Pityriasis Rosea

Aka: Pityriasis Rosea

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II. Epidemiology

  1. Incidence: 170 per 100,000 persons/year
  2. Ages 10 to 50 years (peaks age 20 to 30 years)
  3. No gender predisposition
  4. Seasonal variation: more common in spring and fall
  5. Higher risk in pregnancy (RR 3)
    1. Associated with increased Miscarriage rate before 15 weeks gestation (see below)

III. Pathophysiology

  1. Papulosquamous eruption
  2. Thought to be of infectious etiology (Viral Exanthem)
    1. May be associated with reactivation of Human Herpes Virus 6 (Roseola Infantum, HHV-6) or HHV-7
    2. Campolat (2009) J Eur Acad Dermatol Venereol 23(1): 16-21 [PubMed]

IV. Symptoms

  1. Moderate to Severe Pruritus (25-50% of cases)
    1. Especially in children
  2. Other symptoms present in only 5% of patients
  3. Viral prodrome-type constitutional symptoms may occur with mild URI symptoms
    1. Headache
    2. Malaise
    3. Arthralgias
    4. Chills
  4. Nervousness
  5. Gastrointestinal symptoms
    1. Vomiting
    2. Diarrhea or Constipation

V. Signs

  1. Herald Patch (initial presenting lesion in 80-90% of patients)
    1. Single oval Macule or patch on trunk
    2. Diameter: 2 to 10 cm
    3. Characteristics: Annular Lesion (oval)
      1. Erythematous (rose colored) border with fine peripheral scale
      2. Central clearing
  2. Christmas tree pattern rash
    1. Onset occurs 7-14 days after herald patch
    2. Lesions may continue to appear for up to 6 weeks after onset
    3. Symmetric bilaterally
    4. Smaller than herald patch (<1 cm)
    5. Rash follows skin Cleavage Lines (Langer Lines)
      1. Christmas-Tree distribution on back
      2. V-Shaped distribution on the chest
    6. Individual lesions appear similar to herald patch
      1. Small fawn or salmon colored oval Macules
      2. Peripheral scaly collarettes
      3. Central clearing
  3. Darker skin: Black Children
    1. More facial (30% of cases) and scalp involvement
    2. Post-inflammatory pigment changes take place in nearly two thirds of patients
  4. Variants: Atypical Pityriasis Rosea
    1. Pityriasis Rosea Gigantea of Darier
      1. Fewer, but larger lesions
    2. Inverse Pityriasis Rosea
      1. Lesions primarily involve face, axilla, groin
    3. Pityriasis Rosea of Vidal
      1. Large patches involve the axillae or inguinal region

VI. Differential Diagnosis: Medical Conditions

  1. See Annular Lesion
  2. Viral Exanthem
  3. Seborrheic Dermatitis
  4. Secondary Syphilis
    1. Unlike pityriasis, Syphilis affects palms and soles
  5. Nummular Eczema
  6. Tinea Corporis
    1. Typically a single lesion (may be confused with herald patch)
    2. Once Christmas Tree pattern of lesions develops, Pityriasis diagnosis becomes more obvious
  7. Guttate Psoriasis
  8. Lichen Planus

VII. Associated Conditions: Medications associated with Pityriasis Rosea Eruptions

  1. Adalimumab (Humira)
  2. Allopurinol
  3. Arsenic
  4. Asenaprine
  5. Atenolol
  6. Barbiturates
  7. BCG vaccine
  8. Bismuth
  9. Bupropion
  10. Captopril
  11. Clonidine
  12. Clozapine
  13. Ergotamine
  14. Gold
  15. Hepatitis B Vaccine
  16. Imatinib (Gleevec)
  17. Interferon alfa
  18. Influenza Vaccine
  19. Isotretinoin
  20. Ketotifen
  21. Lamotrigine (Lamictal)
  22. Lisinopril
  23. Nortriptyline
  24. Omeprazole (Prilosec)
  25. Pneumovax Vaccine
  26. Rituximab
  27. Smallpox Vaccine
  28. Terbinafine
  29. Yellow Fever Vaccine

VIII. Labs

  1. Syphilis Serology (RPR)
  2. Skin biopsy for direct fluorescent Antibody
    1. Indicated only if Syphilis strongly considered
    2. Pityriasis Rosea will show dyskeratotic degeneration

IX. Management (No effective treatment)

  1. Severe Pruritus
    1. See Pruritus Management
    2. Topical Corticosteroid
    3. Oral Antihistamine
    4. Calamine lotion or Zinc Oxide
  2. Severe Cases
    1. Ultraviolet A Light
    2. Ultraviolet B Light
    3. Systemic Corticosteroids
    4. Acyclovir
      1. Adult standard dosing: 800 mg orally five times daily for 7 days (400 mg may also be effective)
  3. Disproven treatments
    1. Macrolides (e.g. Erythromycin) are now not thought to be effective

X. Complications

  1. Associated with Miscarriage (57%) when presents in the first 15 weeks of pregnancy
    1. Drago (2014) J Am Acad Dermatol 71(1): 198-99 [PubMed]

XI. Course

  1. Spontaneous resolution within 6 to 8 weeks in 80% cases (range 2-12 weeks duration)
  2. Recurrence in less than 3%

XII. References

  1. Allen (1995) Cutis 56:198-202 [PubMed]
  2. Allmon (2015) Am Fam Physician 92(3): 211-6 [PubMed]
  3. Chuh (2016) J Eur Acad Dermatol Venereol 30(10): 1670-81 [PubMed]
  4. Hsu (2001) Am Fam Physician 64(2):289-96 [PubMed]
  5. Kempf (2000) Arch Virol 154(8):1509-20 [PubMed]
  6. Stulberg (2004) Am Fam Physician 69:97-94 [PubMed]

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Related Studies

Ontology: Pityriasis Rosea (C0032026)

Definition (NCI) A mild, self-limited skin disorder that is most commonly seen in children and young adults. It is characterized by an initial large round spot on the chest, abdomen, or back, often referred to as a herald patch, that is usually followed within a week by a distinctive pattern of similar but smaller papules on the torso, arms, and legs. There may also be itching, especially when overheated.
Definition (MSH) A mild exanthematous inflammation of unknown etiology. It is characterized by the presence of salmon-colored maculopapular lesions. The most striking feature is the arrangement of the lesions such that the long axis is parallel to the lines of cleavage. The eruptions are usually generalized, affecting chiefly the trunk, and the course is often self-limiting.
Concepts Disease or Syndrome (T047)
MSH D017515
ICD9 696.3
ICD10 L42
SnomedCT 156373006, 77252004
French PITYRIASIS ROSE, Pityriasis rosé, Pityriasis rosé de Gibert
English PITYRIASIS ROSEA, Pityriasis Rosea, pityriasis rosea (diagnosis), pityriasis rosea, Pityriasis Rosea [Disease/Finding], pityriasis roseas, rosea pityriasis, Pityriasis rosea, Pityriasis circinata et maculata, PR - Pityriasis rosea, Pityriasis rosea (disorder), Gibert, circinata; pityriasis, pityriasis; circinata, pityriasis; rosea, rosea; pityriasis, Pityriasis circinata
Spanish pitiriasis rosada de Gibert, pitiriasis de Gibert, pitiriasis maculosa y circinada, pitiriasis rosada de Gibert (trastorno), pitiriasis rosada, Pitiríasis rosada, Pitiriasis Rosada
Japanese ばら色粃糠疹, ﾊﾞﾗｲﾛﾋｺｳｼﾝ
Swedish Pityriasis rosea
Czech pityriasis rosea, Pityriasis rosea
Finnish Punatäplähilseily
Russian PITIRIAZ ROZOVYI, ПИТИРИАЗ РОЗОВЫЙ
Portuguese PETIRIASE ROSADA, Pitiríase Rósea, Pitiríase rosada
Korean 장미색 잔비늘증(비강진)
Polish Łupież różowy
Hungarian Pityriasis rosea
Norwegian Fransk rosen, Pityriasis rosea
Dutch circinata; pityriasis, pityriasis; circinata, pityriasis; rosea, rosea; pityriasis, pityriasis rosea, Pityriasis rosea
German Pityriasis rosea
Italian Pitiriasi rosea
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Hyperplastic Skin Disorders

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