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Updated: Jun 15 2019

Pityriasis Rosea

  • Snapshot
    • A 10-year-old boy is brought to his dermatologist for a developing rash. A couple of weeks ago, he recovered from a common cold. A week after, he developed an oval rash on his chest. Thinking it was a fungus infection, his parents applied anti-fungal cream to the area. However, a week after the first lesion appeared, he developed multiple smaller rashes in his lower abdomen. They are sometimes itchy, but only mildly so.
  • Introduction
    • Common, self-limited papulosquamous eruption
    • Pathogenesis
      • idiopathic
      • often associated with URI
      • seasonal pattern suggests viral etiology, though not confirmed
        • potential link to herpesvirus types 6 and 7
    • Epidemiology
      • children
      • young adults
  • Presentation
    • Symptoms
      • prodrome or URI within a month of onset
      • little or no pruritus
    • Physical exam
      • herald patch, a single lesion
        • usually on the trunk
        • plaque with thin collarette of scale inside the border
      • eruption in 1-2 weeks
        • multiple smaller papules appear in “Christmas tree” distribution
          • oriented along Langer (skin cleavage) lines
        • rose-colored or violet
      • resolution in 4-12 weeks
        • resolves spontaneously without scarring
  • Evaluation
    • Diagnosis from clinical exam and history
    • Diagnosis confirmed with skin biopsy
      • potassium hydroxide preparation to exclude Tinea spp.
  • Differential Diagnosis
    • Tinea corporis
    • Secondary syphilis (especially if palm and soles involved)
    • Tinea versicolor
    • Drug eruption
    • Guttate psoriasis
  • Treatment
    • Observation
      • lesions heal within 4-12 weeks
    • Natural sunlight
  • Prognosis, Prevention, and Complications
    • Prognosis
      • very good
      • typically self-limited and self-resolving in 4-12 weeks
    • Complications
      • relapse
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