II. Epidemiology

  1. Ages 10 to 50 years (peaks age 20 to 30 years)
  2. No gender predisposition
  3. Seasonal variation: more common in spring and fall

III. Pathophysiology

  1. Papulosquamous eruption
  2. Thought to be of infectious etiology (Viral Exanthem)
    1. May be associated with Human Herpes Virus 6 or 7

IV. Symptoms

  1. Pruritus (25-50% of cases)
  2. Other symptoms present in only 5% of patients
  3. Viral prodrome-type constitutional symptoms may occur with mild URI symptoms
    1. Headache
    2. Malaise
    3. Arthralgias
    4. Chills
  4. Nervousness
  5. Gastrointestinal symptoms
    1. Vomiting
    2. Diarrhea or Constipation

V. Signs

  1. Herald Patch (initial presenting lesion in 80% of patients)
    1. Single oval Macule on trunk
    2. Diameter: 2 to 10 cm
    3. Characteristics: Annular Lesion (oval)
      1. Erythematous (rose colored) border with fine peripheral scale
      2. Central clearing
  2. Christmas tree pattern rash
    1. Onset occurs 7-14 days after herald patch
    2. Symmetric bilaterally
    3. Smaller than herald patch (<1 cm)
    4. Rash follows skin Cleavage Lines (Langer Lines)
    5. Individual lesions appear similar to herald patch
      1. Small fawn or salmon colored oval Macules
      2. Peripheral scaly collarettes
      3. Central clearing

VI. Differential Diagnosis

  1. See Annular Lesion
  2. Secondary Syphilis
    1. Unlike pityriasis, Syphilis affects palms and soles
  3. Nummular Eczema
  4. Tinea Corporis
    1. Typically a single lesion (may be confused with herald patch)
    2. Once Christmas Tree pattern of lesions develops, Pityriasis diagnosis becomes more obvious
  5. Guttate Psoriasis
  6. Lichen Planus
  7. Medication or toxin reaction
    1. Arsenic
    2. Barbiturates
    3. Bismuth
    4. BCG vaccine
    5. Captopril
    6. Clonidine
    7. Gold
    8. Hepatitis B Vaccine
    9. Interferon

VII. Labs

  1. Syphilis Serology (RPR)
  2. Skin biopsy for direct fluorescent Antibody
    1. Indicated only if Syphilis strongly considered
    2. Pityriasis Rosea will show dyskeratotic degeneration

VIII. Management (No effective treatment)

IX. Course

  1. Spontaneous resolution within 6 to 8 weeks in 80% cases (range 2-12 weeks duration)
  2. Recurrence in less than 3%

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Ontology: Pityriasis Rosea (C0032026)

Definition (NCI) A mild, self-limited skin disorder that is most commonly seen in children and young adults. It is characterized by an initial large round spot on the chest, abdomen, or back, often referred to as a herald patch, that is usually followed within a week by a distinctive pattern of similar but smaller papules on the torso, arms, and legs. There may also be itching, especially when overheated.
Definition (MSH) A mild exanthematous inflammation of unknown etiology. It is characterized by the presence of salmon-colored maculopapular lesions. The most striking feature is the arrangement of the lesions such that the long axis is parallel to the lines of cleavage. The eruptions are usually generalized, affecting chiefly the trunk, and the course is often self-limiting.
Concepts Disease or Syndrome (T047)
MSH D017515
ICD9 696.3
ICD10 L42
SnomedCT 156373006, 77252004
French PITYRIASIS ROSE, Pityriasis rosé, Pityriasis rosé de Gibert
English PITYRIASIS ROSEA, Pityriasis Rosea, pityriasis rosea (diagnosis), pityriasis rosea, Pityriasis Rosea [Disease/Finding], pityriasis roseas, rosea pityriasis, Pityriasis rosea, Pityriasis circinata et maculata, PR - Pityriasis rosea, Pityriasis rosea (disorder), Gibert, circinata; pityriasis, pityriasis; circinata, pityriasis; rosea, rosea; pityriasis, Pityriasis circinata
Spanish pitiriasis rosada de Gibert, pitiriasis de Gibert, pitiriasis maculosa y circinada, pitiriasis rosada de Gibert (trastorno), pitiriasis rosada, Pitiríasis rosada, Pitiriasis Rosada
Japanese ばら色粃糠疹, バライロヒコウシン
Swedish Pityriasis rosea
Czech pityriasis rosea, Pityriasis rosea
Finnish Punatäplähilseily
Portuguese PETIRIASE ROSADA, Pitiríase Rósea, Pitiríase rosada
Korean 장미색 잔비늘증(비강진)
Polish Łupież różowy
Hungarian Pityriasis rosea
Norwegian Fransk rosen, Pityriasis rosea
Dutch circinata; pityriasis, pityriasis; circinata, pityriasis; rosea, rosea; pityriasis, pityriasis rosea, Pityriasis rosea
German Pityriasis rosea
Italian Pitiriasi rosea