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Pityriasis rosea, a self-limited exanthematous disease of unknown etiology, is a fairly common exanthem encountered by dermatology nurses and nurse practitioners. Their special roles in diagnosis, symptomatic relief, care for patients with atypical rash, patient education, and counseling are described.
The treatment of seborrhoea oleosa capillitii should aim at inhibiting depletion of the sebaceous glands, lipid synthesis in the sebaceous gland and microbial lipolysis of the triglycerides in the scalp and hair lipids. The use of isopropyl alcohol as a vehicle in a hair tonic reduces sebum depletion. Coal tar and estrogens reduce the lipid synthesis in the sebaceous gland. The lipolysis can be inhibited by various surfactants, isopropyl alcohol, colloidal sulphur, selenium disulphide, Omadine MDS and benzoyl peroxide. In the treatment of pityriasis simplex capillitii (dandruff) one aims at achieving inhibition of mitosis in the epidermis and, if possible, an additional "keratolytic" effect. Inhibition of mitosis could be demonstrated for coal tar, corticosteroids, selenium disulphide, cadmium sulphide, Omadine MDS, Zn Omadine and ichthyol sodium. Colloidal sulphur, salicylic acid, Omadine MDS and various surfactants act "keratolytically".
Tinea versicolor is a common noninvasive cutaneous fungal disease. We recount a case of tinea versicolor that mimicked type I (classic adult) pityriasis rubra pilaris. A 54-year-old white man reported a 20-year history of a recurrent pruritic eruption that had marginally improved with use of selenium sulfide shampoo and treatment with oral antihistamines. Results of a skin examination revealed erythematous plaques; islands of spared skin; and follicular erythematous keratotic papules on the trunk, shoulders, and upper arms. A lesion was scraped to obtain skin scales for potassium hydroxide staining. Examination of the stained samples revealed the characteristic "spaghetti and meatballs," confirming the diagnosis.
Pityriasis alba (PA) is a common benign condition in children that has no definitive treatment. Its etiology and pathogenesis are still poorly understood. Recent studies have found direct correlations between the incidence of PA and atopy, amount of sun exposure, lack of sunscreen use, and frequency of bathing. It is often an incidental finding on physical examination because it is usually asymptomatic. Although treatment with emollients and mild topical corticosteroids may accelerate the repigmentation, they have limited efficacy. Without intervention, the lesions normally resolve within months to years. Extensive PA and pigmenting PA are rarer variants.
Pityriasis rubra pilaris (PRP) is a rare idiopathic erythematosquamous disorder. Griffiths proposed five clinical and prognostic forms: (1) classic adult, (2) atypical adult, (3) classic juvenile, (4) circumscribed juvenile and (5) atypical juvenile. A 2 1/2 year old boy presented with type 3 PRP; as is typical, the skin eruption was preceded by an infectious disorder. Although type 3 PRP normally shows spontaneous resolution after several months to years, our young patient had a severe and protracted course, only responding to systemic retinoids.
A 4-year-old girl presented with a 3-year history of demarcated, salmon-pink, hyperkeratotic plaques, which were symmetrically distributed on the elbows, knees, ankles, and dorsal aspects of the hands and feet. A diffuse, orange-pink palmoplantar keratoderma was also evident. Clinical and histologic findings were consistent with a diagnosis of pityriasis rubra pilaris (PRP), type IV (circumscribed juvenile). Type IV PRP develops in prepubertal children, is typically localized to the distal aspects of the extremities, and has an unpredictable course. Although ultraviolet (UV) radiation can potentially exacerbate PRP, our patient has improved with broad-band UVB phototherapy.
Pityriasis rubra pilaris is a skin condition with many different clinical presentations. History, histology, clinical presentation, its different classified forms, treatments, and differential diagnoses are reviewed.
We report a case of bismuth-induced pityriasis rosea-like drug eruption. Although historical accounts of bismuth hypersensitivity exist, contemporary reports are lacking. Given the frequency of bismuth administration, a modern review of this phenomenon would seem prudent.
Circumscribed juvenile-onset pityriasis rubra pilaris (PRP) manifests as well-defined erythematous scaly plaques with follicular keratosis mainly over the elbows and knees. There are several reports of the association of PRP with other conditions. We report a boy with scattered erythematosquamous skin lesions and follicular hyperkeratotic papules since he was 6 years old. Results of a skin biopsy were compatible with PRP. The patient also had hypoparathyroidism and brachyonychia. To our knowledge, this association has not been reported to date, though minor disturbances of calcium and vitamin D metabolism have been mentioned in some disorders of keratinization. We further discuss the epidemiologic, clinical, and pathologic features of PRP; review the conditions associated with brachyonychia; and give a brief discussion about the possible role of calcium metabolism in disorders of keratinization.
Lymphomatoid papulosis (LyP) and pityriasis lichenoides et varioliformis acuta (PLEVA) are benign self-healing cutaneous eruptions that may be clinically and histologically similar. However LyP has a 5% to 20% risk of associated lymphoid malignancy, whereas PLEVA does not. To determine whether the immunophenotype of lymphoid cells is useful in the distinction of these two disorders, the pattern of expression of lymphoid cell lineage and activation antigens in nine cases of LyP and seven cases of PLEVA were compared. In all cases of LyP most larger cells expressed the activation antigen Ki-1 (CD30) and lacked expression of the T-cell antigen CD7 and at least one other T-cell antigen (CD2, CD3, CD5). In contrast, CD30-antigen expression was rare or absent in PLEVA, CD3- and CD7-antigen expression was found in all cases, and diminished expression of T-cell antigens (CD2 and CD5) was seen in only one case. Diffuse expression of HLA-DR antigen by epidermal keratinocytes was found in a greater proportion of PLEVA cases (6 of 7) than LyP cases (3 of 6). In addition, CD8+ cells predominated at the dermal/epidermal junction in 3 of 6 cases of PLEVA but in only 1 of 7 cases of LyP. We conclude that LyP and PLEVA can be distinguished immunohistochemically in most, if not all, cases. Furthermore these results suggest that LyP and PLEVA are separate disorders, thus accounting for their variable prognoses.
The therapeutic choice in treating Pityriasis Rubra Pilaris (PRP) is difficult, particularly in extensive erythrodermic forms and in those characterized by a strong tendency to recur. None of the therapeutic modalities till now employed have been proved to be resolutive. The curative potential of photochemotherapy in the treatment of PRP has been particularly uncertain. Here a case of recurrent PRP in an adult female subject is reported. The disease covered about 90% of the skin surface and was treated by means of photochemotherapy (total dose: 179.56 J/cm2). A complete remission of the disease has been obtained and is still maintained nine months after the end of the treatment.
Captopril is an antihypertensive drug that works by inhibiting the angiotensin-converting enzyme and provokes increased levels of plasma quinine. In the case here reported a picture of pityriasis rosea-like reaction is described. The frequency of the observed and reported reactions by captopril suggests a particular caution in the use of this drug.
A 74-year-old female patient with an erythrodermic pityriasis rubra pilaris developed multiple seborrheic keratoses during the early stage of the skin disorder. There was no evidence of an underlying internal malignancy. Initially, the patient was treated with etretinate. The seborrheic keratoses all faded away during the next 3-4 months without any specific treatment. The possible role of retinoid treatment in the resolution of seborrheic keratoses is discussed.
Lectins are used to study four cases of keratosis pilaris, four of lichen spinulosus, 11 of porokeratosis, 8 of striated lichen and one case of pityriasis rubra pilaris, with the aim of providing data to improve knowledge of the histogenesis of these processes.
In various skin diseases with a possible viral and/or autoimmune etiology, the peripheral lymphocytes were studied with regard to serum interferon levels and the interferon-induced activity of (2'-5')-oligoadenylate synthetase (OAS). This enzyme is a sensitive marker of interferon and can be detected even some days after the clearance of interferon from the blood. In patients with pityriasis rosea (n = 13), basal cell carcinoma (n = 12), malignant melanoma (n = 11), and molluscum contagiosum (n = 13), the serum interferon levels were not increased. In comparison to healthy persons, 5 patients with melanoma (Clark's levels I, I-II and II) showed a significantly elevated activity of OAS. In 6 other patients with melanoma (Clark's level III, III-IV and IV), the OAS activity was not increased. Although the elevated activity of OAS found in patients with melanoma of lower Clark's levels indicates a participation of the interferon system in the course of the disease, our results do not allow a clear statement regarding a viral and/or an autoimmune etiology of the skin disease.
Using 2 color fluorescein activated cytometric analysis, HLA-DR antigen expression in T cell subsets was studied in pityriasis rosea (PR) and compared to the results from herpes zoster (HZ) of viral origin and psoriasis (Ps). In HZ and PR, HLA-DR was significantly expressed on the T cell surface (Leu-4+ cells). Among the T cell subsets, HLA-DR antigen was predominantly expressed on suppressor/cytotoxic cells (Leu-2a+) in HZ. In contrast, it was predominantly expressed on helper cells (Leu-3a+) in PR. However, activated T cell antigen (Tac) was not significantly expressed on T cells (Leu-4+) in either HZ or in PR. This HLA-DR antigen expression of T cell subsets was depressed to the normal level in the recovery phases of HZ and PR.
Ten children clinically and histologically diagnosed as having pityriasis lichenoides (PL), have been studied by direct immunofluorescence (DIF). Circulating immune complexes (CI) have also been studied in four children. Granular deposits of IgM, located in the walls of the dermal vessels have been observed in two cases, but they have never been found at the dermo-epidermal junction. Granular deposits of C3 have been observed in three children, both in the walls of the dermal vessels and at the dermo-epidermal junction. The search for immune complexes gave negative results in all cases. The hypothesis of some authors that PL is an immune complex disease cannot be confirmed by our findings.
Patients with the skin disorder pityriasis lichenoides et varioliformis acuta (PLEVA) develop recurrent, self-healing papulonecrotic lesions that contain infiltrates of cytologically and antigenically normal T lymphocytes. DNA extracted from the lesions of 3 patients with PLEVA was analyzed for rearrangement of beta-T-cell receptor genes for the purpose of assessing the clonality of T lymphocytes within the tissues of this disease. Lesions from all 3 cases showed clonal gene rearrangements. In each of 2 cases from which two separate lesions were biopsied, identical rearrangements were found in specimens from both sites. DNA from a variety of inflammatory lesions obtained from patients with other types of skin diseases failed to show detectable rearrangements of beta-T-cell receptor genes. These results suggest that PLEVA represents a T-cell lymphoproliferative process, rather than an inflammatory disorder, as had been previously thought.