Pityriasis Rosea
Husein Oozeerally
Pityriasis rosea
• Originally described by Camille
• Melchior Gibert in 1860
• Pityriasis: fine scales
• Rosea: rose coloured or pink
• Benign Self limiting but associated with
increased miscarriage in first 15 wks of
pregnancy
Pityriasis Rosea
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2 % of OP visits
F>M
Children and young adults (10-35yr)
0.15% prevalence
No racial variation (lesion colour)
Seasonal outbreaks and climatic variation
Institutional outbreaks
Pityriasis Rosea
• Uncertain cause
• Possible viral trigger
– HHV 6 HHV 7
– Not contagious
• Life long immunity after outbreak
Initially….
• Prodromal symptoms
– Malaise
– Headache
– Mild constitutional symptoms
– Respiratory infection in 69%
Then..
• “Herald patch”
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Large (2 - 10cm)
Isolated
Single or multiple
Oval
Pink
Scaly
Central clearing occasionally (mimic tinea)
• Cluster of small oval spots (mimic acne)
• Location abdomen (occn armpit)
Images
5 to 10 days later
• Smaller lesion appear on the body
• Trunk (sometimes thighs)
• Occasionally on face, palms and soles
– African american boys
– Termed inverse pityriasis
Progression
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Small round papules
> enlarge to1-2cm ovals
Scaly surface
Raised or flat
Hyper or hypo pigmented
Run along dermatomal lines/ribs giving
Christmas tree distribution
4 to 6 weeks
• Begins to fade
• Lasts average 2 - 3 months
Differential
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Viral Exanthems
Measle like drug eruptions
Secondary syphilis
Tinea (KOH test negative)
Guttate psoriasis
Diagnosis
• Experienced Clinician!!!
• A biopsy of lesion show erthrocytes with
dermal papillae and dyskeratotic cells within
the dermis
Management
No treatment but…….
Symptom relief from itching
Avoided soap
Oral erythromycin
UVB light (used in the first week)may hasten the
disappearance
The END
• Summary
– Common
– Benign
– Self limiting (no tx)
References
• Atlas of Pedistric Physical Diagnosis
Zitelli 5 ed
• Emedicine Medscape www