Indian Journal of Dermatology
LETTER IN RESPONSE TO PREVIOUS PUBLICATION IN IJDŽ
Year
: 2017  |  Volume : 62  |  Issue : 1  |  Page : 95-

Pityriasis rosea: An update on etiopathogenesis and management of difficult aspects – a reply


Francesco Drago, Giulia Ciccarese 
 DISSAL Department of Dermatology, IRCCS AOU San Martino-IST, 16132 Genoa, Italy

Correspondence Address:
Giulia Ciccarese
DISSAL Department of Dermatology, IRCCS AOU San Martino-IST, 16132 Genoa
Italy




How to cite this article:
Drago F, Ciccarese G. Pityriasis rosea: An update on etiopathogenesis and management of difficult aspects – a reply.Indian J Dermatol 2017;62:95-95


How to cite this URL:
Drago F, Ciccarese G. Pityriasis rosea: An update on etiopathogenesis and management of difficult aspects – a reply. Indian J Dermatol [serial online] 2017 [cited 2020 Oct 26 ];62:95-95
Available from: https://www.e-ijd.org/text.asp?2017/62/1/95/198042


Full Text

Sir,

We read with great interest the review by Mahajan et al. [1] regarding an update on pityriasis rosea (PR) recently published on your journal. The article prompted us, on the basis of our experience, to make some observations. Controversial opinion remains on PR seasonal prevalence mainly related to its occurrence in clusters. Chuh et al. [2] who examined patients from three different geographic areas found significant clustering though in different seasons. In our experience on 590 patients, PR occurs uniformly all during the year, and we could not demonstrate statistically significant cluster.[3] The authors make also an exhaustive description of all the morphological variants of PR and its recurrent form, but not cite the most recent classification of all PR variants.[4] This classification is easy and intuitive for dermatologists, general practitioners, and other specialists taking simultaneously into account the pathogenesis, clinical features, and course of the disease. In addition, it may be helpful in identifying the atypical forms of PR to avoid misdiagnosis and establish the best treatment options. Finally, this classification provides indications for managing potentially harmful forms of PR (such as PR in pregnancy) and PR-like eruptions. In fact, in case of PR during pregnancy, a particular attention should be carried out when PR develops within the 15th gestational week and is associated with an aggressive course with unusually widespread skin lesions, long duration, and severe constitutional symptoms. In these cases, a prolonged human herpesvirus 6 viral reactivation in the plasma may facilitate intrauterine transmission with fetal damage. Notably, these data are obtained by a careful follow-up from 61 women who developed PR during pregnancy, using the most modern techniques of molecular biology.[4] Other studies on PR during pregnancy are partial and cover a few cases little more than anecdotal. Finally, we believe to be important to report the criteria recently proposed for distinguishing between PR and PR-like eruptions [5] and vaccine-induced PR and PR-like eruptions [6] since they have a completely different pathogenesis from a virological point of view.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Mahajan K, Relhan V, Relhan AK, Garg VK. Pityriasis rosea: An update on etiopathogenesis and management of difficult aspects. Indian J Dermatol 2016;61:375-84.
2Chuh AA, Molinari N, Sciallis G, Harman M, Akdeniz S, Nanda A. Temporal case clustering in pityriasis rosea: A regression analysis on 1379 patients in Minnesota, Kuwait, and Diyarbakir, Turkey. Arch Dermatol 2005;141:767-71.
3Drago F, Broccolo F, Rebora A. Pityriasis rosea: An update with a critical appraisal of its possible herpesviral etiology. J Am Acad Dermatol 2009;61:303-18.
4Drago F, Ciccarese G, Rebora A, Broccolo F, Parodi A. Pityriasis rosea: A comprehensive classification. Dermatology 2016;232:431-7.
5Drago F, Broccolo F, Agnoletti A, Drago F, Rebora A, Parodi A. Pityriasis rosea and pityriasis rosea-like eruptions. J Am Acad Dermatol 2014;70:196.
6Drago F, Ciccarese G, Javor S, Parodi A. Vaccine-induced pityriasis rosea and pityriasis rosea-like eruptions: A review of the literature. J Eur Acad Dermatol Venereol 2016;30:544-5.