Evidence of human herpesvirus-6 and -7 reactivation in miscarrying women with pityriasis rosea

Drago, Francesco; Broccolo, Francesco; Javor, Sanja; Drago, Francesca; Rebora, Alfredo; Parodi, Aurora

doi:10.1016/j.jaad.2014.02.023

Cited by 50 publications

(77 citation statements)

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“…PR in pregnancy can be included in CPR, or it can have a more aggressive course with unusually widespread skin lesions, long duration, and severe constitutional symptoms. These atypical forms require a closer follow-up since they may be associated with a prolonged viral reactivation in the plasma, eventually determining a HHV-6 intrauterine transmission and even fetal death, especially if PR develops within the 15th gestational week [31,32]. Finally, PR-like eruption is not a true form of PR, with a pathogenesis completely different from the previously described forms.…”

Section: Discussionmentioning

confidence: 99%

“…Since pregnancy is a state of altered immune response, a risk of viral reactivations and intrauterine transmission of HHV-6/7 exists. We previously studied 61 women who developed PR during pregnancy, finding that 22 (36%) had unfavorable outcomes, and 8 miscarried (13%) [31,32]. Patients with normal pregnancy usually had a CPR, whereas all miscarrying women presented with an atypically aggressive course with skin lesions unusually widespread, exanthem duration of 8-12 weeks, and severe associated constitutional symptoms (fatigue, headache, inability to concentrate, insomnia, and loss of appetite).…”

Section: Pr Classificationmentioning

confidence: 99%

“…On the whole, the total abortion rate among women with pregnancy PR is the same as that of the general population (13%), but, noteworthy, when PR develops within the 15th gestational week, the abortion rate is definitely higher (57%), probably because the risk of intrauterine transmission of HHV-6 (or less commonly HHV-7) is increased. Therefore, in such patients, especially with aggressive PR forms, a closer follow-up should be recommended and HHV-6 DNA investigated in the plasma [31,32]. …”

Section: Pr Classificationmentioning

confidence: 99%

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Pityriasis Rosea: A Comprehensive Classification

et al. 2016

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Pityriasis rosea (PR) is an acute, self-limiting exanthematous disease associated with the endogenous systemic reactivation of human herpesvirus (HHV)-6 and/or HHV-7. The disease typically begins with a single, erythematous plaque followed by a secondary eruption with lesions on the cleavage lines of the trunk (configuration of a ‘Christmas tree'). The duration may vary from 2 weeks to a few months. Besides the typical presentation of PR, atypical forms have been described. The previous classifications of PR are mainly based on its atypical morphological features rather than on the pathogenetic mechanisms that underlie the different presentations of the disease. Notably, most of the morphologically atypical forms follow a course amenable to the classic form. The classification that we propose, taking into account the pathogenesis, clinical features, and course of the disease, is easy and intuitive and may be helpful in identifying the atypical forms of PR in order 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.

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Section: Discussionmentioning

confidence: 99%

Section: Pr Classificationmentioning

confidence: 99%

Section: Pr Classificationmentioning

confidence: 99%

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Pityriasis Rosea: A Comprehensive Classification

et al. 2016

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“…ery and fetal demise. The onset of PR within the first 15 weeks of gestation, especially if associated with severe constitutional symptoms and a widespread diffusion of the eruption, has been indicated as an alarming sign for the outcome of pregnancy [5,6]. We studied a large cohort of patients with PR occurring during pregnancy to determine, by applying statistical methods, which risk factors could compromise the course of the pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Pityriasis Rosea during Pregnancy: Major and Minor Alarming Signs

Drago¹,

Ciccarese²,

Herzum³

et al. 2018

Dermatology

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Background: Pityriasis rosea (PR) is a self-limiting exanthematous disease associated with human herpesvirus (HHV)-6 and/or HHV-7 reactivation. In pregnant women, PR may be associated with pregnancy complications. Objective: To determine relevant risk factors in the development of negative pregnancy outcome in PR. Methods: Between 2005 and 2017 at the Department of Dermatology, University of Genoa, we recruited 76 women who developed PR during pregnancy. In 60 patients without known risk factors for intrauterine fetal death (30 with pregnancy complications and 30 without) we analyzed the pregnancy week of PR onset, presence of enanthem and of constitutional symptoms, PR body surface area involvement, age, and in 50 patients (20 with pregnancy complications and 30 without), the viral load of HHV-6 and HHV-7 (copies/mL). Results: In logistic regression analysis, early onset of PR (p = 0.0017) and enanthem (p = 0.0392) proved to be significantly associated with pregnancy complications. HHV-6 viral load (copies/mL) (p < 0.0001), constitutional symptoms (p < 0.001), and PR body surface area involvement (p < 0.004) were also significantly associated with pregnancy complications. Conclusion: The onset of PR before week 15 and enanthem may be considered major risk factors that should alarm the dermatologist. Constitutional symptoms and involvement of > 50% of the body area may be considered minor risk factors.

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“…It might be related to primary infections and endogenous reactivations of human herpesviruses (2,3). Autoimmunity (9,10) and atopic tendencies (11)(12)(13) have been suspected to be predisposing factors.…”

Section: Introductionmentioning

confidence: 99%

The first reported patient with non-Hodgkin lymphoma presenting as pityriasis rosea

Chuh¹

2015

cderm

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SummaryBackground. Owing to the spontaneous remission with no complication being the rule, pityriasis rosea (PR) has been termed Doctor's Delight. Only two patients have been reported to have Hodgkin lymphoma and atypical PR concomitantly. There exists no report on the association of PR and non-Hodgkin lymphoma. Case report. We present a 62-year-old male patient with fever and coryzal symptoms, followed by a herald patch at the right inferior quadrant of his anterior abdominal wall. One week later, generalised skin lesions erupted on his trunk and proximal aspects of his four limbs. We saw him 12 days after onset of the primary patch. Examination revealed clinical features entirely compatible with classical PR. Systemic examination revealed enlarged and firm inguinal lymph nodes bilaterally. Spontaneous rash resolution occurred two weeks later. As the inguinal lymph nodes were still enlarging over time, we referred him to a physician. Lymph node biopsy revealed non-Hodgkin lymphoma. Discussion. This is the first reported patient with non-Hodgkin lymphoma presenting as classical PR. PR in the elderlies, pregnant women, people with autoimmune diseases or tendencies, people after organ transplantation, and immunocompromised people might be at a higher risk of serious underlying diseases or severe complications, and are important exceptions for this Doctor's Delight.

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Evidence of human herpesvirus-6 and -7 reactivation in miscarrying women with pityriasis rosea

Cited by 50 publications

References 5 publications

Pityriasis Rosea: A Comprehensive Classification

Pityriasis Rosea: A Comprehensive Classification

Pityriasis Rosea during Pregnancy: Major and Minor Alarming Signs

The first reported patient with non-Hodgkin lymphoma presenting as pityriasis rosea

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