Pityriasis Rosea

23
Pityriasis rosea is a papulosquamous, self-
limiting condition, seen usually in adolescents
and young adults. The etiology is unknown,
however, it may be of viral origin. The lesions
usually disappear in 6 to 8 weeks.

CLINICAL FEATURES
The initial lesion, ‘herald’ patch, a diagnostic
hallmark, is 2 to 6 cm, round, erythematous,
scaly plaque. It may not be a presenting feature
in a few. In a couple of days, there is appearance
of multiple, oval, 1 to 2 cm sized, erythematous,
scaly eruptions. The surface is crinkly and the
scales are disposed in a collarette fashion. The
long axes of the lesions are oriented in the planes
of cleavage, running parallel to the ribs. It appears
to form an inverted ‘Christmas tree’. The lesions
are distributed over the trunk and proximal
Figure 23.1A: Pityriasis rosea: Herald patch, a
extremities (Figs 23.1A and B). The face, hands, diagnostic hallmark
and feet are usually spared. The lesions continue
to appear for 7 to 10 days, and disappear in 6 to Tinea corporis: This usually starts as an ery-

8 weeks. Besides the classic appearance, variants
may be encountered, namely: (a) inverse pityriasis
rosea, (b) papular eruptions, (c) vesicular and
bullous eruptions.
DIAGNOSIS
The diagnosis of pityriasis rosea is clinical.
However, it should be differentiated from the
following:
thematous, itchy papule which progresses to form
a circinate lesion. It is studded at the periphery
with papules or papulovesicles. The lesions are
scaly, showing clear or apparently normal looking
centers. They show seasonal variations, common
in hot and humid climate. The demonstration of
fungus in 10 percent KOH from the scrapings
seen under the microscope and their recovery in
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 106 Textbook of Clinical Dermatology

Circinate syphilides: This condition some-

times creates a problem in diagnosis. However,
history of sexual exposure, primary chancre or
scar on the genitals and polymorphic syphilitic
rash is helpful in diagnosis. The diagnosis may
EHFRQÀUPHGE\WKHGHPRQVWUDWLRQRITreponema
pallidum in the lesions and reactive serological
tests for syphilis.
Pityriasis versicolor: It is characterized by

asymptomatic, hypopigmented, mildly scaly,

multiple macules distributed on the body sur-
face, largely corresponding to the ‘lady’s bath-
ing suit’. Seasonal variation is the main feature.
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mycelia and spores of Malassezia furfur in the
scrapings seen under the microscope.
Chronic parapsoriasis or pityriasis lichenoi-
des et varioliform acuta (PLEVA). It should be
suspected if the lesions do not resolve in 8 to 12
weeks.

TREATMENT
It is a self-limiting condition and usually no
Figure 23.1B: :HOOGH¿QHG VFDO\ ULQJOLNH SODTXH
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over the chest along the body cleavages preceded by
herald patch
Psoriasis: The lesions of this condition are
typical—they are erythematoscaly eruptions,
single or multiple, disposed primarily on the
extensor surfaces of the body. The scales are
lamellated and silvery white. Auspitz’s sign
is positive, evident as a pinpoint bleeding on
grattage. Histology is diagnostic.
treatment is required. The patient needs to be
explained about the disease and reassured.
However, if pruritus is present, antihistamines
may be given orally. Topical soothing lotions
may be applied.
RECOMMENDED READING
1. Abdel-Hafez K, Deyab Z. Pityriasis rosea. Int J
Dermatol 1987;26:231-233.
2. Crissey JT. Pityriasis rosea. Pediatr Clin North Am
1956;3:801-809.
3. Parsons JM. Pityriasis rosea: Update: 1986. J Am
Acad Dermatol 1986;15:159-167.