Atypical pityriasis rosea: a case report and a review of literature
DOI:
https://doi.org/10.15587/2313-8416.2015.37943Keywords:
pityriasis rosea, erythema multiforme, papulosquamous eruption, herald patch, purpuraAbstract
Aim: Pityriasis rosea (PR) is a common acute inflammatory skin disease characterized by pruritic erythematous papulosquamous eruption that is self-limited which can rarely pose a diagnostic challenge. In this report, we present a rare presentation of PR.
Method: the case was completely evaluated including laboratory works and a final diagnosis of erythema multiforme-like PR was reached. Besides, we reviewed all atypical presentations of PR that are reported in the medical literature.
Results: our patient has a morphological variant of PR which is erythema multiforme-like. The presence of a herald patch and the rapid resolution of the symptoms supports our diagnosis. This variant is considered rare and to our knowledge, this is the seventh case of erythema multiforme-like PR reported in the medical literature.
In conclusion: we report a case of erythema multiforme-like PR. It is important that physicians recognize the wide spectrum of PR variants so that appropriate management can be arranged.
References
Chuh, A. A. T., Lee, A., Molinari, N. (2003). Case Clustering in Pityriasis Rosea. Archives of Dermatology, 139 (4), 489–493. doi: 10.1001/archderm.139.4.489
Chuh, A., Molinari, N., Sciallis, G., Harman, M., Akdeniz, S., Nanda, A. (2005). Temporal case clustering in pityriasis rosea: a regression analysis on 1379 patients in Minnesota, Kuwait and Diyarbakir, Turkey. Archives of Dermatology, 141 (6), 767–771. doi: 10.1001/archderm.141.6.767
Messenger, A. G., Knox, E. G., Summerly, R., Muston, H. L., Ilderton, E. (1982). Case clustering in pityriasis rosea: support for role of an infective agent. BMJ, 284 (6313), 371–373. doi: 10.1136/bmj.284.6313.371
Watanabe, T., Kawamura, T., Jacob, S. E., Aquilino, E. A., Orenstein, J. M., Black, J. B., Blauvelt, A. (2002). Pityriasis Rosea is Associated with Systemic Active Infection with Both Human Herpesvirus-7 and Human Herpesvirus-6. Journal of Investigative Dermatology, 119 (4), 793–797. doi: 10.1046/j.1523-1747.2002.00200.x
Gonzalez, L. M., Allen, R., Janniger, C. K., Schwartz, R. A. (2005). Pityriasis rosea: An important papulosquamous disorder. International Journal of Dermatology, 44 (9), 757–764. doi: 10.1111/j.1365-4632.2005.02635.x
Tay, Y. K., Goh, C. L. (1999). One year review of pityriasis rosea at the National Skin Centre, Singapore. Ann Acad Med Singapore, 28, 829–831.
Chuh, A., Zawar, V., Lee, A. (2005). Atypical presentations of pityriasis rosea: case presentations. Journal of the European Academy of Dermatology and Venereology, 19 (1), 120–126. doi: 10.1111/j.1468-3083.2004.01105.x
Bari, M. (1990). Purpuric Vesicular Eruption in a 7-Year-Old Girl. Archives of Dermatology, 126 (11), 1497. doi: 10.1001/archderm.1990.01670350111020
Anderson, C. R. (1971). Dapsone treatment in a case of vesicular pityriasis rosea. The Lancet, 298 (7722), 493. doi:10.1016/s0140-6736(71)92662-6
Verbov, J. (1980). Purpuric Pityriasis Rosea. Dermatology, 160 (2), 142–144. doi: 10.1159/000250488
Klauder, J. V. (1924). Pityriasis rosea with particular reference to its unusual manifestations. Journal of the American Medical Association, 82, 178–183. doi: 10.1001/jama.1924.02650290008002
Pierson, J. C., Dijkstra, J. W. E., Elston, D. M. (1993). Purpuric pityriasis rosea. Journal of the American Academy of Dermatology, 28 (6), 1021. doi: 10.1016/s0190-9622(08)80661-5
Verbov, J. (1980). Purpuric Pityriasis Rosea. Dermatology, 160 (2), 142–144. doi: 10.1159/000250488
Bernardin, R. M., Ritter, S. E., Murchland, M. R. (2002). Papular pityriasis rosea. Cutis, 70, 51–55.
Vano-Galvan, S., Ma, D.-L., Lopez-Neyra, A., Perez, B., Muñoz-Zato, E., Jaén, P. (2009). Atypical Pityriasis rosea in a black child: a case report. Cases Journal, 2 (1), 6796. doi: 10.1186/1757-1626-2-6796
Bukhari, I. (2005). Pityriasis rosea with palmoplantar plaque lesions. Dermatol Online Journal, 11, 27.
Pringle, J. J. (1915). Case presentation, section on dermatology, Royal Societyof Medicine. British Journal of Dermatology, 27, 309.
Truhan, A. P. (1984). Pityriasis rosea. Am Fam Physician, 29, 193–196.
Relhan, V., Sinha, S., Garg, V., Khurana, N. (2013). Pityriasis rosea with erythema multiforme – like lesions: An observational analysis. Indian Journal of Dermatology, 58 (3), 242. doi: 10.4103/0019-5154.110855
Gibney, M. D., Leonardi, C. L. (1997). Acute papulosquamous eruption of the extremities demonstrating an isomorphic response. Inverse pityriasis rosea (PR). Archives of Dermatology, 133 (5), 651–654. doi: 10.1001/archderm.133.5.651
Little, E. E. (1914). Discussion on pityriasis rosea. British Journal of Dermatology, 26, 329.
Fox, C. (1906). Pityriasis rosea with vesiculation. British Journal of Dermatology, 18, 281.
Vidimos, A. T., Camisa, C. (1992). Tongue and cheek: oral lesions in pityriasis rosea. Cutis, 50, 276–280.
Eslick, G. D. (2002). Atypical pityriasis rosea or psoriasis guttata? Early examination is the key to a correct diagnosis. International Journal of Dermatology, 41 (11), 788–791. doi: 10.1046/j.1365-4362.2002.01627.x
Ghersetich, I., Rindi, L., Teofoli, P. et al. (1990). Pityriasis rosea-like skin eruptions caused by captopril. G Ital Dermatol Venereol, 125, 457–459.
Bonnetblanc, J. M. (1996). Cutaneous reactions to gold salts. Presse Med, 25, 1555–1558.
Helfman, R. J., Brickman, M., Fahey, J. (1984). Isotretinoin dermatitis simulating acute pityriasis rosea. Cutis, 33, 297–300.
Yosipovitch, G., Kuperman, O., Livni, E. et al. (1993). Pityriasis rosea-likeeruption after anti-inflammatory and antipyretic medication. Harefuah, 124, 198–200.
Buckley, C. (1996). Pityriasis rosea-like eruption in a patient receiving omeprazolc syndrome. British Journal of Dermatology, 135 (4), 660–661. doi: 10.1111/j.1365-2133.1996.tb03863.x
Gupta, A. K., Lynde, C. W., Lauzon, G. J. et al. (1998). Cutaneous adverse effects associated with terbinafine therapy: 10 case reports and a review of the literature. British Journal of Dermatology, 138 (3), 529–532. doi: 10.1046/j.1365-2133.1998.02140.x
Konstantopoulos, K., Papadogianni, A., Dimopoulou, M., Kourelis, C., Meletis, J. (2002). Pityriasis rosea Associated with Imatinib (STI571, Gleevec). Dermatology, 205 (2), 172–173. doi: 10.1159/000063900
Weedon, D. (1998). Skin pathology.. New York, NY: Churchill Livingstone, 96–97.
Imamura, S., Ozaki, M., Oguchi, M., Okamoto, H., Horiguchi, Y. (1985). Atypical Pityriasis rosea. Dermatology, 171 (6), 474–477. doi: 10.1159/000249476
Okamoto, H., Imamura, S., Aoshima, T., Komura, J., Ofuji, S. (1982). Dyskeratotic degeneration of epidermal cells in pityriasis rosea: light and electron microscopic studies. British Journal of Dermatology, 107 (2), 189–194. doi: 10.1111/j.1365-2133.1982.tb00337.x
Sharma, P., Yadav, T., Gautam, R., Taneja, N., Satyanarayana, L. (2000). Erythromycin in pityriasis rosea: A double-blind, placebo-controlled clinical trial. Journal of the American Academy of Dermatology, 42 (2), 241–244. doi: 10.1016/s0190-9622(00)90132-4
Leenutaphong, V., Jiamton, S. (1995). UVB phototherapy for pityriasis rosea: A bilateral comparison study. Journal of the American Academy of Dermatology, 33 (6), 996–999. doi: 10.1016/0190-9622(95)90293-7
Drago, F., Vecchio, F., Rebora, A. (2006). Use of high-dose acyclovir in pityriasis rosea. Journal of the American Academy of Dermatology, 54 (1), 82–85. doi: 10.1016/j.jaad.2005.06.042
Ganguly, S. (2014). A Randomized, Double-blind, Placebo-Controlled Study of Efficacy of Oral Acyclovir in the Treatment of Pityriasis Rosea. Journal of clinical and diagnostic research, 8 (5), YC01–YC04. doi: 10.7860/jcdr/2014/8140.4360
Anderson, C. R. (1971). Dapsone treatment in a case of vesicular pityriasis rosea. The Lancet, 298 (7722), 493. doi: 10.1016/s0140-6736(71)92662-6
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