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Updated: Dec 16 2021

Pityriasis Rosea

Images rosea.jpg
  • Snapshot
    • A 20-year-old student presents to the school’s health clinic complaining of a scaly rash on his trunk. He recalls having a mild fever and headaches a few weeks prior, but did not think much of it. The lesions do not itch. He loves to play tennis and spends a lot of time outdoors and wear proper attire during activities. On exam, the lesions are primarily on his central trunk. His sun-exposed arms have no lesions on them.
  • Introduction
    • Common, self-limited papulosquamous eruption
      • three stages of disease
        • herald patch
        • secondary eruption
        • spontaneous resolution
  • Epidemiology
    • Children
    • Young adults
    • Rare above 35 years of age
    • Pathogenesis
      • idiopathic
      • often associated with URI
      • seasonal pattern suggests viral etiology, though not confirmed
        • potential link to herpesvirus types 6 and 7
  • Presentation
    • Symptoms
      • prodrome or URI within a month of onset
      • little or no pruritus
    • Physical exam
      • herald patch, a single lesion
        • usually on the trunk
        • plaque with thin collarette of scale inside the border
      • eruption in 1-2 weeks
        • multiple smaller papules appear in “Christmas tree” distribution
          • oriented along Langer (skin cleavage) lines
        • rose-colored or violet
        • common clustering in lower abdominal and pubic area
      • resolution in 4-12 weeks
        • resolves spontaneously without scarring
        • may have post-inflammatory hypo- or hyper-pigmentation
  • Evaluation
    • Diagnosis from clinical exam and history
    • Diagnosis confirmed with skin biopsy
      • potassium hydroxide preparation to exclude Tinea spp. infections (Tinea versicolor and Tinea corporis)
    • If sexually active and palms and soles involved
      • serologic testing for secondary syphilis
  • Differential
    • Tinea corporis
    • Secondary syphilis (esp if palm and soles involved)
    • Tinea versicolor
    • Drug eruption
    • Guttate psoriasis
  • Treatment
    • Observation
      • lesions heal within 4-12 weeks
    • To hasten recovery
      • UVB from natural sunlight or in the dermatology office
      • oral erythromycin
    • If itchy
      • antihistamines
      • topical steroids
  • Complications
    • Post-inflammatory pigmentary changes
    • Relapse
  • Prognosis
    • Very good
    • Typically self-limited and self-resolving in 4-12 weeks
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