A clinical study on pityriasis rosea

Anand S Egwin; Jacintha Martis; Ramesh M Bhat; Ganesh H Kamath; Kishore B Nanda

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Year : 2005 | Volume : 50 | Issue : 3 | Page : 136-138

A clinical study on pityriasis rosea

Anand S Egwin, Jacintha Martis, Ramesh M Bhat, Ganesh H Kamath, Kishore B Nanda
Department of Dematology, Venereology & Leprosy, Father Muller Medical College, Kankanady, Mangalore-575002, Karnataka, India

Correspondence Address:
Jacintha Martis
Department of Dematology, Venereology & Leprosy, Father Muller Medical College, Kankanady, Mangalore-575002, Karnataka
India

Source of Support: None, Conflict of Interest: None

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Abstract

Pityriasis rosea is an acute inflammatory dermatosis of unknown etiology with a self-limited course. Fifty patients of pityriasis rosea attending out patient department of our hospital were selected for the study and the data was analysed. In the present study out of 50 cases, 30(60%)were males and 20(40%)were females, giving male: female ratio 1.5:1. Majority of the patients 16(32%) were seen in the age group of 11-20 years. Precipitating factors include wearing new garments in 10(20%) patients, drugs in 5(10%) and both new garment and drug in 1(2%) patient. Thirty five (70%) patients presented with herald patch and the distributions of secondary eruptions were mainly on the trunk among 47(94%) patients. Classical pityriasis rosea (62%) was the commonest morphologic type, followed by atypical pityriasis rosea (38%) which include absence of herald patch (30%), localized pityriasis rosea (4%) and inverse pityriasis rosea and papulo -vesicular pityriasis rosea (2%) each.

Keywords: Pityriasis rosea, Herald patch

How to cite this article:
Egwin AS, Martis J, Bhat RM, Kamath GH, Nanda KB. A clinical study on pityriasis rosea. Indian J Dermatol 2005;50:136-8

How to cite this URL:
Egwin AS, Martis J, Bhat RM, Kamath GH, Nanda KB. A clinical study on pityriasis rosea. Indian J Dermatol [serial online] 2005 [cited 2023 Dec 2];50:136-8. Available from: https://www.e-ijd.org/text.asp?2005/50/3/136/18926

Introduction

Pityriasis rosea is an acute inflammatory dermatosis of unknown etiology with a self limited course.[1] Various[1], [2] reports have suggested possible links between pityriasis rosea and bacterial, viral or mycoplasmal infections. In majority of cases, the first manifestation is "herald patch" or "mother patch" followed by the secondary eruptions; appear in crops at an interval of 7 to 14 days after the appearance of herald patch. Various clinical patterns have been reported.[2] The present study was conducted to know the various clinical presentations and patterns, and to find out the precipitating factors.

Materials and methods

The study was conducted for a period of one year from May 1998 to April 1999. Fifty patients with pityriasis rosea attending out patient department of our hospital were included in the study and the diagnosis of pityriasis rosea was made based on the clinical features alone. All the patients were interrogated for a detailed history and a complete clinical examination was carried out and recorded giving special emphasis to the duration of the disease, site of onset, presence of herald patch, secondary rashes, progress of the lesions, precipitating factors and any other cutaneus or systemic illness.

Apart from routine blood and urine examination, blood VDRL and skin scrapings for fungus were done in all cases. Skin biopsy for histopathological examination was done in atypical cases.

Results

In this clinical study, the age group of the patient ranged from 6 months to 50 years. Among 50 patients, 30(60%) were males and 20(40%) were females giving male: female ratio 1.5:1. Sixteen (32%) patients were seen in the age group of 11-20 years (2nd decade). Highest number of cases 18(36%) was reported in the months of June and July, which coincides with monsoon in Mangalore. Among 50; 46 (92%) patients were associated with itching. There was history of having worn new garments among 10(20%) patients before the onset of illness. The other precipitating factors include intake of drug (NSAIDS) in 5(10%) patients and in one (2%) patient both drug (NSAIDS) and new garment.

Thirty five (70%) patients presented with herald patch and the most common site of involvement was the trunk (40%), followed by upper (14%) and lower extremities (6%) [Table - 1].

The distribution of secondary eruptions mainly involved the trunk 47(94%), followed by trunk and extremities 19(38%) and trunk, neck and extremities 15(30%) and 6(12%) patients had on the face and trunk. In 29(58%) cases the secondary eruptions appeared in the first week after the appearance of herald patch.

Classical pityriasis rosea (62%) was the commonest morphological type [Table - 2], other types seen were atypical pityriasis rosea (38%) which include absence of herald patch in 15 (30%), localized pityriasis rosea in 2(4%) and inverse pityriasis rosea and papulo-vesicular pityriasis rosea in 1(2%) each. Routine hemogram and urine analysis were normal in all patients. Skin scrapings for fungus was negative and VDRL was non reactive in all cases.

Discussion

In our study, 30(60%) cases belonged to the age group of 11-30 years, which corresponds to the study done earlier.[3],[4] A male preponderance (60%) reported in our study agrees with another published data.[5]

Cohen[6] reported an incidence of 12.8% among children. We found 11(22%) patients were below the age of 10 years.

It is generally accepted that highest incidence of pityriasis rosea in the temperate zones occurs during the cooler part of the year[4] and in the tropical countries during the hot dry months of the year.[7] We also noticed the incidence of pityriasis rosea was more common during early part of rainy season (36%).

Itching was the commonest symptom reported (92%) in our study, which is similar with the findings of Mandal, et al .[8]

Several reports[1],[9],[10] indicated the drug being the cause of pityriasis rosea. In our study pityriasis rosea appeared after the intake of drugs mainly NSAIDS in 5(10%) patients.

Thirty five (70%) patients presented with herald patch, which was commonly seen on the trunk in 20(57.14%) patients [Table - 2]. Similar observation was reported by an earlier study.[3]

Imamura, et al[11], reported absence of herald patch in 10(20%) cases. In our study 15(30%) cases presented without the classical herald patch.

In the present study, 39(78%) cases noticed the secondary eruptions within the first two weeks of appearance of herald patch, which corresponds to the earlier report.[12]

The site of secondary eruptions was mainly on the trunk, extremities and neck.[1] We observed that the trunk was involved in 47(94%) cases, followed by trunk and extremities in 19(38%) cases and trunk, neck and extremities in 15(30%) cases.

Though one study[13] reported oral lesions in 9% of cases. But in our study, there was no involvement of oral mucosa. Previous studies[1], [3]-[5] have shown 80% of the cases presenting with classical form of pityriasis rosea and 20% of cases with atypical types. In the present study 31(62%) cases presented with classical pityriasis rosea and 19(38%) cases with atypical forms. The atypical morphological lesions observed in previous studies[14], [15] include papular, vesicular, bullous, urticarial, purpuric or erythema multiforme like lesions. In the present study 1(2%) patient presented with papulo vesicular form of pityriasis rosea. Localized inverse pityriasis rosea have also been reported.[16],[17] Two (4%)cases of localised pityriasis rosea and 1(2%) case of inverse pityriasis rosea were seen in our study.

References

1.	Jerome M, Parsons, Richmond. Pityriasis rosea update. J Am Acad Dermatol 1986; 15: 159-67.
2.	Bjornberg A, Tegner E. Pityriasis Rosea, In: Fitzpatrick TB, Freedberg IM, Eisen AZ, et al , eds. Dermatology in General Medicine. 5th ed. New York: McGraw Hill, 1999; 541-6.
3.	Bjornberg A, Hellgren I. Pityriasis Rosea: A statistical, clinical and laboratory investigation of 826 patients and matched healthy controls. Acta Derm Venereol 1962 ; 42: 1-68.
4.	Chuang T, Ilstrup DM, Perry HO, Kurland LT. Pityriasis rosea in Rochester, Minnesota, 1969 to 1978: A 10-year epidemiologic study. J Am Acad Dermatol 1982; 7: 80-9.
5.	Cheong WK, Wong KS. An epidemiological study of pityriasis rosea in Middle Road Hospital. Singapore Med J 1989; 30: 60-2.
6.	Cohen EL. A clinical study of 206 cases of pityriasis rosea. Br J Dermatol 1967; 79; 533-7.
7.	Gilbert CM. Traite Pratique des Maladies de la Peau et de la Syphilis. 3 rd ed. Paris:1860; 402.
8.	Mandal SB, Datta AK. A clinical study of pityriasis rosea. Indian J Dermatol 1972; 17: 100 - 2.
9.	Maize JC, Tomecki KJ. Pityriasis rosea like drug eruption secondary to metronidazole . Arch Dermatol 1977; 113: 1457-8.
10.	Wolf R, Wolf D, Livni E. Pityriasis rosea and Ketotifen. Dermatologica 1985; 171: 355-6.
11.	Imamura S, Ozaki M, Oguchi M, Okamoto H, Horiguchi Y. Atypical pityriasis rosea. Dermatologica 1985; 171: 474-7.
12.	Weiss RS, Lane CW, Showman WA. Pityriasis rosea . Arch Dermatol Syph 1927; 15: 304 -22.
13.	Jacyk WK. Pityriasis rosea in Nigerians . Int J Dermatol 1980; 19: 397-9.
14.	Percival GH. Pityriasis rosea . Br J Dermatol 1932; 44: 241 -53.
15.	Crissey JT. Pityriasis rosea. Pediatr Clin North Am 1956; 3: 801-9.
16.	Hurley HJ, Roberts. Localised pityriasis rosea. Aust J Dermatol 1961; 12: 52-3.
17.	Davis M, Leonard CL. Acute papulosquamous eruption of the extremities demonstrating an isomorphic response. Inverse pityriasis rosea. Arch Dermatol 1997; 133: 649-54.