PITYRIASIS ROSEA

Question 1

(1) Common, acute, self-limited papulosquamous skin rash that most commonly seen in individuals 10-35 years old.
(2) Etiology isn’t completely understood; viral etiology hypothesized based upon the following observations:
(a) PR is sometimes preceded by a prodrome.
(b) It occasionally occurs in small case clusters.
(c) It has not been shown to be associated with bacterial or fungal organisms.

Answer 1

Pityriasis Rosea

Question 2

Presentation

Answer 2

(1) Prodromal symptoms are reported in as much as 69% of patients and typically include some variation of the following:
(a) Malaise, mild fever, headache, sore throat, cough, or mild URI or GI symptoms
(b) Classic PR begins with a solitary herald patch that appears on the trunk or proximal limbs that precedes secondary eruption by 7-14
days.***
(c) Herald patch: a 2-5 cm round or oval, sharply delimited, pink or salmon-colored lesion on the chest, neck, or back.
(d) Within 7-14 days, oval lesions similar in appearance to the herald patch, but smaller, appear in crops on the trunk and proximal areas
of the extremities.
(e) Lesions range from 0.5 to 2 cm oval papules and plaques, and have a scaly, slightly raised border (collarette) and resemble ringworm (tinea corporis).
(f) Lesions are distributed with long axes along cleavage (Langer’s)
lines:
1) “Christmas tree pattern” on back
2) V-shaped pattern on upper chest
3) Mild to moderate pruritus is a common complaint. However,
in rare cases patients may experience severe pruritus on lesions.
4) The rose or fawn color is not as evident in patients with darker skin.Lesions generally resolve spontaneously after ~ 45 days.
5) No treatment or symptomatic treatment is indicated for most patients.
6) If you’re not actively treating the patient, you’re on the hook for educating the patient why.

Question 3

Symptomatic treatment of pruritus

Answer 3

Symptomatic treatment of pruritus

Question 4

Labs/studies/imaging:

Answer 4

(1) Clinical Dx; consider KOH if atypical presentation.

(2) Serologic Syphilis testing if clinically indicated

Question 5

Differential diagnosis:

Answer 5

(1) Tinea Corporis
(2) Tinea Versicolor
(3) Drug eruptions

Question 6

Disposition

Answer 6

Full duty

Question 7

Complications

Answer 7

(1) Hyper- or hypopigmentation of resolved lesions may be cosmetic concern; derm consult advised with long-term pigmentary changes post PR.
(2) PR during pregnancy associated with spontaneous abortion & fetal demise.