Pityriasis Rosea: An Updated Review

Abstract

Background: Pityriasis rosea is a common acute, self-limited papulosquamous dermatosis that primarily affects children and young adults. The condition and its clinical variants may pose a diagnostic challenge, especially in the absence of the herald patch. Objective: This article aimed to familiarize pediatricians with clinical manifestations, evaluation, diagnosis, and management of pityriasis rosea. Methods: A search was conducted in March 2020 in Pubmed Clinical Queries using the key term " pityriasis rosea". The search strategy included all clinical trials (including open trials, non-randomized controlled trials, and randomized controlled trials), observational studies, and reviews (including narrative reviews and meta-analyses) published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. Results: Pityriasis rosea occurs mainly in individuals between 10 and 35 years of age with a peak during adolescence. Human herpesvirus (HHV)-7 and HHV-6 have been implicated as the causative agents in some patients with pityriasis rosea. A mild prodrome consisting of headaches, fever, malaise, fatigue, anorexia, sore throat, enlarged lymph nodes and arthralgia is present in about 5% of patients. The most common presenting sign, found in approximately 80% of patients, is a "herald" or “mother” patch which is larger and more noticeable than the lesions of the later eruption. A generalized, bilateral, symmetrical eruption develops in approximately 4 to 14 days and continues to erupt in crops over the next 12 to 21 days. Typical lesions are 0.5 to 1 cm, oval or elliptical, dull pink or salmon-colored macules with a delicate collarette of scales at the periphery. The long axes tend to be oriented along the skin lines of cleavage (Langer lines). Lesions on the back may have a characteristic “Christmas tree” whereas lesions on the upper chest may have a V-shaped pattern. There are many conditions that may mimic pityriasis rosea. Pityriasis rosea in the absence of the herald patch and its variants may pose a diagnostic challenge. The typical course is 6 to 8 weeks. In the vast majority of cases, reassurance and symptomatic treatment should suffice. Active intervention may be considered for individuals with severe or recurrent pityriasis rosea and pregnant women with the disease. Treatment options include acyclovir, macrolides (in particular, erythromycin), and ultraviolet phototherapy. If active intervention is needed, there is evidence supporting the use of oral acyclovir to shorten the duration of illness. Conclusion: Pityriasis rosea is a common, acute, self-limiting exanthematous skin disease that primarily affects children and young adults. The condition is characterized by a "herald patch" after which oval erythematous squamous lesions appear along Langer's lines of cleavage on the trunk and proximal extremities, giving it a “Christmas tree” appearance. The disease presenting in its classical form can easily be diagnosed. Clinical variants of the disease may pose a diagnostic challenge for the general pediatrician. Knowledge of the disease is essential to allow a prompt diagnosis and to avoid unnecessary investigations.

Pityriasis rosea‐like cutaneous eruption as a possible dermatological manifestation after Oxford‐AstraZeneca vaccine: Case report and brief literature review

“…Diagnosis of typical PR, with Christmas tree‐shaped truncal involvement, is not difficult for doctors like dermatologists or general pediatrician however, its atypical presentations can be challenging even for these professionals. 13 In the typical form diagnostic doubts hardly arise but, as 20% of the cases present atypically, this can favor unnecessary procedures and drug prescriptions. 34 Although it usually demonstrates a truncal predilection, this presentation may be absent in some patients who instead exhibit atypical features and distributions such as only lesions located in the extremities, 12 as seen in this case report.…”

“…The initial phase is characterized by salmon‐colored plaques, in the clinical phase a scaling begins and finally, the healing process is characterized by the lightening of the spots. 11 , 12 , 13 , 14 The evolution can vary from 6 to 8 weeks and can last from 3 to 6 months. Regression is spontaneous, leaving changes in skin color that disappear over the months.…”

Six cases of pityriasis rosea following SARS‐CoV‐2 vaccination with BNT162b2

“…It is a self-limiting condition but can cause itching and discomfort [9]. Possible triggers for PR or PR-like rash include insect bites, viral infections (including SARS-CoV-2) [10] and many different drugs [9]. Interestingly, vaccinations have been reported to be an important triggering factor, and a PR-like rash has been reported after influenza, hepatitis B, smallpox, Bacillus Calmette-Guerin, diphtheria, and pneumococcus vaccines [11][12][13].…”

Sechs Fälle von Pityriasis rosea nach SARS‐CoV‐2‐Impfung mit BNT162b2

“…Pityriasis rosea ist eine papulosquamöse Hauterkrankung, die mit der Reaktivierung des humanen Herpesvirus (HHV) 6/7 in Verbindung gebracht wird. Sie ist selbstlimitierend, kann jedoch Juckreiz und Unbehagen verursachen [9]. Mögliche Auslöser für PR oder PR-ähnlichen Ausschlag sind Insektenstiche, Virusinfektionen (einschließlich SARS-CoV-2) [10] und eine Vielzahl verschiedener Medikamente [9].…”

“…Weedon et al fanden bei 3465 KA in 5,7 % der Fälle ein PEK [8]. Eine weitere Gruppe fand bei 380 "krateriformen" epidermalen Tumoren KA-ähnliche Bilder in 259 Läsionen, wovon 45 (17,4 %) PEK-Komponenten aufwiesen [9]. UV-Schädigung…”