Case clustering in pityriasis rosea: a multicenter epidemiologic study in primary care settings in Hong Kong

OBJECTIVES: To investigate the epidemiology of pityriasis rosea in primary care settings in Hong Kong and to analyze for temporal clustering. DESIGN: Retrospective epidemiologic study. SETTING: Six primary care teaching practices affiliated with a university.Patients Forty-one patients with pityriasis rosea, 564 patients with atopic dermatitis (negative control condition), and 35 patients with scabies (positive control condition). METHODS: We retrieved all records of patients with pityriasis rosea, atopic dermatitis, or scabies diagnosed in 3 years. We analyzed temporal clustering by a method based on a regression model. RESULTS: The monthly incidence of pityriasis rosea is negatively but insignificantly correlated with mean air temperature (gamma s = -0.41, P =.19) and mean total rainfall (gamma s = -0.34, P =.27). Three statistically significant clusters with 7, 6, and 7 cases were identified (P =.03), occurring in the second coldest month in the year (February), the second hottest month (July), and a temperate month (April), respectively. For atopic dermatitis (negative control condition), the nonclustering regression model was selected by Akaike information criteria. For scabies (positive control condition), 1 cluster of 20 cases was detected (P =.03). CONCLUSIONS: Significant temporal clustering independent of seasonal variation occurred in our series of patients with pityriasis rosea. This may be indicative of an infectious cause.     

STUDY OF ROLE OF STREPTOCOCCAL THROAT INFECTION IN PITYRIASIS ROSEA

Background:

Pityriasis rosea is a common, acute exanthem of uncertain etiology. The exact cause of pityriasis rosea is not known but various hypotheses have been postulated incriminating infective agents such as viruses, bacteria, spirochete and noninfective etiologies such as atopy and autoimmune causes have also been investigated.

Aim:

We undertook a study to investigate the role of Streptococcus haemolyticus in the causation of pityriasis rosea and study the levels of C-reactive protein (CRP) and ASLO titer in patients with pityriasis rosea.

Materials and Methods:

The study included 20 patients with pityriasis rosea attending the outpatient dermatology department at JIPMER hospital during the period from June to December 2004. Corresponding number of age- and sex-matched controls were chosen from amongst healthy individuals and patients attending skin OPD with dermatological disorders other than pityriasis rosea.

Results:

On analyzing the data collected from 20 cases of pityriasis rosea, the average age was found to be 15.3 years and ranged from 5 years to 30 years. The male to female ratio was found to be 1.5:1. The average duration of illness was 14.5 days (median) and 29.3 days (mean). CRP was negative in all the cases as well as the controls. ASLO titer was found to be raised in 2 (10%) cases, while it remained below the critical value in all the controls. On comparing the cases and controls, the raised ASLO titer in the cases was found to be not statistically significant (p = 0.147). From the throat swab culture, Streptococcus haemolyticus was isolated from only one case and none of the controls. This finding was not statistically significant (p = 0.310).

Conclusion:

As per the findings of the present study, we arrived at conclusion that there is no association between streptococcus pharyngitis and pityriasis rosea.     

玫瑰糠疹与人类疱疹病毒-7型关系的研究

目的探讨玫瑰糠疹(PR)与人类疱疹病毒-7型(HHV-7)的关系。方法采用巢式PCR检测了22例PR急性期患者的血浆、外周血单核细胞(PBMC)、皮损、唾液、尿液,14例恢复期患者的唾液、血浆、外周血单核细胞,14例正常人的唾液、血浆、外周血单核细胞中的HHV-7特异性序列。结果急性期唾液与单核细胞中HHV-7DNA检出率(95.5%,45.4%)明显高于正常人(64.3%,21.4%),唾液中HHV-7DNA检出率亦明显高于恢复期(57.1%),但单核细胞中HHV-7DNA检出率与恢复期(28.6%)无明显差异。8例皮损组织(36.4%)检测到HHV-7DNA。1例血浆中检测到HHV-7DNA(4.54%),其外周血单核细胞、皮损、唾液中亦均检测到HHV-7DNA,其恢复期唾液、单核细胞中HHV-7DNA仍可检测到。恢复期HHV-7DNA在唾液和单核细胞中的检出率与正常人无明显差别。结论有一部分玫瑰糠疹的发生可能与潜伏的HHV-7活化感染有关。     

Human herpesvirus 6 and 7 DNA in peripheral blood leucocytes and plasma in patients with pityriasis rosea by polymerase chain reaction: a prospective case control study.

An association between pityriasis rosea and human herpesvirus 7 (HHV-7) has been reported but remains controversial. The purpose of the present study was to investigate the association between HHV-6 and HHV-7 with pityriasis rosea. Fifteen patients aged 6-54 years with a diagnosis of pityriasis rosea and 15 age-matched controls were recruited. None of the patients had HHV-6 or HHV-7 DNA detected by polymerase chain reaction in the acute or convalescent plasma specimen. In the acute peripheral blood leucocytes specimen, 3 patients and one control had RHV-6 DNA detected (p=0.299; NS), while 7 patients and 5 controls had HHV-7 DNA (p=0.355; NS). Antibody to HHV-6 was detected in the acute specimen of 13 patients and 13 controls, while antibody to HHV-7 was found in all 15 of patients and controls. We thus found no evidence of recent HHV-6 or HHV-7 infection in patients with a diagnosis of pityriasis rosea.     

Tongue and cheek: oral lesions in pityriasis rosea.

Fifty-one consecutive patients with clinical findings and history consistent with pityriasis rosea underwent a complete oral examination to search for any concomitant oral lesions. One case was omitted from the statistical analysis because the results of a rapid plasma reagin test were positive. Of the fifty remaining cases, eight patients (16 percent) were noted to have various oral lesions, all of which were asymptomatic. These findings suggest that the actual incidence of oral lesions in pityriasis rosea may be higher than previously reported. A complete oral examination in a patient presenting with a papulosquamous eruption may be helpful in ascertaining the diagnosis of pityriasis rosea.     

玫瑰糠疹患者T细胞亚群检测及意义探讨

目的探讨玫瑰糠疹发病中外周血T淋巴细胞的变化。方法应用免疫组化技术对52例急性期及32例恢复期玫瑰糠疹患者的外周血T细胞亚群进行检测。结果玫瑰糠疹患者外周血CD8+百分比急性期明显高于恢复期(t=7.83,P<0.01),CD4+/CD8+比值明显降低(t=8.95,P<0.01),CD4+百分比急性期与恢复期无明显变化(t=1.43,P>0.05)。结论实验说明玫瑰糠疹急性期免疫细胞间的正常比例发生变化。急性期CD8+比例明显增高,说明Ts和(或)Tc细胞功能明显增强,这是否与抗病毒免疫的增强有关,尚待进一步研究。     

Temporal case clustering in pityriasis rosea: a regression analysis on 1379 patients in Minnesota, kuwait, and diyarbakir, Turkey

OBJECTIVE: To detect temporal case clustering in patients with pityriasis rosea in different geographic locations. DESIGN: Regression analysis of dates on which 1379 patients were diagnosed as having pityriasis rosea in 3 different geographic locations. The control data consisted of dates of diagnosis of patients with psoriasis in the same settings. SETTING: Dermatology clinics in Kuwait, Minnesota, and Diyarbakir, Turkey.Patients Patients with pityriasis rosea and psoriasis seeking care in the clinics. RESULTS: Three significant positive clusters (P = .005, P =.001, and P =.01, respectively) and 1 significant negative cluster (P<.001) were detected in these series of patients. No cluster was detected in 2 corresponding series of patients with psoriasis in Kuwait and Turkey. CONCLUSION: Temporal case clustering exists in pityriasis rosea.     

CORNEOCYTES IN SCALY PARAKERATOTIC DISEASES

Background and Objectives. The stratum corneum of some of the scaly (parakeratotic) diseases was examined with light and scanning electron microscopy (SEM) with the purpose to reveal the importance of this layer in the diagnosis of some of the diseases associated with the formation of scales. Materials and Methods. Two biopsies of the skin surface were taken: one, obtained from 80 patients with various parakeratotic scaly diseases and from 25 control subjects, was processed for light microscopy; the other biopsy for SEM was taken from 10 control subjects and 25 patients. The diagnoses of these patients were: psoriasis (5 patients), erythrodermic psoriasis (2 subjects), parapsoriasis (5 patients), pityriasis rubra pilaris (5 subjects), pityriasis rosea (3 subjects), and seborrheic dermatitis (5 subjects). Results. The light microscopic studies showed that normal corneocytes are of polygonal shape with their largest diameter measuring 42 μm; these cells lacked nuclei. All parakeratotic cells appeared bizarre in shape, smaller than normal, and the cells contained a nucleus. With SEM, normal cells appeared relatively regular in size and shape, trabeculated, and had a flat surface. Cells examined in all the diseases revealed various sizes, outlines, and trabeculae. Specific surface patterns (print) of diseased cells were: “fish-scale” in psoriasis; “marbled” in parapsoriasis, “rocky stone” in pityriasis rubra pilaris; “heart-shaped” in seborrheic dermatitis, and semi-crystalloid in pityriasis rosea. Conclusions. Parakeratosis is characterized not only by the retention of the nucleus in keratinocytes, but is also characterized by a cell of smaller size. The specific print of a disease helps in the diagnosis. The print will change with different stages of a disease.     

A Case of Pityriasis Rosea Concurrent with the Novel Influenza A (H1N1) Infection

Abstract: Pityriasis rosea is a common skin disease with a self‐limiting course. Multiple etiologies including viruses, bacteria, and fungi have been investigated in an attempt to confirm a casual association. Pityriasis rosea has not been associated with influenza virus, but has been associated with herpes simplex virus types 6 and 7. We encountered a case of a proven pandemic H1N1 infection associated with a clincopathological diagnosis of pityriasis rosea. We conclude that influenza A (H1N1) virus could either be a primary cause of pityriasis rosea or a trigger for reactivation of other viral causes.     

Effectiveness of acyclovir in the treatment of pityriasis rosea. A systematic review and meta-analysis

Background:There is a lack of evidence to support acyclovir administration in pityriasis rosea.Objective:To determine the efficacy of acyclovir in patients with typical pityriasis rosea.Methods:A systematic review and meta-analysis of experimental studies was performed in MEDLINE, SCOPUS, EMBASE and others, from January 1990 to October 2016 on acyclovir for pityriasis rosea. Random effect model was used to find the pooled Risk Ratio. Outcomes, evaluated between weeks 1 to 8, were regression of lesions, cessation of lesions, decrease of symptoms and duration of disease. Comparisons were acyclovir vs. placebo; acyclovir vs. symptomatic treatment; acyclovir vs. antibiotic; acyclovir vs. observation and combined therapy (acyclovir plus symptomatic treatment) vs. symptomatic treatment alone.Results:Seven papers were analyzed with 324 participants, of which 159 received acyclovir and 165 were controls. Acyclovir was superior to placebo for complete regression of lesions at week 1 (Risk Ratio 5.72, CI95% 2.36-13.88). However, combined therapy was not superior to symptomatic treatment at week 4 (Risk Ratio 1.46, CI95% 0.93-2.29). Individual studies showed the superiority of acyclovir for the control of symptoms and pruritus.Study limitations:We faced differences designs of trials and inconsistency between reports.Conclusion:Symptomatic treatment is a reasonable option for pityriasis rosea, and the addition of acyclovir is justified for the control of symptoms and pruritus.     

Pityriasis Rosea

The disease or syndrome of pityriasis rosea presents an epidemiological challenge and two studies have been performed attempting to link this condition with infectious diseases endemic in the community. No correlation was found in times of incidence of pityriasis rosea and of infectious diseases, and no evidence of mycoplasma infection was found in patients with pityriasis rosea.     

玫瑰糠疹与柯萨奇B组病毒感染关系的研究

用病毒学及免疫学方法研究了玫瑰糠疹与柯萨奇Ｂ组病毒感染的关系。结果表明，急性期患者血清抗柯萨奇Ｂ组病毒特异性ＩｇＭ的阳性率明显高于健康对照组，血清循环免疫复合物的含量急性期明显高于恢复期，中和试验和病毒分离都证明患者体内有柯萨奇Ｂ组病毒感染。这些结果提示，玫瑰糠疹的发病与柯萨奇Ｂ组病毒感染有直接关系，而造成免疫病理损伤的原因是柯萨奇Ｂ组病毒与其相应抗体形成的循环免疫复合物。     

Pityriasis rosea is associated with systemic active infection with both human herpesvirus-7 and human herpesvirus-6

Pityriasis rosea is a common skin disease that has been suspected to have a viral etiology. We performed nested polymerase chain reaction to detect human herpesvirus-7, human herpesvirus-6, and cytomegalovirus DNA in lesional skin, nonlesional skin, peripheral blood mononuclear cells, serum, and saliva samples isolated from 14 pityriasis rosea patients. Viral mRNA expression and virion visualization within lesional skin were studied by in situ hybridization and transmission electron microscopy, respectively. By nested polymerase chain reaction, human herpesvirus-7 DNA was present in lesional skin (93%), nonlesional skin (86%), saliva (100%), peripheral blood mononuclear cells (83%), and serum (100%) samples, whereas human herpesvirus-6 DNA was detected in lesional skin (86%), nonlesional skin (79%), saliva (80%), peripheral blood mononuclear cells (83%), and serum (88%) samples. By contrast, cytomegalovirus DNA was not detected in these tissues. Control samples from 12 healthy volunteers and 10 psoriasis patients demonstrated rare positivity for either human herpesvirus-7 or human herpesvirus-6 DNA in skin or serum. By in situ hybridization, infiltrating mononuclear cells expressing human herpesvirus-7 and human herpesvirus-6 mRNA were identified in perivascular and periappendageal areas in 100% and 75% pityriasis rosea skin lesions, respectively, compared to herpesviral mRNA positivity in only 13% normal skin and psoriasis skin controls. Transmission electron microscopy failed to reveal herpesviral virions in pityriasis rosea lesional skin. Nested polymerase chain reaction and in situ hybridization enabled detection of human herpesvirus-7 and human herpesvirus-6 in skin and other tissues isolated from patients with pityriasis rosea. These results suggest that pityriasis rosea is associated with systemic active infection with both human herpesvirus-7 and human herpesvirus-6.     

真菌荧光染色法检测健康皮肤和炎症性皮损的真菌定植

目的:利用荧光染色法检测健康皮肤和炎症性皮损的真菌阳性率及定植数量。方法:门诊收集正常皮肤及银屑病、特应性皮炎、湿疹和玫瑰糠疹患者,采集每位患者和健康对照组皮脂溢出部位(面部、胸部和背部)、干燥部位(双上肢)、潮湿部位(腹股沟、腘窝、肘窝)、头皮及足底部位的皮损皮屑,利用真菌荧光染色试剂快速染色,随机选择30个视野计数真菌(孢子)数量,数据使用R 3.5.3软件进行统计学分析。结果:共收集457例患者和888名健康对照,健康对照头皮和皮脂溢出部位的真菌检出率高分别为95%和96%,足底真菌检出率最低(44.29%)。湿疹组、银屑病组和玫瑰糠疹组皮脂溢出部位的真菌检出率分别为77.05%、66.67%、91.42%高于相应的干燥部位58.93%、47.62%、57.89%。在头皮、皮脂溢出部位、干燥部位,疾病组真菌检出率低于健康组,差异有统计学意义(均P<0.05)。健康组4个部位真菌分布的数量不同且差异有统计学意义(P<0.05)。皮脂溢出部位中,18～44岁年龄组孢子数量最多。结论:健康皮肤不同部位的真菌阳性率和孢子数量不同。特应性皮炎、湿疹、银屑病和玫瑰糠疹的皮损部位真...     

Mucositis Secondary to Chlamydia pneumoniae Infection: Expanding the Mycoplasma pneumoniae–Induced Rash and Mucositis Concept

The term Mycoplasma pneumoniae–induced rash and mucositis (MIRM) was recently proposed to identify the mucocutaneous condition secondary to M. pneumoniae infection that had historically been regarded among the more confusing pathologies of erythema multiforme and Stevens–Johnson syndrome. Based on a number of previous reports, these syndromes require differentiation since they have different prognoses and specific treatment requirements. We report a case of oral and genital erosions that strongly resembled MIRM without rash but were found to be secondary to a Chlamydia pneumoniae infection. After a thorough review of the literature on this subject, we propose that C. pneumoniae should also be considered a potential causative agent of MIRM and that this term should be amended to include C. pneumoniae infection.     

Adenoviral‐induced rash and mucositis: Expanding the spectrum of reactive infectious mucocutaneous eruption

Mucocutaneous eruptions associated with respiratory pathogens, specifically Mycoplasma pneumoniae (MP), has recently been described as a MIRM (MP‐induced rash and mucositis). The term reactive infectious mucocutaneous eruption (RIME) has been proposed, since non‐MP pathogens may also cause a similar rash and mucositis. We report two cases with clinical manifestations suggestive of MIRM/RIME, both with documented adenovirus infection.     

Fuchs Syndrome Associated with Mycoplasma pneumoniae (Stevens–Johnson Syndrome without Skin Lesions)

Abstract: Stevens–Johnson syndrome is a severe mucocutaneous disease following drugs or infections. We present a 7‐year‐old boy with mucous membrane lesions (stomatitis, conjunctivitis, and urethritis) but without skin lesions. The diagnosis of acute Mycoplasma pneumoniae infection strongly suggests a concomitant Fuchs syndrome.     

Palmar herald patch in pityriasis rosea

Pityriasis rosea is an acute self-limited inflammatory disorder of the skin. The initial clinical features of typical cases are the appearance of a herald patch. The herald patch is commonly located on the thigh, upper arm, trunk or neck; rarely the patch may be on the face, scalp or penis. There are no reports of a palmar herald patch in pityriasis rosea. In this article we present a 14-year-old male patient who had a palmar herald patch with truncal lesions of pityriasis rosea.     

Human herpes virus-like particles in pityriasis rosea lesions: an electron microscopy study

BACKGROUND: In a previous study we detected virions with electron microscopy features of human herpes viruses in the supernatant of cocultured mononuclear cells from patients with acute pityriasis rosea. Because of their morphology and of polymerase chain reaction studies, we ascribed them to human herpes virus 7. OBJECTIVE: To find such virions in the lesional skin of pityriasis rosea patients. METHODS: Skin specimens from lesions of 21 patients with acute pityriasis rosea were examined by elecron microscopy. RESULTS: In 15 (71%) patients, human herpes virus particles in various stages of morphogenesis were detected. Mature enveloped virions appeared as typical human herpes virus virions, measuring about 160-200 nm in diameter and containing an electrodense cylindrical core, a capsid, an envelope with typical spikes and a very distinct tegument layer between the capsid and the envelope. They were very similar to those we reported in the supernatant of co-cultured circulating mononuclear cells from patients with pityriasis rosea. CONCLUSION: Our results confirm our previous findings and provides further evidence of a viral etiology for pityriasis rosea.     

Pityriasis rosea is not associated with human herpesvirus 7.

OBJECTIVE: To examine the proposed association between pityriasis rosea and human herpesvirus 7 (HHV-7). DESIGN: A retrospective cross-sectional survey. SETTING: University medical center in Switzerland. PATIENTS: Thirteen patients with pityriasis rosea and 14 persons with normal skin (control subjects). MAIN OUTCOME MEASURES: Detection of HHV-7-specific DNA sequences and antigen (85-kd phosphoprotein [pp85]) by nested polymerase chain reaction and immunohistochemical analysis, respectively. RESULTS: Human herpesvirus 7 DNA sequences and expression of the HHV-7-specific immunodominant pp85 antigen were found in 1 (8%) of 13 lesional skin biopsy specimens of pityriasis rosea. The prevalence of HHV-7 DNA sequences and antigens is even slightly lower in lesional skin of patients with pityriasis rosea than in clinically and morphologically normal skin of 14 control persons, in 2 of whom (14%) HHV-7 DNA sequences and antigens could be detected. CONCLUSION: The low detection rate of HHV-7 DNA sequences and antigens argues strongly against a causative role for HHV-7 in the pathogenesis of pityriasis rosea.