Pityriasis rosea in pregnancy: A case series and literature review

Abstract

Summary Background and objective Pityriasis rosea (PR), a common skin disease in young adults, may adversely affects the course of pregnancy and the unborn child. Patients and methods Data from forty‐six pregnant women with PR seen in the dermatological university clinic between 2003 and 2018 were analyzed and compared with patient data (n = 53) from previously published studies to determine the incidence and risk factors for an unfavorable pregnancy outcome after PR infection. Results Unfavorable pregnancy outcomes (defined as miscarriage, preterm delivery before week 37 of gestation, or birth weight < 2,500 g) were significantly less frequent in our study population than in a pooled cohort obtained from previously published studies (10.9 % vs. 39.6 %; P = 0.0012). Analysis of pooled data from our study and from previous studies revealed that the week of pregnancy at onset of PR was inversely associated with an unfavorable outcome (odds ratio [OR] = 0.937; 95 % CI 0.883 to 0.993). In addition, duration of PR (OR = 1.432; 95 % CI 1.129 to 1.827), additional extracutaneous symptoms (OR = 4.112; 95 % CI 1.580 to 10.23), and widespread rash distribution (OR 5.203, 95 % CI 1.702 to 14.89) were directly associated with unfavorable outcome. Conclusion In most cases, PR does not influence pregnancy or birth outcomes.

Pregnancy and pityriasis rosea: Current concepts

“…12 On the other hand, Wenger-Oehn et al studied 46 pregnant women with PR and found no significant odds ratio for adverse pregnancy outcomes and concluded that PR does not have adverse impact on pregnancy outcomes in most cases. 5 A very recent controlled cohort study on 31 PR patients and 75 age-and gender-matched controls also reported similar unfavorable pregnancy outcomes (about 13% abortion rate) between patients and their control 6 and further validated the results of Stashower et al retrospective study on 33 patients with PR without any abortion in cases with PR onset before 15 weeks gestation. 13 In summary, despite it's widely prevalence, conflicting results of studies regarding PR in pregnancy has raised some issues about appropriate assessment and treatment of this group of patients.…”

“…However, the association of PR with abnormal pregnancy results has not been shown in some newer studies. 5,6 Due to these discrepancies in the literature, clinicians remain unsure about management of PR during pregnancy. Drago et al conducted a cohort study on 76 women who developed PR during pregnancy and found a significant association between pregnancy complication with viral load (copies/mL), constitutional symptoms and PR body surface area involvement (p <0.0001, <0.001, and <0.004 respectively).…”

“…14 Considering its prevalence in pregnant females and also recent data regarding relative safety of PR occurrence in most pregnant women, it is not or enanthem), and widespread rash distribution were significantly associated with worse prognosis (OR: 0.937, 1.432, 4.112, and 5.203) respectfully. 5 Although a review article showed that the onset of PR during second trimester was more frequent among those with unfavorable pregnancy outcomes, 4 the onset of PR within the first 15 weeks of gestation was shown to be a red flag in most of studies. 2,3 It seems that some clinical clues could be considered for predicting the prognosis of pregnancy in patients with PR including widespread (involvement of >50% of the body area) or longer lasting cutaneous lesions, presence of extracutaneous constitutional or enanthem symptoms and early PR onset (during the first 20 weeks of pregnancy).…”