Background:
Pityriasis rosea is a common acute, self-limited papulosquamous dermatosis that primarily
affects children and young adults. The condition and its clinical variants may pose a diagnostic challenge, especially in the
absence of the herald patch.
Objective:
This article aimed to familiarize pediatricians with clinical manifestations, evaluation, diagnosis, and
management of pityriasis rosea.
Methods:
A search was conducted in March 2020 in Pubmed Clinical Queries using the key term " pityriasis rosea". The
search strategy included all clinical trials (including open trials, non-randomized controlled trials, and randomized
controlled trials), observational studies, and reviews (including narrative reviews and meta-analyses) published within the
past 10 years. Only papers published in the English literature were included in this review. The information retrieved from
the above search was used in the compilation of the present article.
Results:
Pityriasis rosea occurs mainly in individuals between 10 and 35 years of age with a peak during adolescence.
Human herpesvirus (HHV)-7 and HHV-6 have been implicated as the causative agents in some patients with pityriasis
rosea. A mild prodrome consisting of headaches, fever, malaise, fatigue, anorexia, sore throat, enlarged lymph nodes and
arthralgia is present in about 5% of patients. The most common presenting sign, found in approximately 80% of patients,
is a "herald" or “mother” patch which is larger and more noticeable than the lesions of the later eruption. A generalized,
bilateral, symmetrical eruption develops in approximately 4 to 14 days and continues to erupt in crops over the next 12 to
21 days. Typical lesions are 0.5 to 1 cm, oval or elliptical, dull pink or salmon-colored macules with a delicate collarette
of scales at the periphery. The long axes tend to be oriented along the skin lines of cleavage (Langer lines). Lesions on the
back may have a characteristic “Christmas tree” whereas lesions on the upper chest may have a V-shaped pattern. There
are many conditions that may mimic pityriasis rosea. Pityriasis rosea in the absence of the herald patch and its variants may pose a diagnostic challenge. The typical course is 6 to 8 weeks. In the vast majority of cases, reassurance and
symptomatic treatment should suffice. Active intervention may be considered for individuals with severe or recurrent
pityriasis rosea and pregnant women with the disease. Treatment options include acyclovir, macrolides (in particular,
erythromycin), and ultraviolet phototherapy. If active intervention is needed, there is evidence supporting the use of oral
acyclovir to shorten the duration of illness.
Conclusion:
Pityriasis rosea is a common, acute, self-limiting exanthematous skin disease that primarily affects children
and young adults. The condition is characterized by a "herald patch" after which oval erythematous squamous lesions
appear along Langer's lines of cleavage on the trunk and proximal extremities, giving it a “Christmas tree” appearance.
The disease presenting in its classical form can easily be diagnosed. Clinical variants of the disease may pose a diagnostic
challenge for the general pediatrician. Knowledge of the disease is essential to allow a prompt diagnosis and to avoid
unnecessary investigations.
