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Pityriasis rotunda affects dark-skinned persons and appears as nearly perfectly round or oval scaling patches. Often associated with chronic and debilitating illness or malignant disease, it is probably a localized variant of acquired ichthyosis.
A rapid plasma reagin (RPR) test was performed in fifty patients with a clinical diagnosis of pityriasis rosea to determine the frequency of syphilis as the underlying cause of the eruption. In none of the fifty patients was syphilis the cause. Experience in diagnosing skin diseases, frequency of syphilis in the community served, and the characteristics of the individual eruption are important factors in the decision to perform an RPR test.
A case of acute pityriasis lichenoides associated with a distal ischemia and a similar evolution is reported. The vasculitic cause is demonstrated by angyologic exploration. The gross vascular afectation other than dermal vessels is suggested.
A 41-year-old man was referred because of a slightly pruritic eruption, and a classic case of pityriasis rosea was diagnosed on the first examination. Results of routine tests for syphilis were strongly positive, and on repeated examination the eruption had grown further. Skin biopsy specimens showed plasma cells and Treponema pallidum. All symptoms disappeared following antisyphilitic treatment. The possibility of an isomorphic response is discussed.
Oral lesions are not commonly reported with pityriasis rosea (PR). We encountered a patient with clinical and histologic evidence of PR who developed aphthous ulcer-like oral lesions on the buccal mucosa, palate, and tongue. The oral lesions resolved concomitantly with the patient's skin lesions. The previous literature reports a wide variety of oral lesions in association with PR, but few dermatologists, to our knowledge, are aware of such an occurrence.
Pityriasis lichenoides is a notoriously difficult disease to treat. Three patients with this condition and a fourth with lymphomatoid papulosis have been successfully treated with doses of methotrexate once a week. Toxicity noted during the treatment periods has been minimal.
Five patients with a histopathologically confirmed diagnosis of pityriasis lichenoides were treated with PUVA or irradiated with a light source emitting UVB and UVA, without prior intake of psoralens. All patients showed a good response to treatment. Long-term follow up showed that patients remained free of lesions during a period of 20 to 36 months; 3 patients had a recurrence of the disease, though less extensive than before, after 25, 23, and 23 months, respectively.
A patient with longstanding erythroderma and decreased sweat secretion due to the classical adult form of pityriasis rubra pilaris is described. The patient did not respond to oral megadoses of Vitamin A, even though a large increase of liver content of Vitamin A was demonstrated. Retinol-binding protein levels in serum of this patient and his relatives were normal. Danazol (Danatrol, Winthrop) therapy caused an increase of retinol-binding protein level, but clinical improvement did not occur.
A complete study of pityriasis rosea (Gibert) has been performed; this study includes: --a pathological and ultrastructural examination of the skin biopsies; --an immunological study: direct and indirect immunofluorescence (seric anti-cutaneous antibodies); --a virological investigation: ultrastructural examination of the specimens, inoculation of homogenized-skin specimens to 3 cellular cultures; --serological investigations for influenza A, B, parainfluenza 1, 2, 3, adenovirus, respiratory syncitial virus, Mycoplasma pneumoniae, ornithosis-psittacosis, Q-fever, herpes-virus, herpes-virus varicellae, cytomegalovirus, Epstein-Barr virus. All viral investigations had a negative result. Virus or virus-like particle has were not detected on the ultrastructural examinations. A viral infective agent cannot be incriminated as the cause of PRG. However, a large number of PRG patients had antibodies for the Epstein-Barr virus early antigen. The authors are carrying on with this particular investigation.
63 patients with Pityriasis capitis (PC) "dandruff" and Seborrheic dermatitis (SD) as well as normal controls were studied. Antigenicity was checked "in vitro" by the lymphocytic transformation test. A significant transformation in the PC to P. ovale was observed while in SD it was to Stanphyloccocus and P. ovale. In view of results the authors suggest that there is a similar immunoalergic response in the host to those antigens. The clinic will differ according to the antigens. This is significant for a new local treatment and general.
In the Institute of Skin and Veneral Diseases 252 patients suffering from pityriasis rosea were treated yearly since 1970. As opposed to descriptions published so far several differences were observed. The disease occurs not only in young adults, but also in infants and in old age. It may be observed not only in certain months, but throughout the year. The disease becomes manifest more frequently in workers of larger collectives. It does not leave behind prolonged immunity, but may return after an intervall of 1-12 years with milder symptoms. The repeated incidence was 3,57 per cent. Recurrence was observed in two cases within one family. P.r. was followed by herpes zoster in 3 cases, which is indicative of increased susceptibility for viral infection. The point of attack of the supposed pathogen is the pharyngeal mucous membrane, which may explain the difficulty of isolation of the unknown virus as this region has a rich microflora.
Pityriasis rosea is a common, self-limited, scaling disorder of unknown etiology, seen predominantly in young adults. The lesions, typically found on the trunk and proximal extremities, are ovoid, salmon-colored and symmetric. A "herald patch" appears in 70 percent of cases. Variants appear frequently. Papular, urticarial, vesicular or hemorrhagic lesions may be seen. Management with antipruritic lotions, emollients or antihistamines may be necessary to relieve itching.
Pityriasis Alba, a dermatosis whose significance is basically cosmetic, is extremely common and so benign that the majority of patients-dark skinned children and young people do not consult a physician. Nevertheless due to its high incidence and chronicity a large number of patients eventually seek relief. The various treatments currently employed based on a mistaken concept of its etiology are ineffective, though the dermatosis disappears spontaneously after some time. The use of cream containing 2% coal tar., 1% diiodohydroxyquinolin and 0.5% hydrocortisone applied 3 times a day for one month on 29 patients in a double blind trial compared with on the contralateral region, proved to have acceptable results, with a highly significant difference compared with the placebo (P less than 0,0005).
The association of pityriasis rubra pilaris (PRP) with an underlying disease is unusual. A case of a PRP-like eruption presenting as the initial manifestation of acute stem cell leukemia is reported. Other noncutaneous diseases previously reported in association with PRP are reviewed. Other cutaneous lesions associated with leukemia are also briefly described.
Twenty patients with symptomatic and extensive pityriasis rosea were treated with unilateral UV-B phototherapy in a bilateral comparison study. Five consecutive daily erythemogenic exposures resulted in substantially decreased pruritus and extent of disease greater than that on the untreated side in approximately 50% of the patients. Therapy seems to be most beneficial to patients receiving treatment within the first week of the eruption.
We describe two patients with pityriasis rubra pilaris in whom hypertriglyceridemia developed following the oral administration of high-dose vitamin A (retinol). The effects of transient hypertriglyceridemia are unknown, as both patients tolerated high-dose vitamin A therapy with minor, if any, other side effects. Both patients had minimal clinical improvement with this therapy. Patients being treated with 1,000,000 IU of vitamin A each day for ten to 14 days should have frequent determinations of serum lipid levels and liver function during the period of drug administration.
A new synthetic oral retinoid, 13-cis retinoic acid, is fairly well tolerated in patients and appears to be effective in those with Darier's disease and lamellar ichthyosis. It is less effective in those with pityriasis rubra pilaris. The mechanism of action of 13-cis retinoic acid in disorders of keratinization is unknown at the present time; however, it does not appear to cause lysosomal proliferation in therapeutic doses.
Pityriasis rosea (Gibert) is an acute self limited disease with clinically characteristic skin eruptions. In about 20% of cases complications with an atypic clinical picture and a prolonged course are found. Histopathology and ultrastructure of the lesions are not characteristic. The etiology is unknown.