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PubMed2004

Pityriasis rosea.

Pityriasis rosea is a common, acute exanthem of uncertain etiology. Viral and bacterial causes have been sought, but convincing answers have not yet been found. Pityriasis rosea typically affects children and young adults. It is characterized by an initial herald patch, followed by the development of a diffuse papulosquamous rash. The herald patch often is misdiagnosed as eczema. Pityriasis rosea is difficult to identify until the appearance of characteristic smaller secondary lesions that follow Langer's lines (cleavage lines). Several medications can cause a rash similar to pityriasis rosea, and several diseases, including secondary syphilis, are included in the differential diagnosis. One small controlled trial reported faster clearing of the exanthem with the use of erythromycin, but the mechanism of effect is unknown. Resolution of the rash may be hastened by ultraviolet light therapy but not without the risk of hyperpigmentation. Topical or systemic steroids and antihistamines often are used to relieve itching.

Adult↗

PubMed2006

Pityriasis rosea-like adverse reaction: review of the literature and experience of an Italian drug-surveillance center.

Pityriasis rosea is a common, acute eruption of uncertain etiology. A rash very similar to this idiopathic disease is also attributed to several drugs, and recovery, which depends on withdrawal of the responsible drug, can be delayed by its late identification. A prospective study to record all cases of adverse cutaneous reactions presenting with pityriasis rosea like manifestations was conducted at the center for drug-surveillance of the dermatology department of Cagliari University. We developed an intensive surveillance program from June 2002 to May 2005, adopting the WHO Collaborating center for Drug Monitoring causality assessment criteria and algorithm. Eight cases, six male and two female, were studied in a 3-year period. None had previously suffered from drug intolerance or allergy. Clinical manifestations were very similar to pityriasis rosea. Responsible drugs were mainly angiotensin-converting enzyme inhibitors, alone or in combination with hydrochlorothiazide, followed by one case each for hydrochlorothiazide plus sartan, allopurinol, nimesulide, acetyl salicylic acid. Recovery was obtained in all cases with drug withdrawal. Final causality assessment was probable for all eruptions. Frequency of drug pityriasis rosea-like eruptions is probably underreported. The mildness of the eruption, mimicking a very common and self-limiting disease does not prompt physicians to verify the use of medications until persistence, severity of lesions and itching require re-evaluation of the original diagnosis.

Adult↗

PubMed1979

[Multiple basaliomas in pityriasis rubra pilaris].

This is a report of a 73 year old patient with pityriasis rubra pilaris and multiple basal cell carcinomas which especially appeared on the face. One of the tumors was located in the anal and perianal region. This is the first report of basal cell carcinomas in a patient with pityriasis rubra pilaris. Further observations will clarify whether there exists a closer relationship between the presence of basal cell carcinoma and pityriasis rubra pilaris. Therefore more attention should be paid to the existence of basal cell carcinoma in patients with pityriasis rubra pilaris.

Aged↗

PubMed1995

Familial pityriasis rubra pilaris.

BACKGROUND: Familial pityriasis rubra pilaris is a rare autosomal dominant skin disorder. Four individuals from one family are described who demonstrate clinical features compatible with a diagnosis of familial pityriasis rubra pilaris. Results of light and electron microscopic, immunocytochemical, and biochemical analysis of skin biopsy specimens from three of these four individuals are presented. OBSERVATIONS: All affected individuals demonstrated erythematous scaly skin with follicular prominence and islands of sparing. Inheritance was consistent with an autosomal dominant trait. Light and electron microscopic findings were compatible with those reported in sporadic cases of pityriasis rubra pilaris. Immunocytochemistry showed suprabasal staining with monoclonal antibody AE1. Immunoblot analysis revealed abnormal keratins with K6/16 expression, the possibility of an abnormal K14 or K16, and a 45-kd acidic keratin not normally expressed in epidermis. Because similar biochemical analyses have not been reported previously in other cases of pityriasis rubra pilaris (familial or sporadic), comparisons cannot be made. CONCLUSIONS: The observations suggest that the cutaneous abnormality in this family extends beyond clinical and morphological alterations to abnormalities in biochemical markers of epidermal differentiation.

Adult↗

PubMed2002

Efficacy of itraconazole in the prophylactic treatment of pityriasis (tinea) versicolor.

BACKGROUND: Pityriasis (tinea) versicolor has a high tendency to recur after being treated successfully. Prophylactic treatment to reduce recurrence is needed. OBJECTIVE: To determine whether recurrence of pityriasis versicolor could be prevented by prophylactic itraconazole treatment. DESIGN: Open treatment followed by a randomized, double-blind, placebo-controlled phase. SETTING: Multinational outpatient centers. PATIENTS: A total of 239 consecutive patients were included; 238 started open treatment. A total of 209 patients started prophylactic treatment: 106 in the itraconazole group and 103 in the placebo group. INTERVENTIONS: Open treatment: itraconazole, 200 mg once daily for 7 days. Prophylactic treatment: itraconazole, 200 mg, or placebo twice daily 1 day per month for 6 consecutive months. MAIN OUTCOME MEASURES: Mycological cure rates at the end of open treatment and at the end of prophylactic treatment. RESULTS: Mycological cure at the end of open treatment was 92% (205/223). At the prophylactic treatment end point (6 months), mycological cure was 88% (90/102) in the itraconazole group and 57% (56/99) in the placebo group (P<.001). In open treatment, 11 patients were not able to be evaluated for efficacy. In prophylactic treatment, 4 patients in the itraconazole group and 4 in the placebo group were not able to be evaluated. Adverse events were reported during open treatment by 26 patients (11%) and during prophylactic treatment by 17 (16%) in the itraconazole group and 14 (14%) in the placebo group. No patients experienced any serious adverse events. CONCLUSIONS: Prophylactic itraconazole treatment is efficacious for pityriasis versicolor after 6 months, as is itraconazole in the treatment of pityriasis versicolor.

Adolescent↗

PubMed2004

Treatment of pityriasis versicolor in the United States.

BACKGROUND: Pityriasis versicolor is a common chronic superficial fungal infection of the skin. OBJECTIVE: The purpose of this study is to determine the frequency of visits for pityriasis versicolor and to assess how it is currently being treated. METHODS: Data from the National Ambulatory Medical Care survey were used from the years 1990-1999. RESULTS: There were 2.9 million visits per year in which pityriasis (tinea) versicolor was listed as a diagnosis; this corresponds to a visit rate of 110 visits per 100,000 persons per year. Visit rates varied among racial and ethnic groups, with the highest visit rates for black people and American Indians/Eskimos. A total of 76% of the medications listed at visits for pityriasis versicolor are FDA approved for the condition; however, many treatments that were prescribed were not. CONCLUSIONS: Given that as many as one-quarter of treatments prescribed for this easily treatable condition are inappropriate, continued education of medical practitioners concerning appropriate treatment options is needed.

Ambulatory Care↗

PubMed2001

Epidemiology of Malassezia yeasts associated with pityriasis versicolor in Ontario, Canada.

The genus Malassezia was recently revised to include seven species, but the clinical significance of each of these species is not clearly understood. To obtain a better understanding of the contribution of individual Malassezia species to the epidemiology of pityriasis (tinea) versicolor, we used Leeming-Notman medium to culture patient skin specimens showing positive evidence of Malassezia infection in direct microscopy. Isolates were identified on the basis of recently published morphological and physiological tests for distinction of the new species. Identification using recently developed molecular criteria was also carried out for the ambiguous cases. Malassezia species were cultured from 111 cases of pityriasis versicolor in the Canadian province of Ontario. The most frequently isolated species were Malassezia sympodialis, M. globosa and M. furfur which respectively made up 59.4%, 25.2% and 10.8% of the isolated etiological agents. M. globosa was commonly isolated from a small number of pityriasis versicolor specimens obtained from investigators outside Canada. A large number of additional Ontario specimens with positive direct microscopy failed to yield a culture; however, it is suggested that this is consistent with the standard sampling practice of scraping the older portions of pityriasis lesions rather than the margins, where viable fungal cells are most likely to occur.

Canada↗

PubMed1994

Cell-mediated immune responses to Malassezia furfur serovars A, B and C in patients with pityriasis versicolor, seborrheic dermatitis and controls.

It has been postulated that patients with Malassezia furfur-associated dermatoses have a deficient cell-mediated immune response to M. furfur. This study examined the cell-mediated immune responses to M. furfur serovars A, B and C of 10 patients with pityriasis versicolor and 10 age- and sex-matched controls; and 10 patients with seborrheic dermatitis and 10 age- and sex-matched controls. The responses to each serovar of M. furfur were assessed using the lymphocyte transformation assay and the leukocyte migration inhibition assay. The lymphocyte transformation responses of the patients with pityriasis versicolor to M. furfur serovars A, B and C (0/10, 6/10 and 5/10 respectively) were not significantly different from those of controls (0/10, 2/10 and 1/10). However, for patients with seborrheic dermatitis, significantly more patients' lymphocytes responded to serovars B and C (6/10 and 6/10 respectively) than those of controls (1/10 and 1/10). No patient or control responded to serovar A. In the leukocyte migration inhibition assay, the leukocytes from a greater proportion of patients with pityriasis versicolor (5/7) responded to serovar B than controls (2/10); and the leukocytes from a greater proportion of patients with seborrheic dermatitis (4/10) responded to serovar C than controls (0/9). Thus, this data did not indicate the presence of any cell-mediated immune deficiency to M. furfur in patients with pityriasis versicolor or seborrheic dermatitis, as measured by the lymphocyte transformation assay or the leukocyte migration inhibition assay. The greater responsiveness of T lymphocytes from patients may indicate that T lymphocytes might be involved in the pathogenesis of these diseases.

Adult↗

PubMed1997

Pityriasis versicolor: clinical experience with Lamisil cream and Lamisil DermGel.

Pityriasis versicolor is a chronic superficial fungal disease usually located on the upper trunk, neck or upper arms. Terbinafine is an orally and topically active allylamine antifungal derivative with a broad antifungal spectrum. Several studies have documented the high activity of terbinafine (Lamisil) cream in the treatment of pityriasis versicolor, with cure rates of 79-100% after 2-4 weeks of treatment. Lamisil emulsion gel (Lamisil DermGel) is a new topical formulation that remains in the skin in high concentrations for several months after just 1 week of application. Recently, in a prospective, double-blind, placebo-controlled, randomised, parallel-group, comparative, multicentre study, we have treated patients with pityriasis versicolor with either terbinafine 1% emulsion gel (Lamisil DermGel) or placebo gel. Sixty-one patients were included, 31 in the Lamisil DermGel group and 30 in the placebo gel group. The gel was applied once daily for 7 days and the patients were followed up for 8 weeks. Twenty-eight patients in the active and 29 patients in the placebo group were evaluable for efficacy. Using the intent-to-treat efficacy analysis, 21/28 (75%) were cured in the Lamisil-DermGel-treated group compared to 4/29 (14%) in the placebo group. No side-effects were seen. In conclusion, Lamisil DermGel was well tolerated and superior to placebo in the treatment of pityriasis versicolor when applied once daily for 7 days.

Administration, Topical↗

PubMed1977

[Pityriasis versicolor in Greece and its predisposition factors].

The age and seasonal incidence of 2610 patients with pityriasis versicolor in Greece were studied. Determination of the pH of Na and K ions of the sweat and the microbiol flora of the skin of pityriasis versicolor patients was undertaken. Besides these the effectiveness of a 1% selenium disulfid suspension was tested. The results indicate that the age groups of 20-29 and 30-30 years are mostly affected by the disease. A high incidence of the skin manifestation was noted during the summer and fall months. A difference of the pH of the sweat between pityriasis versicolor and healthy controls was observed, but no difference was found in the Na and K ions of the sweat among these two groups. Neither did the microbial flora from the skin lesions of patients and from corresponding sites of controls show any difference. The high relapse in this experiment indicates the relative ineffectiveness of selenium disulfid preparations when used as a 1% suspension in the treatment of pityriasis versicolor.

Adolescent↗

PubMed1993

Pityriasis versicolor.

The lipophilic yeast Pityrosporum ovale is both a member of the normal human cutaneous flora in adults and the etiological agent of pityriasis versicolor. Pityriasis versicolor develops under the influence of predisposing factors. The presence of these factors are also the reason for the high rate of recurrence seen in pityriasis versicolor and for its chronicity. There are numerous ways of treating pityriasis versicolor topically and systemically. Propylene glycol 50% in water is effective and cheap, but the imidazoles and the older antidandruff shampoos as well as two new antifungals: ciclopiroxolamine and terbinafine are also effective topically. However, short-term oral treatment with ketoconazole, itraconazole or fluconazole are very effective and the risk for side effects minimized with short treatment regiments. The patient compliance is also higher with oral treatment. The recurrence rate is very high, and to avoid this a prophylactic treatment schedule (eg, ketoconazole) one 200 mg tablet on three consecutive days every month or a single dose of 400 mg every month are effective.

Administration, Cutaneous↗

PubMed1983

Pityriasis rotunda. A cutaneous sign of malignant disease in two patients.

The term pityriasis rotunda refers to strikingly circular scaly lesions, with the histologic appearance of ichthyosis vulgaris. Pityriasis rotunda has been described in the Japanese, South African blacks, and West Indian blacks. The condition occurs only in association with certain serious systemic illnesses, usually tuberculosis, or malignant neoplasms or less severe diseases of the female genital tract (eg, fibroids, ovarian cyst). We describe two South African blacks with pityriasis rotunda and neoplasms. The cutaneous lesions cleared when the primary neoplasm was treated.

Black People↗

PubMed2002

[Myerson nevus as a primary patch of Gibert pityriasis rosea. A case report].

UNLABELLED: There are only few articles in literature which discuss the association between Meyerson's naevi and Pityriasis rosea. And when so, the discussion is done in a controversial way. Here an 18 year old man is presented who visits the outpatient clinic. He has a ten day history of a solitary Meyerson's naevus on his back. Over the next three weeks this naevus will develop to the typical herold patch followed by the classical exantheme of Pityriasis rosea. CONCLUSION: Halo dermatitis associated with Pityriasis rosea don't represent Meyerson's naevi. But they reflect the rare "nevocentric" property of a not so rare dermatose.

Adolescent↗

PubMed1995

UVB phototherapy for pityriasis rosea: a bilateral comparison study.

BACKGROUND: Pityriasis rosea is a common self-limiting disease. UV light has been mentioned as helpful, but only a few studies substantiate this possibility. OBJECTIVE: Our purpose was to evaluate the clinical efficacy of UVB phototherapy in pityriasis rosea and the course of the disease after treatment. METHODS: Seventeen patients with extensive pityriasis rosea were treated with unilateral UVB phototherapy in a bilateral comparison study. One joule of UVA was used as a "placebo" on the untreated side. The treatments were given five times per week for 2 weeks. The rate of clearing was monitored by estimation of the severity score. RESULTS: Ten daily erythemogenic exposures of UVB resulted in substantially decreased severity of disease, greater than that on the untreated side in 15 of 17 patients. The overall reduction of severity score showed a significant difference after the third treatment; the UVB irradiation was superior. However, during the follow-up period the two sides were indistinguishable in regard to severity score (p = 0.6784). No significant difference in pruritus was noted between the two sides (p > 0.1638). The duration of disease did not relate to the success of UVB phototherapy. CONCLUSION: During the treatment period UVB phototherapy resulted in decreased severity of disease. However, the itching and the course of the disease were unchanged.

Adult↗

PubMed2006

Pityriasis lichenoides and its subtypes.

Pityriasis lichenoides represents a unique group of inflammatory skin disorders that include pityriasis lichenoides et varioliformis acuta (PLEVA), febrile ulceronecrotic Mucha-Habermann disease (a subtype of PLEVA), and pityriasis lichenoides chronica. The history, epidemiology, clinical features, pathophysiology, and treatment of this group of conditions are reviewed in this manuscript.

Humans↗

PubMed2006

Oral pityriasis rubra pilaris.

Pityriasis rubra pilaris is a chronic, papulosquamous dermatosis of unknown etiology. Oral mucosal involvement of this condition is rare with only 3 previously reported cases in the English literature. A case of a 68-year-old man with pityriasis rubra pilaris with involvement of tongue and palate is presented. Clinical features, histopathologic features, and management of pityriasis rubra pilaris are discussed. We hereby present an additional case, the fourth worldwide, and review the literature.

Aged↗

PubMed2000

Erythromycin in pityriasis rosea: A double-blind, placebo-controlled clinical trial.

BACKGROUND: The study stemmed from an incidental observation of improvement in 2 patients with pityriasis rosea while receiving erythromycin. OBJECTIVE: The purpose of the study was to evaluate the efficacy of erythromycin in patients with pityriasis rosea. METHODS: A double-blind, placebo-controlled clinical study was performed in an outpatient setting in a major hospital. Ninety patients over a period of 2 years were alternatively assigned to treatment group or placebo group. Patients in the treatment group received erythromycin in divided doses for 14 days. The response was categorized as complete response, partial response, or no response. All patients were followed up for 6 weeks. RESULTS: Both groups were comparable with regard to age at presentation, sex, and average duration of disease at the time of reporting to the clinic. Upper respiratory tract infection before the appearance of skin lesions was reported in 68.8% of all patients. Complete response was observed in 33 patients (73.33%) in the treatment group and none in the placebo group (P <.0001). CONCLUSION: Oral erythromycin was effective in treating patients with pityriasis rosea.

Administration, Oral↗

PubMed1986

The nails in adult type 1 pityriasis rubra pilaris. A comparison with Sézary syndrome and psoriasis.

The fingernails of twenty-four patients with classical adult (type 1) pityriasis rubra pilaris were examined for changes in nail morphology and a comparison was made with the fingernail morphology of twenty-seven consecutive psoriatic patients with nail changes. Distal yellow-brown discoloration, subungual hyperkeratosis, nail plate thickening, and splinter hemorrhages indicate a diagnosis of type 1 pityriasis rubra pilaris rather than psoriasis, while onycholysis (particularly marginal), salmon patches, small pits, and larger indentations of the nail plate indicate a diagnosis of psoriasis. Histology demonstrated that a nail biopsy would be a useful diagnostic procedure if nails were involved in isolation but provided no additional diagnostic features to those found from biopsy specimens of involved skin in the two conditions. The similarity in nail morphology between the type 1 pityriasis rubra pilaris patients and five patients with chronic erythroderma resulting from Sézary syndrome indicated that these changes may represent a nonspecific reaction pattern that may result from prolonged erythema of the proximal nail bed and matrix. The rough nails (trachyonychia) described in advanced Sézary syndrome were not observed in any of our patients.

Humans↗