Vesicular pityriasis rosea: response to erythromycin treatment

Pityriasis rosea (PR) is a relatively common disease although its aetiology has not yet been identified. It occurs worldwide and there is no racial susceptibility factor. It usually affects teenagers and young adults between 10 and 35 years of age. Typical PR is much easier to diagnose than the rare atypical forms. We report a rare case of vesicular PR in a black woman who had vesicular lesions limited to her palms and soles in addition to regular typical lesions. We devised an efficient oral erythromycin treatment for this patient.     

玫瑰疹病毒属与玫瑰糠疹发病的相关性研究现况

玫瑰糠疹是一种病因尚未明确的炎症性、自限性红斑鳞屑性皮肤病,至今病因尚未明确。近年来,关于玫瑰糠疹与玫瑰疹病毒属人疱疹病毒6、7型的研究较为深入,本文对相关文献进行了综述。     

Atypical pityriasis rosea and Hodgkin's disease.

Pityriasis rosea (PR)-like eruptions have been associated with several neoplasms and drugs. These eruptions may be atypical. To date, the association of Hodgkin's disease with PR-like eruptions has rarely been reported. We report a 37-year-old patient with clinical lesions of PR-like, systemic symptoms and lymphadenopathies, who was subsequently diagnosed with Hodgkin's disease.     

Correlation between HLA and pityriasis rosea susceptibility in Brazilian blacks

Objectives The human leucocyte antigen (HLA) has been related to susceptibility factors in several diseases. This study aimed to determine the potential genetic susceptibility of patients with pityriasis rosea (PR) through HLA molecular typing analysis. Methods The method of choice was polymerase chain reaction with sequence‐specific primers (PCR‐SSP) using low‐resolution typing kits, with determination of the alleles class I (HLA‐A, HLA‐B and HLA‐C) and class II (HLA‐DRB1, DRB3, DRB4, DRB5 and DQB1) performed in 30 Afro‐Brazilian PR‐diagnosed patients and 45 healthy individuals as the control group (PR‐C). Results Analysis of the HLA typing results showed that the relative risk (RR) of 4.00 [95% confidence interval (95% CI) 1.20–13.28, two‐tailed P = 0.018] for allele HLA‐DQB1*04 class II, detected in 33.3% of PR patients, was significant. By contrast, in the control group only 11.1% of subjects had that allele. Three out of six B*51 alleles and three out of six B*53 alleles detected in PR patients were found, together with the allele DQB1*04. Conclusion We suggest that alleles DQB1*04 may be involved in the genetic susceptibility of PR based on the significant predominance of those alleles observed in the black PR patients. We also recommend that more studies are conducted on populations of other ethnic origins, preferentially with higher resolution techniques of DNA typing.     

非索非那定联合UVB治疗玫瑰糠疹疗效观察

目的:评价非索非那定联合中波紫外线照射治疗玫瑰糠疹的疗效。方法:将58例患者随机分为两组,治疗组30例口服非索非那定60 mg,2次/d,同时照射中波紫外线,隔日1次,连续10次。对照组28例口服非索非那定60 mg,2次/d,20天后观察疗效。结果:治疗组总有效率为96.6%,对照组为64.2%,二者差异有显著性(P0.01)。结论:非索非那定联合紫外线治疗玫瑰糠疹疗效好。     

Concurrence of lichen striatus and localised pityriasis rosea: Cutaneous mosaicism

Cutaneous mosaicism has always been an intriguing subject. A 15‐year‐old boy presented to us with a unilateral band of lesions of pityriasis rosea and lichen striatus. The case is discussed in the light of the concept of genetic mosaicism.     

玫瑰糠疹患者外周血IL-17和IL-22的表达

目的：检测外周血IL-17和IL-22在玫瑰糠疹患者中的水平。方法：采取酶联免疫(ELISA)双抗体夹心法,检测45例玫瑰糠疹急性期患者、45例恢复期患者和45名健康人外周血中IL-17和IL-22的水平。结果：玫瑰糠疹急性期、恢复期患者与正常对照组外周血IL-17浓度分别为45.08±14.34 pg/mL,29.34±11.88 pg/mL,15.51±8.79 pg/mL;IL-22浓度分别为85.43±20.01 pg/mL,61.26±10.37 pg/mL,50.54±13.28 pg/mL。三组IL-17和IL-22水平比较差异有统计学意义(P＜0.05)。结论：玫瑰糠疹急性期及恢复期患者均存在IL-17和IL-22的表达异常,该疾病可能存在Th17细胞亚群失衡。     

L‐lysine therapy to control the clinical evolution of pityriasis rosea: Clinical case report and literature review

Pityriasis rosea (PR) is a dermatological disease with an erythemato‐papulosquamous manifestation, distributed on the trunk and extremities affecting healthy people, especially children and young people between 10 and 35 years of age. The evolution is 6 to 8 weeks and may remain for 3 to 6 months. It regresses spontaneously and can leave changes in the skin color but reversibly. Acyclovir is indicated to minimize clinical manifestations with the suspected of viral association (HHV‐6 and 7). Another group of the human herpesvirus family (HHV‐1 and 2), causes herpes simplex that is controlled with the antivirals, including acyclovir, as well as the amino acid L‐lysine, both showing positive and similar results in reducing the number of annual manifestations and the healing time of the lesions. The aim of this study is to report a case of PR in a child, to review the literature on the etiopathogenesis of the disease and on the effects of L‐lysine as well as another amino acid in the treatment. An 11‐year‐old girl, phototype II, presented lesions diagnosed as PR. The cycle would be 6 to 8 weeks on average. A solution of L‐lysine was prescribed for 30 days, on an empty stomach. After the fourth day of therapy, the cycle of new eruptions was interrupted, initial lesions regressed, accelerating the repair of larger lesions resulting in an improvement of the clinical condition. We concluded that the administration of L‐lysine, in therapeutic doses, can be a safe alternative for the PR control.     

中药煎剂治疗玫瑰糠疹48例疗效观察

目的观察中药煎剂治疗玫瑰糠疹的疗效。方法将78例玫瑰糠疹患者随机分为两组，治疗组48例服用自拟中药方治疔，对照组30例口服西可韦（西替立嗪）、维生素c治疗。结果治疗组服药7天和14天后总有效率分别为60．4％和93．8％，对照组为20％和53．3％，两组差异有显著性意义（P〈0．01）。结论中药煎剂治疗玫瑰糠疹疗效优于常规西医治疗。     

玫瑰糠疹表皮内血管细胞黏附分子1和细胞间黏附分子1的表达

目的:研究血管细胞黏附分子(1VCAM-l)和细胞间黏附分子(1ICAM-1)在玫瑰糠疹发病中的作用。方法:采用链酶卵白素-过氧化物酶法检测表皮内VCAM-l、ICAM-1的表达。结果:VCAM-1在玫瑰糠疹皮损表皮基底层、棘层表达高于皮损周围正常皮肤及正常人皮肤,在皮损周围正常皮肤棘层表达高于正常人皮肤。ICAM-1在皮损、皮损周围正常皮肤基底层的表达高于正常人皮肤,在皮损棘层的表达高于皮损周围正常皮肤及正常人皮肤。结论:玫瑰糠疹表皮VCAM-1、ICAM-1的高表达可能与玫瑰糠疹的发病机制有关。     

Epidemiological study of human herpesvirus-6 and human herpesvirus-7 in pityriasis rosea

BACKGROUND: Pityriasis rosea (PR) is a common papulosquamous skin disorder that is suspected to have an infectious aetiology. OBJECTIVES: We aimed to study the role of human herpesvirus (HHV)-7 and HHV-6 in the pathogenesis of PR. METHODS: We performed seroepidemiological studies (indirect immunofluorescence test) and polymerase chain reaction (PCR) analysis for HHV-6 and HHV-7 in patients with PR. Seventy-two serum samples and 37 samples of peripheral blood mononuclear cells (PBMC) from 44 patients with PR were obtained. Twenty-five patients with other skin disorders such as drug eruption, urticaria or herpes zoster were studied as controls in the PCR analysis. RESULTS: HHV-7 DNA was detected in 13 of 30 (43%) samples of PBMC of the patients with PR and 14 of 25 (56%) samples of PBMC of controls. HHV-6 DNA was detected in six of 29 (21%) patients with PR and nine of 23 (39%) controls. Thus there was no difference in the prevalence of HHV-6 or HHV-7 in PBMC between patients with PR and those with other skin disorders. In the seroepidemiological study, two cases of at least a fourfold rise in titre and five cases of a fourfold decrease in titre to HHV-7 antibody, and two cases of a fourfold rise in titre and two cases of a fourfold decrease in titre to HHV-6 antibody, were observed in 24 patients with PR. This seroepidemiological study revealed antibody responses consistent with active infection in several PR patients, but the greater proportion of the patients had no definite increase in the antibody titres. CONCLUSIONS: We conclude that HHV-7 and HHV-6 may play a part in some patients with PR, but that other causative agents may exist. Further analyses are needed to determine the causative agents of PR.     

Low dose of acyclovir may be an effective treatment against pityriasis rosea: a random investigator‐blind clinical trial on 64 patients

Background Pityriasis rosea (PR) is a papulosquamous disease with an unknown aetiology, but recently the role of two herpes viruses human herpes virus 6 and human herpes virus 7 was defined as being the aetiology of PR. Objective The aim of this study was to compare a low dose (400 mg five times a day for a week) anti‐viral agent, acyclovir, with follow‐up protocol for the treatment of PR. Methods A randomized, investigator‐blind, prospective, 4‐week study was designed. Sixty‐four patients with PR presenting at the outpatient clinic were randomly allocated to acyclovir (400 mg five times a day for 1 week) or follow‐up group. Fifty‐four of them completed the period of study and their clinical responses such as improvement rate of erythema, and scaling and occurrence of complications were evaluated by two dermatologists using weekly photographic records. Results Statistically, acyclovir was more effective than follow‐up in reducing erythema at the end of the first, second, third and fourth week of treatment. Although the decrease in scaling was higher in the acyclovir group at the end of the first, second and third week of treatment, there was no statistical significance between two groups at the end of fourth week of treatment in the both groups. Conclusions According to our study, acyclovir may be more effective than follow‐up in reducing erythema and shortening of duration of PR even in lower doses than was applied in previous studies. So given the safety of acyclovir, we suggest to our colleagues to consider this treatment when facing a patient suffering from this conundrum, at least in extensive or having pruritus ones.     

Pityriasis rosea-like eruption due to pneumococcal vaccine in a child with nephrotic syndrome

A pityriasis rosea-like eruption can occur as a consequence of treatments with gold compounds and captopril. It has rarely been reported to have an association with vaccinations such as smallpox, BCG, hepatitis B, and diphtheria toxoid. It has not previously been documented to develop after pneumococcal vaccination. We report a case of pityriasis rosea-like eruption that developed following pneumococcal vaccination in a child with nephrotic syndrome.     

白细胞介素22在玫瑰糠疹患者外周血单一核细胞及血清中的表达

【摘要】 目的 探讨白细胞介素（IL）-22在玫瑰糠疹发病机制中的作用。 方法 荧光实时定量反转录（RT）-PCR检测玫瑰糠疹患者急性期、恢复期及健康对照组PBMC中IL-22mRNA的表达水平。采用酶联免疫吸附试验检测血清中IL-22的水平。 结果 玫瑰糠疹患者急性期、恢复期及健康对照组PBMC中IL-22 mRNA的相对表达量分别为4.15 ± 1.36、2.89 ± 0.91和1.91 ± 0.60,急性期明显高于恢复期（t = 3.61,P ＜ 0.05）,恢复期高于健康对照组（t = 3.84,P ＜ 0.05）。玫瑰糠疹患者急性期、恢复期及健康对照组血清中IL-22水平分别为（36.87 ± 10.63）、（21.44 ± 7.33）和（13.22 ± 4.26） ng/L,急性期明显高于恢复期（t = 5.01,P ＜ 0.05）,恢复期高于健康对照组（t = 4.49,P ＜ 0.05）。血清IL-22水平与玫瑰糠疹病程呈正相关（r = 0.883,P ＜ 0.05）。结论 IL-22在玫瑰糠疹患者外周血及血清中表达明显升高,可能在玫瑰糠疹的发病中起一定作用。     

Evolutionary changes of immunohistological characteristics of secondary lesions in pityriasis rosea

Summary In 15 patients with pityriasis rosea, we studied the evolutionary changes of the immunohistological characteristics of the secondary lesions. Many CD1a⁺ cells were seen in the epidermis and dermis of early lesions. In the well-developed lesions, the number of CD1a⁺ cells greatly increased in the dermis. In the late lesions, CD1a⁺ cells in the dermis significantly decreased as compared with the well-developed lesions. Early lesions showed a moderate T-cell infiltrate. In the well-developed lesions, the dermal T-cell infiltrate was dense, and the CD4 CD8 ratio was 2.9. The late lesions had a moderate T-cell infiltrate, in which the CD4 CD8 ratio significantly decreased as compared with the well-developed lesions. Thus, the relative decrease in CD4⁺ helper inducer cells during lesion regression, concomitant with a decrease in number of CD1a⁺. Langerhans cells, is in accordance with a broader concept of increased suppressor mechanisms during healing.