History

Pityriasis rotunda patients are usually asymptomatic. In one review of 64 cases, all patients were undergoing assessment for an underlying medical condition and the lesions of pityriasis rotunda were noted incidentally. Few could remember the duration of the lesions, which varied from 1 week to 2 years.

Physical Examination

Two clinical types of pityriasis rotunda are described. Type 1 affects Asian or black patients older than 60 years old who tend to have associated malignancies or systemic disease. These patients present with few hyperpigmented patches (< 30) that are usually nonfamilial. Type 2 affects white patients younger than 40 years who do not have any associated malignancy or systemic diseases and who present with multiple hypopigmented patches (>30) that show familial incidence.^{[3, 41, 42]}

Lesions range from pink to light-brown, are usually perfectly round but sometimes can be oval, and appear as well-demarcated patches that show fine scaling. They range from 0.5-20 cm and are generally isolated, but the merging of lesions results in a polycyclic configuration.

Several lesions are usually present, ranging from 4-80. One patient had more than 100 lesions.

Lesions are usually present on the trunk, buttocks, and upper and lower extremities. See the image below.

Nearly perfectly round, slightly hyperkeratotic, hyperpigmented, asymptomatic plaque on the trunk.

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Differential Diagnoses

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Pinto GM, Tapadinhas C, Moura C, Afonso A. Pityriasis rotunda. Cutis. 1996 Dec. 58(6):406-8. [QxMD MEDLINE Link].
Grimalt R, Gelmetti C, Brusasco A, Tadini G, Caputo R. Pityriasis rotunda: report of a familial occurrence and review of the literature. J Am Acad Dermatol. 1994 Nov. 31(5 Pt 2):866-71. [QxMD MEDLINE Link].
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Pari T, Pulimood S, George S, Jacob M. Pityriasis rotunda. J Eur Acad Dermatol Venereol. 1998 Jul. 11(1):82-3. [QxMD MEDLINE Link].
Toyama T. Uber eine bisher noch nicht beschriebene dermatose: "pityriasis circinata". Arch Dermatol Syphiligr. 1913. 116:243-58.
Toyama T. Uber eine schuppende, pigmentierte: kreisrunde hautaffektion. Jpn Z Derm Urol. 1906. 6:2.
Weiss RM. Pityriasis rotunda. Arch Dermatol. 1989 Jul. 125(7):1002. [QxMD MEDLINE Link].
Zina AM, Ubertalli S, Bundino S. Pityriasis rotunda. Int J Dermatol. 1986 Jan-Feb. 25(1):56-7. [QxMD MEDLINE Link].
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Hashimoto Y, Suga Y, Chikenji T, Matsuba S, Mizoguchi M, Kakuta M, et al. Immunohistological characterization of a Japanese case of pityriasis rotunda. Br J Dermatol. 2003 Jul. 149 (1):196-8. [QxMD MEDLINE Link].
Imamura S. Skin diseases first described in Japan. Clin Dermatol. 1999 Mar-Apr. 17 (2):117-26. [QxMD MEDLINE Link].
Combemale P, L'Henaff N, Guennoc B. [Pityriasis rotunda]. Ann Dermatol Venereol. 1993. 120(4):287-8. [QxMD MEDLINE Link].
Swift PJ, Saxe N. Pityriasis rotunda in South Africa--a skin disease caused by undernutrition. Clin Exp Dermatol. 1985 Sep. 10(5):407-12. [QxMD MEDLINE Link].
Lodi A, Betti R, Chiarelli G, Carducci M, Crosti C. Familial pityriasis rotunda. Int J Dermatol. 1990 Sep. 29(7):483-5. [QxMD MEDLINE Link].
Friedmann AC, Ameen M, Swale VJ. Familial pityriasis rotunda in black-skinned patients; a first report. Br J Dermatol. 2007 Jun. 156(6):1365-7. [QxMD MEDLINE Link].
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Weiss RM. Pigmented lesions in a patient with pulmonary tuberculosis. Pityriasis rotunda. Arch Dermatol. 1991 Aug. 127(8):1221, 1224. [QxMD MEDLINE Link].
Leibowitz MR, Weiss R, Smith EH. Pityriasis rotunda. A cutaneous sign of malignant disease in two patients. Arch Dermatol. 1983 Jul. 119(7):607-9. [QxMD MEDLINE Link].
Etoh T, Nakagawa H, Ishibashi Y. Pityriasis rotunda associated with multiple myeloma. J Am Acad Dermatol. 1991 Feb. 24(2 Pt 1):303-4. [QxMD MEDLINE Link].
Piga S, Cottoni F, Meloni GF. Pityriasis rotunda and G6PD deficiency. Int J Dermatol. 1992 Oct. 31(10):745. [QxMD MEDLINE Link].
Finch JJ, Olson CL. Hyperpigmented patches on the trunk of a Nigerian woman. Pityriasis rotunda (PR). Arch Dermatol. 2008 Nov. 144(11):1509-14. [QxMD MEDLINE Link].
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Rubin MG, Mathes B. Pityriasis rotunda: two cases in black Americans. J Am Acad Dermatol. 1986 Jan. 14(1):74-8. [QxMD MEDLINE Link].
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Aste N, Pau M, Aste N, Biggio P. Pityriasis rotunda: a survey of 42 cases observed in Sardinia, Italy. Dermatology. 1997. 194(1):32-5. [QxMD MEDLINE Link].
Gibbs S. Pityriasis rotunda in Tanzania. Br J Dermatol. 1996 Sep. 135(3):491-2. [QxMD MEDLINE Link].
Gupta S. Pityriasis rotunda mimicking tinea cruris/corporis and erythrasma in an Indian patient. J Dermatol. 2001 Jan. 28(1):50-3. [QxMD MEDLINE Link].
Sarkany I, Hare PJ. Pityriasis rotunda (pityriasis circinata). Br J Dermatol. 1964 May. 76:223-8. [QxMD MEDLINE Link].
el-Hefnawi H, Rasheed A. Pityriasis rotunda. "Pseudo-ichtyose acquise en taches circulaires": report and study of first case in UAR. Arch Dermatol. 1966 Jan. 93(1):84-6. [QxMD MEDLINE Link].
Hasson I, Shah P. Pityriasis rotunda. Indian J Dermatol Venereol Leprol. 2003 Jan-Feb. 69(1):50-1. [QxMD MEDLINE Link].
Segal R, Hodak E, Sandbank M. Pityriasis rotunda in a Caucasian woman from the Mediterranean area. Clin Exp Dermatol. 1989 Jul. 14(4):325-7. [QxMD MEDLINE Link].
DiBisceglie AM, Hodkinson HJ, Berkowitz I, Kew MC. Pityriasis rotunda. A cutaneous marker of hepatocellular carcinoma in South African blacks. Arch Dermatol. 1986 Jul. 122(7):802-4. [QxMD MEDLINE Link].
Ito M, Tanaka T. Pseudo-ichthyose acquise en taches circulaires. Ann Dermatol Syphiligr. 1960. 87:26-37.
Kahana M, Levy A, Ronnen M, Schewach-Millet M, Stempler D. Pityriasis rotunda in a white patient. Report of the second case and review of the literature. J Am Acad Dermatol. 1986 Aug. 15(2 Pt 2):362-5. [QxMD MEDLINE Link].
Berkowitz I, Hodkinson HJ, Kew MC, DiBisceglie AM. Pityriasis rotunda as a cutaneous marker of hepatocellular carcinoma: a comparison with its prevalence in other diseases. Br J Dermatol. 1989 Apr. 120(4):545-9. [QxMD MEDLINE Link].
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Media Gallery

Nearly perfectly round, slightly hyperkeratotic, hyperpigmented, asymptomatic plaque on the trunk.
Classic histology for pityriasis rotunda demonstrating mild hyperkeratosis and a reduced granular layer in the epidermis.

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Author

Jaggi Rao, MD, FRCPC Clinical Professor of Medicine, Division of Dermatology and Cutaneous Sciences, Director of Dermatology Residency Program, University of Alberta Faculty of Medicine and Dentistry, Canada

Jaggi Rao, MD, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, Canadian Dermatology Association, Canadian Medical Association, Canadian Medical Protective Association, Pacific Dermatologic Association, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Coauthor(s)

Kaushik P Venkatesh, MBA MD Candidate, Harvard Medical School

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

James W Patterson, MD Professor of Pathology and Dermatology, Director of Dermatopathology, University of Virginia Medical Center

James W Patterson, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Dermatopathology, Royal Society of Medicine, Society for Investigative Dermatology, United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Andrew Lin, MD, FRCPC  Associate Professor, Department of Internal Medicine, Division of Dermatology, University of Alberta

Andrew Lin, MD, FRCPC is a member of the following medical societies: American Academy of Dermatology, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Andrei I Metelitsa, MD, FRCPC Assistant Clinical Professor, Section of Dermatology, University of Calgary Faculty of Medicine, Canada

Andrei I Metelitsa, MD, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, Canadian Medical Protective Association, Canadian Dermatology Association

Disclosure: Nothing to disclose.

Pityriasis Rotunda Clinical Presentation

History

Physical Examination

References

Tables

Contributor Information and Disclosures

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