Persistent Pityriasis Rosea: An Unusual Form of Pityriasis Rosea with Persistent Active HHV-6 and HHV-7 Infection

Abstract

Pityriasis rosea (PR) is an acute, self-limiting exanthematous disease, associated with the reactivation of the human herpesvirus 6 (HHV-6) and/or human herpesvirus 7 (HHV-7) that usually lasts 6-8 weeks. We studied, from a clinical and virological point of view, 12 patients in whom the features of PR lasted longer than 12 weeks, defining this form of the disease as persistent PR (PPR). As in typical PR, in most of the PPR patients the disease begins with a herald patch, but compared to typical PR, systemic symptoms and oral lesions are more common. Moreover, in PPR we found a persistent reactivation of HHV-6 and/or HHV-7 with higher viral loads than in typical PR, accounting for the unusual persistence of the illness, the more frequent and severer systemic symptoms and the oral lesions. In conclusion, we describe an unusual persistent form of PR, whose prevalence has probably been underestimated so far and which should be added to the other variants of PR.

Pityriasis Rosea: A Comprehensive Classification

“…Persistent PR is an atypical form that lasts for over 12 weeks without interruption, regardless of the presence of constitutional symptoms [14]. In the absence of a diagnostic gold standard test, the persistence of HHV-6/7 plasma viremia (measured by calibrated quantitative real-time PCR) in all the phases of the illness and the persisting PR signs/symptoms are highly suggestive.…”

“…Oral lesions, resembling Nagayama's spots described in primary HHV-6 infection [26], are also more common than in CPR [27], a further sign of active infection [28]. Moreover, the average level of plasma viremia was higher in persistent PR than in CPR [14]. Over the last 2 years, we treated 5 patients with persistent PR with a high dose of acyclovir (800 mg, 5 times a day for 10 days), obtaining after 4 weeks a nearly complete resolution of the skin lesions, an improvement of the systemic symptoms, and a significant reduction in the serum viral load (unpubl.…”

“…As for other exanthems, besides the typical presentation of PR, atypical forms have been described [11,12,13,14,15]. Following the early classification of atypical PR [16], Chuh et al [11] proposed another classification of the PR eruptions that are considered atypical for morphology, size, number, distribution, site, severity of symptoms, and course.…”

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

“…The aetiology of pityriasis rosea (PR) is largely unknown (1)(2)(3)(4)(5)(6)(7)(8). It might be related to primary infections and endogenous reactivations of human herpesviruses (2,3).…”

“…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.…”