Pityriasis rosea

Last Updated: 2022-02-25

Author(s): Anzengruber F., Navarini A.

ICD11: EA10

Gibert, 1860.

Röschenflechte, Gibert's disease.

Self-limiting, exanthematous, inflammatory skin disease.

  • Age peak: 10-35 years
  • Women > men
  • Occurring in all ethnicities
  • Prevalent mainly in spring and autumn

  • The cause is not yet known
  • Possible triggers:
    • Viral infections (HHV-6, HHV-7, H1N1, EBV, CMV)
    • Drugs
    • Stress
  • Increases in tissue-derived interleukin-17 (IL-17) and -22, interferon-γ, vascular endothelium growth factor (VEGF) and CXCL10 (IP-10) have been shown

  • Prodromi
    • ↓ general condition, nausea, (sub-)febrile temperatures, cephalgia
  • Sharply demarcated, erythematous, oval plaques with collerett-like scaling. A tache mère (sometimes called plaque mère, herald patch or primary medallion) manifests first. This is usually located on the trunk and is larger than all the others
  • As it progresses, the skin lesions spread along the cleavage lines (Christmas tree pattern)
  • The face and distal halves of the extremities are usually left out. The oral mucosa (enanthema) is involved only in exceptional cases
  • Special forms:
    • Pityriasis rosea inversa: It mainly affects the axillae and the groin region. An inverse form may be seen in children or African-Americans
    • The skin lesions may also be atypical: urticarial, haemorrhagic, follicular bound, vesicular, psoriasiform and circine

  • Anamnesis (previous infections?)
  • Clinical image (search for plaque mère)

Discreet focal spongiosis and parakeratosis are visible in the epidermis. Erythrocyte extravasations are typical but rare. A perivascular lymphocytic infiltrate is seen in the dermis.

  • Healing after 3-8 weeks
  • Disease can lead to abortion or premature birth in pregnant women (up to 15 weeks gestation)

  • No causal therapy!
  • Spontaneous healing after 3-8 weeks
  • Avoidance of heat by e.g.: Sports, sauna, sun exposure and spicy foods

 

Topical therapy

  • No greasy externals.
  • Tanning solution

 

  • Refatting
    • Carbamide lotion / cream

 

  • Antipruritic topicals
    • 5% polidocanol in cold cream several times a day
    • Carbamide cum 2% menthol (sic!) ad libitum several times a day
      • Achtung Kühlstärke!

 

Systems therapy therapy

  • Anithistamines
  • Levocetirizine p.o. 5 mg 1x daily.
  • Desloratadine p.o. 5 mg 1x daily.
  • Fexofenadine p.o. 180 mg 1x daily.

 

Therapy of 1st choice according to Lebwohl

Evidence level

Topical glucocorticoids

E

Moisturizers

E

Oral antihistamines

E

   

Therapy of the 2nd choice after Lebwohl

 

UVB

B

UVA1

C

   

Therapy of the 3rd choice according to Lebwohl

 

Glucocorticoids p.o.

D

Erythromycin p.o.

B

Aciclovir p.o.

B

Dapsone p.o.

E

 

 

 

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