third patient had a PLC for about 9 years when Hodgkin's disease stage Ia was diagnosed. At the beginning the skin biopsy showed an eczematous pattern, but 2 years later, in 1990, skin infiltrations of a large-cell, anaplastic non-Hodgkin lymphoma were seen. These cases show that PLC in rare cases may either represent a paraneoplastic skin disease or may itself develop into cutaneous lymphomas.

Adult↗
PubMed1991

HLA-DR antigen expression on peripheral T cell subsets in pityriasis rosea and herpes zoster.

Using 2-color fluorescein-activated cytometric analysis, HLA-DR antigen expression on peripheral blood T cell subsets was studied in patients with herpes zoster (HZ), pityriasis rosea (PR) and psoriasis. In HZ and PR, HLA-DR was found to be significantly expressed on T cell surfaces (CD3+ cells), when compared to that of the normal control (HZ: p less than 0.001, PR: p less than 0.05). Among T cell subsets, such HLA-DR antigen was predominantly expressed on suppressor/cytotoxic cells (CD8+) in HZ (vs. normal control, p less than 0.01). However, in the case of PR, it was predominantly expressed on helper cells (CD4+; vs. control, p less than 0.05). On the other hand, activated T cell antigen (CD25+) was not significantly expressed on T cells (CD3+) in either HZ or PR. In the T cell subsets, HLA-DR antigen expression returned to normal levels during the recovery phases of HZ and PR.

Adult↗
PubMed1987

Pityriasis lichenoides et varioliformis acuta and acquired toxoplasmosis.

A patient presented with a typical pityriasis lichenoides et varioliformis acuta (PLEVA) and disclosed serological evidence of an active and recent toxoplasmosis. Specific treatment of toxoplasmosis promptly and definitively resolved PLEVA lesions. Serological tests for Toxoplasma gondii should be performed in all PLEVA patients.

Female↗
PubMed1985

Pityriasis rosea and ketotifen.

A 4-year-old female patient who developed a skin eruption similar to pityriasis rosea after treatment with ketotifen (Zaditen) is presented. The relationship between ketotifen and the eruption has been based on circumstantial evidence and confirmed by the positive results of the MIF test and the rat mast cell degranulation test.

Bronchitis↗
PubMed1983

Pityriasis rosea in children. A review.

Pityriasis rosea is a common disorder of unknown etiology that may simulate a number of other dermatologic entities. Secondary syphilis should always be ruled out, particularly in adolescents. Pruritus occurs more frequently than is generally appreciated. The herald patch may not always be present. Secondary lesions occasionally occur distal to the elbows and knees and on the face. Over the more proximal parts of the body the secondary lesions will characteristically align themselves with the long axis following the skin lines of cleavage. The natural course is that of spontaneous resolution within 6 to 8 weeks. Sequelae are rare and usually medically insignificant. Management with oral antipruritics and/or topical steroids may be necessary to relieve the itching.

Adolescent↗
PubMed2004

Clinical and histopathological findings in pustular psoriaform dermatitis (pityriasis rosea) in pigs.

Three cases of pustular psoriaform dermatitis (pityriasis rosea) in pigs were clinically and histopathologically examined. Grossly, the affected skin was characterized by multiple, circumscribed lesions. Three pigs were the descendants derived from the same Landrace boar. Skin lesions expanded centrifugally to became ring-shaped plaques. There were no abnormal values in hematological and serum biochemical profiles. Histopathologically, the epidermis showed remarkable thickening. The dermal lesions were characterized by a prominent component of superficial and deep perivascular infiltration of eosinophils. Dilatation of microvasculature was accompanied with congested vessels. These results revealed that the etiology of pustular psoriaform dermatitis in pigs was associated with a hereditary predisposition derived from the specific boars. This dermatosis is histopathologically characterized by microcirculatory disturbances with infiltration of abundant eosinophils.

Animals↗
PubMed2006

Azithromycin does not cure pityriasis rosea.

OBJECTIVES: Pityriasis rosea (PR) is a common skin disorder in children. Its cause is unknown. A recent publication reported a 73% cure rate in patients with PR after treatment with erythromycin. To duplicate this result using a drug with fewer adverse effects and greater biological half-life, we set out to study the effect of azithromycin on PR. Azithromycin is an azalide antibiotic with a spectrum of antimicrobial activity very similar to that of erythromycin. DESIGN: We randomly assigned 49 children with PR to receive either azithromycin (12 mg/kg per day, up to a maximum of 500 mg/day) for 5 days or a similar-appearing placebo. Study physicians were blinded to patients' treatment type. Two pediatricians had to agree on the diagnosis of PR before patients could be enrolled. Subjects were seen at follow-up visits 1, 2, and 4 weeks after starting treatment. OUTCOME MEASURES: We measured the appearance of new lesions and resolution of lesions. RESULTS: Rates of cure and of partial resolution were similar in the azithromycin and placebo groups. CONCLUSION: Azithromycin does not cure PR.

Anti-Bacterial Agents↗
PubMed2004

[A case of pityriasis rubra pilaris associated with rapidly progressive finger joint destruction].

A 40-year-old female noticed edema of the lower limbs in March 1995. Nephrotic syndrome due to membranous nephropathy was diagnosed and administration of high-dose corticosteroids resulted in incomplete remission. Progressively enlarging, red scaling skin lesions developed concomitantly from the scalp to the extremities. Pityriasis rubra pilaris (PRP) was diagnosed in 1996 in the Department of Dermatology at Sapporo Medical University hospital. Various treatments proved ineffective. Arthritis of the finger joints developed in July 1999, and proteinuria recurred in April 2000. She was admitted to our department in August 2000. Physical examination on admission revealed marked swelling of both distal interphalangeal (DIP) joints and the right fourth proximal interphalangeal (PIP) joint. Results of testing for antinuclear antibody, rheumatoid factor, and HLA-B27 were all negative. Radiography of the hands revealed destruction of the DIP and PIP joints where MRI indicated the presence of synovitis. Bone scintigraphy demonstrated accumulation in bilateral metatarso-phalangeal joints and the left sacroiliac joint. Arthritis associated with PRP was diagnosed, as both PRP and psoriasis represent keratinizing disorders of the skin and clinical features in the present case resembled those of psoriatic arthritis. Despite administration of high-dose corticosteroids, destruction of finger joints progressed rapidly. Administration of cyclosporine in April 2002 improved arthritic symptoms. Cases of PRP accompanied by arthritis need to be accumulated to allow analysis of the pathogenesis and clinical picture of this association.

Adult↗
PubMedDate not supplied

Pityriasis rosea-like eruptions due to mustard oil application.

A young man employed in a construction company, presented with cutaneous lesions clinically simulating pityriasis rosea. Satisfactory and complete response to corticosteroids and antihistamines was followed by recurrence. Multiple recurrences within a short span of time arose a suspicion of alternative diagnosis. Site visit helped us to rule out occupational contact dermatitis. Further history taking revealed that he was recently using mustard oil for body massage. Subsequent patch testing confirmed contact hypersensitivity to mustard oil. Avoidance of the contact with mustard oil arrested appearance of further skin lesions. We stress the importance of taking a good history in clinical practice in disclosing a possible contactant.

Adult↗
PubMedDate not supplied

Pityriasis rosea--an update.

Recent controversies on the etiology, diagnosis and treatment have led to increased interest in pityriasis rosea (PR). We review these aspects of the disease. PR is universal. The incidence is around 0.68 per 100 dermatological patients, or 172.2 per 100,000 person-years. The prevalence in people aged between 10 and 29 years is 0.6%. The male to female ratio is around 1:1.43. Evidence on seasonal variation is conflicting, but there is no evidence that the incidence is dependent on mean air temperature, mean total rainfall, or mean relative humidity. Spatial-temporal and temporal clustering of cases of PR has been reported. The association of PR with human herpesvirus-7 infection is still controversial. Owing to the extreme high sensitivities of sequence-based detection methods such as polymerase chain reaction, novel criteria should be applied to evaluate the evidence. There is no evidence that PR is associated with other viral or bacterial infections. The role of autoimmunity in PR warrants further investigations. Many patients with PR have one or more atypical features. Application of validated diagnostic criteria may be helpful for atypical cases. The efficacy of macrolides, including erythromycin, in PR is still under evaluation. There is no evidence that antiviral agents are effective. The efficacies of ultraviolet radiotherapy and systemic corticosteroids are not well established. In managing a patient with PR, we should concentrate more on how the eruption is affecting the quality of life, i.e. the illness, rather than the extent and severity of the eruption, i.e. the disease.

Anti-Bacterial Agents↗
PubMed1999

Pityriasis amiantacea: a report of two cases in adults.

Pityriasis amiantacea is a scaly condition of the scalp that is usually seen in children. It is most often associated with an underlying primary dermatosis. We describe two adult patients who did not present with concomitant scalp or cutaneous diseases.

Administration, Topical↗
PubMed2001

Association of pityriasis rosea with human herpesvirus-6 and human herpesvirus-7 in Taipei.

BACKGROUND AND PURPOSE: Pityriasis rosea (PR) is a common papulosquamous skin disease with unknown etiology. The possible relationship of PR with human herpesvirus infection (HHV) has been extensively studied. This study used the polymerase chain reaction (PCR) to investigate the presence of human herpesvirus 6 and 7 (HHV-6 and HHV-7) in 41 PR patients from two hospitals in Northern Taiwan. The epidemiologic features of PR in patients were also studied. METHODS: A total of 41 PR patients (11 males, 30 females) were enrolled in this study from April 1999 to March 2000. PCR of skin biopsy specimens from 24 PR patients was used to identify the existence of HHV-6 and HHV-7. Viral culture from PR biopsy specimens was also performed. Blood from these patients was sampled for Venereal Disease Research Laboratory tests. Skin biopsies from 20 age- and sex-matched controls with other skin diseases were also subjected to PCR study. RESULTS: The ages of the 41 PR patients ranged from 8 to 62 years. An increased incidence (17/41) of PR episodes was observed during the spring. Both HHV-6 and HHV-7 DNA was below the limit of detection in all biopsy specimens from patients and healthy controls. Viral culture for HHV was negative in all patients. CONCLUSION: The epidemiologic features of PR in this series are comparable to other studies except for an exaggerated female predominance (male:female ratio 1:2.7). Our data indicate a lack of association between HHV-6 and HHV-7 infection and PR.

Adolescent↗
PubMedDate not supplied

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.

Adolescent↗
PubMedDate not supplied

Rash orientation in pityriasis rosea: a qualitative study.

Rash orientation in pityriasis rosea (PR) has been described as Christmas-tree pattern, inverted Christmas-tree pattern, fir tree pattern, parallel to the ribs or along skin cleavage lines. We retrieved clinical photographs of 11 patients diagnosed as having PR over a two-year period for qualitative study of rash orientation. We found that Langer's cleavage lines are the most appropriate description. All three components of these lines on the trunk, i.e. V-shaped pattern on upper chest and upper back, circumferential pattern around the shoulders and hips, and transverse pattern on the lower anterior trunk and lower back, are demonstrated by most patients. We believe with the present state of knowledge, the mechanism for PR following Langer's lines is best considered unknown. We advocate abandoning other descriptions which might cause confusion to students and trainee physicians.

Exanthema↗
PubMed2002

[How I treat...pityriasis rubra pilaris].

Pityriasis rubra pilaris is a syndrome of unknown etiology. Six distinct clinical types have been described in infancy and adulthood. Oral retinoids have proven their efficacy. Emollients and topical calcipotriol may improve the clinical presentation.

Administration, Oral↗
PubMed2002

Papular pityriasis rosea.

Pityriasis rosea (PR) is a seasonal papulosquamous disorder that can be easily confused with a wide variety of similar appearing cutaneous disorders. This is particularly evident in its atypical papular form. We present a case report of atypical papular PR, along with a discussion of clinical presentation, histologic criteria, proposed etiology, and treatment options. Papular PR is atypical, presenting in a minority of patients, and may pose a diagnostic challenge. Being familiar with these atypical characteristics will facilitate accurate and timely diagnosis.

Adult↗
PubMedDate not supplied

The association of pityriasis rosea with cytomegalovirus, Epstein-Barr virus and parvovirus B19 infections - a prospective case control study by polymerase chain reaction and serology.

A viral aetiology is suspected for pityriasis rosea (PR). The objective was to investigate the association of PR with cytomegalovirus (CMV), Epstein Barr virus (EBV) and parvovirus B19 infections. Patients with PR were recruited in a primary care setting over 18 months. Blood was collected at initial presentation and four weeks later. Controls were the next age-and-sex-matched patients requiring blood collection for non-dermatological disease. Polymerase chain reaction was performed for EBV and parvovirus B19 DNA. Serology was done for CMV, EBV and parvovirus B19. 12 patients with PR and 12 control subjects were recruited. No patient had viral DNA or significant antibody rise against any of the viruses investigated. The seroprevalence of all three viruses and Ab titres in the patients with PR were insignificantly different from those of control subjects. Two patients had IgM detectable against CMV and EBV respectively. Based on other investigation results, we believe that both IgM results were caused by cross reactivity. PR is not associated with CMV, EBV or parvovirus B19 infections.

Adolescent↗
PubMed1978

Pityriasis rubra pilaris responding to aminonicotinamide.

A 32-year-old man with pityriasis rubra pilaris diagnosed by clinical appearance and histologic examination was treated with 1% aminonicotinamide cream applied once daily. Improvement was noted within four days, and almost complete clearing occurred after two weeks of therapy. No side-effects were noted.

6-Aminonicotinamide↗