Pediatric Pityriasis Rosea 

  • Author: Maria R Nasca, MD, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 3, 2011
 

Background

Pityriasis rosea (PR) was first described by Camille Melchior Gilbert in 1860. The term pityriasis rosea means fine pink scale. It is a common skin disorder observed in otherwise healthy people, most frequently children and young adults. Pityriasis rosea manifests as an acute, self-limiting, papulosquamous eruption with a 6-week to 8-week duration. It may sometimes occur in atypical variants or may mimic other skin disorders, such as secondary syphilis.[1, 2, 39] Guidelines for diagnosing syphilis (and distinguishing the roseola from pityriasis rosea) have been established.[3]

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Pathophysiology

The specific cause of the disorder remains unclear; however, its seasonal occurrence, clinical course, possibility of epidemic occurrence, presence of occasional prodromal symptoms, and infrequent likelihood of recurrences have all suggested an infectious viral etiology.

The disease has been associated with recent upper respiratory infections. Increased incidence among groups with close physical contact (eg, families, students, military personnel) has been reported. A higher incidence among patients with decreased immunity (eg, pregnant women, bone marrow transplant patients) has also been noted. Additionally, ampicillin has been found to increase the distribution of the eruption; this phenomenon bears a striking resemblance to the effect of ampicillin on the rash of infectious mononucleosis. Finally, some immunological findings, including the presence of immunoglobulin (Ig)M directed against keratinocytes or the increase of Langerhans cells and CT4 T lymphocytes in the dermal infiltrate of patients with pityriasis rosea also support the pathogenetic role of a transmissible agent.[36]

Many common infectious microorganisms have been considered (eg, influenza A, B, and H1N1; parainfluenza I, II, and III; Epstein-Barr virus; parvovirus B19; cytomegalovirus; herpesviruses 1, 2, and 8; Mycoplasma) and have been shown not to be causative. Recent reports using polymerase chain reaction (PCR) analysis have suggested a role for human herpesvirus (HHV)-7 and HHV-6 but this has not been confirmed in later studies.[4, 5, 6, 7, 34, 8, 9, 10, 11, 26, 29, 33, 37]

Despite the prevailing opinion that pityriasis rosea is caused by an infectious agent, it does not appear to be very contagious; household contacts and schoolmates usually do not develop the disease.

Pityriasis rosea–like eruptions can also occur in association with many drugs. These include acetylsalicylic acid, barbiturates, bismuth, captopril, clonidine, gold, imatinib, isotretinoin, ketotifen, levamisole, metronidazole, omeprazole, D-penicillamine, terbinafine, and Bacillus Calmette-Guérin or diphtheria vaccine. Anti TNF-alpha agents such as adalimumab and etanercept have also been implicated.[12, 35] Drug-induced pityriasis rosea often lasts longer than non–drug-induced pityriasis rosea.

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Epidemiology

Frequency

United States

An estimated frequency of 0.13-0.14% has been reported, with a 0.3-3% prevalence at dermatologic centers.

International

Pityriasis rosea accounts for approximately 2% of outpatient visits in dermatology. It is present worldwide and occurs year round, although it may be more common in the fall and spring. In some geographic areas, such as India, Malaysia, and Australia, it may be more frequent in the dry hot season.

Mortality/Morbidity

Pityriasis rosea is a self-limiting, benign disorder with a recurrence rate of less than 3%. It usually lasts for 6-8 weeks but can last as long as 3-6 months. Postinflammatory pigment changes are common, especially in black people. Bacterial superinfections are rarely observed. In pregnant women, it has sometimes been associated with miscarriage (if occurring within the first 15 wk of pregnancy), or premature delivery, neonatal hypotonia and hyporeactivity.[13]

Race

Pityriasis rosea shows no racial specificity, although black people may have more extensive or atypical disease. The lesions may show a dark hue and lack the erythematous component.

Sex

Pityriasis rosea occurs slightly more often in females than in males. The female-to-male ratio is reported as 2:1 or 3:2 in the United States.

Age

Pityriasis rosea is observed in people of all age groups, although it is most common in persons aged 10-35 years. The youngest patient reported in the literature was aged 3 months, and the oldest was aged 85 years.

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Contributor Information and Disclosures
Author

Maria R Nasca, MD, PhD  Assistant Professor, Department of Dermatology, University of Catania School of Medicine, Italy

Disclosure: Nothing to disclose.

Coauthor(s)

Giuseppe Micali, MD  Head, Professor, Department of Dermatology, University of Catania School of Medicine, Italy

Giuseppe Micali, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Kevin P Connelly, DO  Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University School of Medicine; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center

Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Merrily P M Poth, MD  Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences

Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Allen RA, Janniger CK, Schwartz RA. Pityriasis rosea. Cutis. Oct 1995;56(4):198-202. [Medline].

  2. González LM, Allen R, Janniger CK, Schwartz RA. Pityriasis rosea: an important papulosquamous disorder. Int J Dermatol. Sep 2005;44(9):757-64. [Medline].

  3. [Guideline] Finnish Medical Society Duodecim. Syphilis. EBM Guidelines. Jun 6 2008.

  4. Blauvelt A. Skin diseases associated with human herpesvirus 6, 7, and 8 infection. J Investig Dermatol Symp Proc. Dec 2001;6(3):197-202. [Medline].

  5. Broccolo F, Drago F, Careddu AM, Foglieni C, Turbino L, Cocuzza CE, et al. Additional evidence that pityriasis rosea is associated with reactivation of human herpesvirus-6 and -7. J Invest Dermatol. Jun 2005;124(6):1234-40. [Medline].

  6. Canpolat Kirac B, Adisen E, Bozdayi G, et al. The role of human herpesvirus 6, human herpesvirus 7, Epstein-Barr virus and cytomegalovirus in the aetiology of pityriasis rosea. J Eur Acad Dermatol Venereol. Jan 2009;23(1):16-21. [Medline].

  7. Chuh AA, Chan PK, Lee A. The detection of human herpesvirus-8 DNA in plasma and peripheral blood mononuclear cells in adult patients with pityriasis rosea by polymerase chain reaction. J Eur Acad Dermatol Venereol. Jul 2006;20(6):667-71. [Medline].

  8. Drago F, Malaguti F, Ranieri E, Losi E, Rebora A. Human herpes virus-like particles in pityriasis rosea lesions: an electron microscopy study. J Cutan Pathol. Jul 2002;29(6):359-61. [Medline].

  9. Kempf W, Adams V, Kleinhans M, Burg G, Panizzon RG, Campadelli-Fiume G, et al. Pityriasis rosea is not associated with human herpesvirus 7. Arch Dermatol. Sep 1999;135(9):1070-2. [Medline].

  10. Watanabe T, Kawamura T, Jacob SE, Aquilino EA, Orenstein JM, Black JB, et al. Pityriasis rosea is associated with systemic active infection with both human herpesvirus-7 and human herpesvirus-6. J Invest Dermatol. Oct 2002;119(4):793-7. [Medline].

  11. Chuh A, Chan H, Zawar V. Pityriasis rosea--evidence for and against an infectious aetiology. Epidemiol Infect. Jun 2004;132(3):381-90. [Medline].

  12. Rajpara SN, Ormerod AD, Gallaway L. Adalimumab-induced pityriasis rosea. J Eur Acad Dermatol Venereol. Oct 2007;21(9):1294-6. [Medline].

  13. Drago F, Broccolo F, Zaccaria E, Malnati M, Cocuzza C, Lusso P, et al. Pregnancy outcome in patients with pityriasis rosea. J Am Acad Dermatol. May 2008;58(5 Suppl 1):S78-83. [Medline].

  14. Robati RM, Toossi P. Plantar herald patch in pityriasis rosea. Clin Exp Dermatol. Mar 2009;34(2):269-70. [Medline].

  15. Anderson CR. Dapsone treatment in a case of vesicular pityriasis rosea. Lancet. Aug 28 1971;2(7722):493. [Medline].

  16. Sezer E, Saracoglu ZN, Urer SM, Bildirici K, Sabuncu I. Purpuric pityriasis rosea. Int J Dermatol. Feb 2003;42(2):138-40. [Medline].

  17. Amer A, Fischer H, Li X. The natural history of pityriasis rosea in black American children: how correct is the "classic" description?. Arch Pediatr Adolesc Med. May 2007;161(5):503-6. [Medline].

  18. Chuh AA, Dofitas BL, Comisel GG, Reveiz L, Sharma V, Garner SE. Interventions for pityriasis rosea. Cochrane Database Syst Rev. 2007;(2):CD005068. [Medline].

  19. Sharma PK, Yadav TP, Gautam RK, Taneja N, Satyanarayana L. Erythromycin in pityriasis rosea: A double-blind, placebo-controlled clinical trial. J Am Acad Dermatol. Feb 2000;42(2 Pt 1):241-4. [Medline].

  20. Rasi A, Tajziehchi L, Savabi-Nasab S. Oral erythromycin is ineffective in the treatment of pityriasis rosea. J Drugs Dermatol. Jan 2008;7(1):35-8. [Medline].

  21. Amer A, Fischer H. Azithromycin does not cure pityriasis rosea. Pediatrics. May 2006;117(5):1702-5. [Medline].

  22. Drago F, Vecchio F, Rebora A. Use of high-dose acyclovir in pityriasis rosea. J Am Acad Dermatol. Jan 2006;54(1):82-5. [Medline].

  23. Arndt KA, Paul BS, Stern RS, Parrish JA. Treatment of pityriasis rosea with UV radiation. Arch Dermatol. May 1983;119(5):381-2. [Medline].

  24. Leenutaphong V, Jiamton S. UVB phototherapy for pityriasis rosea: a bilateral comparison study. J Am Acad Dermatol. Dec 1995;33(6):996-9. [Medline].

  25. Zawar V. Pityriasis amiantacea-like eruptions in scalp: a novel manifestation of pityriasis rosea in a child. Int J Trichology. Jul 2010;2(2):113-5. [Medline]. [Full Text].

  26. Rebora AE, Drago F. A novel influenza a (H1N1) virus as a possible cause of pityriasis rosea? A comment. J Eur Acad Dermatol Venereol. Aug 2011;25(8):991-2. [Medline].

  27. Osawa A, Haruna K, Okumura K, Taneda K, Mizuno Y, Suga Y. Pityriasis rosea showing unilateral localization. J Dermatol. Jun 2011;38(6):607-9. [Medline].

  28. Ehsani A, Esmaily N, Noormohammadpour P, Toosi S, Hosseinpour A, Hosseini M, et al. The comparison between the efficacy of high dose acyclovir and erythromycin on the period and signs of pitiriasis rosea. Indian J Dermatol. Jul-Sep 2010;55(3):246-8. [Medline]. [Full Text].

  29. Rebora A, Drago F, Broccolo F. Pityriasis rosea and herpesviruses: facts and controversies. Clin Dermatol. Sep-Oct 2010;28(5):497-501. [Medline].

  30. Kwon NH, Kim JE, Cho BK, Park HJ. A novel influenza a (H1N1) virus as a possible cause of pityriasis rosea?. J Eur Acad Dermatol Venereol. Mar 2011;25(3):368-9. [Medline].

  31. Lim SH, Kim SM, Oh BH, Ko JH, Lee YW, Choe YB, et al. Low-dose Ultraviolet A1 Phototherapy for Treating Pityriasis Rosea. Ann Dermatol. Aug 2009;21(3):230-6. [Medline]. [Full Text].

  32. Rassai S, Feily A, Sina N, Abtahian S. Low dose of acyclovir may be an effective treatment against pityriasis rosea: a random investigator-blind clinical trial on 64 patients. J Eur Acad Dermatol Venereol. Jan 2011;25(1):24-6. [Medline].

  33. Mubki TF, Bin Dayel SA, Kadry R. A case of Pityriasis rosea concurrent with the novel influenza A (H1N1) infection. Pediatr Dermatol. May-Jun 2011;28(3):341-2. [Medline].

  34. Prantsidis A, Rigopoulos D, Papatheodorou G, Menounos P, Gregoriou S, Alexiou-Mousatou I. Detection of human herpesvirus 8 in the skin of patients with pityriasis rosea. Acta Derm Venereol. Nov 2009;89(6):604-6. [Medline].

  35. Guarneri C, Polimeni G, Nunnari G. Pityriasis rosea during etanercept therapy. Eur Rev Med Pharmacol Sci. Sep-Oct 2009;13(5):383-7. [Medline].

  36. Neoh CY, Tan AW, Mohamed K, Sun YJ, Tan SH. Characterization of the inflammatory cell infiltrate in herald patches and fully developed eruptions of pityriasis rosea. Clin Exp Dermatol. Apr 2010;35(3):300-4. [Medline].

  37. Drago F, Broccolo F, Rebora A. Pityriasis rosea: an update with a critical appraisal of its possible herpesviral etiology. J Am Acad Dermatol. Aug 2009;61(2):303-18. [Medline].

  38. Zawar V, Kumar R. Multiple recurrences of pityriasis rosea of Vidal: a novel presentation. Clin Exp Dermatol. Jul 2009;34(5):e114-6. [Medline].

  39. Browning JC. An update on pityriasis rosea and other similar childhood exanthems. Curr Opin Pediatr. Aug 2009;21(4):481-5. [Medline].

 
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Herald patch. Courtesy of the Drexel Department of Dermatology slide collection.
 
 
 
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