Recurrent and persistent pityriasis rosea: an atypical case presentation

Abstract

It is a common, acute, selflimiting papulosquamous eruption that is characterised by oval erythematous squamous lesions of the trunk and limbs, usually sparing the face, scalp, palms and soles.(1) Typically, the disease begins with a solitary patch termed a 'herald patch', after which generalised eruption appears along Langer's lines of cleavage. The herald patch has been observed in over 50% of patients, and multiple herald patches have also been reported.Up to 69% of patients have a prodromal illness before the herald patch appears, suggestive of an infectious origin, although this remains unproven.(2,3) CA S E R EPO RTA 24-year-old Malay man, who works as a full-time tutor, presented with an 11-month history of recurrent and persistent papulosquamous rashes. He first presented in December 2010 with a sudden onset of mildly pruritic eruptions on his trunk and thighs, which had persisted for a week. A larger oval patch appeared on his left iliac fossa a week before the other eruptions, which were also associated with multiple oral ulcers. There was no prodromal illness, the patient's medical history was unremarkable and he was not on any medication.Physical examination revealed a papulosquamous rash on his face, trunk, upper limbs and thighs. A larger oval patch with a slightly elevated fine-scaling border (most likely the herald patch), was present on his left iliac fossa (Fig. 1) ABSTRACT We report a case of atypical pityriasis rosea in a 24-year-old Malay man. He presented with an 11-month history of three recurrent and persistent episodes of pityriasis rosea associated with oral ulcers. The first episode lasted for one month and recurred within 14 days. The second episode lasted for three months and recurred within nine days. The third episode lasted for seven months. Although all three episodes were not preceded by any prodromal symptoms, a herald patch was noted on three different sites (the left iliac fossa, abdomen and chest) on each successive episode. Recurrent pityriasis rosea and its association with oral ulcers, although quite uncommon, have been reported in the literature. However, reports of multiple recurrences, with prolonged duration of each episode and very short remissions in between, have not been made. To the best of our knowledge, this is the first report of such unique presentation. Keywords: atypical, oral ulcers, persistent, pityriasis rosea, recurrentSingapore Med J 2014; 55(1): e4-e6 doi: 10.11622/smedj.2013190

Pityriasis Rosea Recurrence is Much Higher than Previously Known: A Prospective Study

“…A herald patch was not detected in relapses, the number and size of the lesions decreased and the duration was shorter compared to the primary disease (15). In a 24-year-old man, Chuah et al (18) observed 3 attacks, each manifesting with a herald patch, but the form and severity of the lesions were milder compared to the primary disease. In contrast, Zawar & Kumar.…”

“…In the literature, after the primary episode, the earliest and latest recurrence cases were reported to be two weeks (18) and two years (20), respectively. In the current study, the earliest recurrence occurred after 3 weeks and the latest after 4 years.…”

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

“…PR usually lasts 6-8 weeks, although durations as short as 2 weeks have also been reported. A persistent form of PR (PPR) has been reported only in 1 patient so far [7]. Here, we report on 12 patients in whom the clinical and virological features of PR lasted longer than 12 weeks, suggesting that, as in the case of relapsing PR [8], PPR is another atypical form of PR.…”

Geographic tonguelike presentation in a child with pityriasis rosea: Case report and review of oral manifestations of pityriasis rosea

“…Features of reported PR cases with oral lesions are summarized in Table 1. [7][8][9][10][11][12][13][14] Oral lesions appear to be more common in children than adults with PR. 5,15,16 In a study of 31 Caucasian children with PR, 11 (35%) had oropharyngeal lesions.…”