BAGIAN ILMU KESEHATAN KULIT & KELAMIN

Pityriasis rosea

MENTOR
dr. Sukma Anjayani Sp. KK, M.Kes

Arranged by :

Andi rhayu, S.Ked 17 21 777 14 443

Muhammad fadhel , S.Ked 17 21 777 14 448
 Definition
Pityriasis rosea is an acute skin disorder that begins with the
appearance of solitary pink macules/plaques with fine scales (herald
patches), then within a few days to several weeks a similar lesion of
smaller size appears on the trunk and proximal extremities arranged
according to skin folds. (chritmas tree pattern).
 Epidemiologi

• The estimated incidence of pityriasis rosea is 0.5%

to 2%. It affects people of both sexes, usually
between 15 and 30 years of age, but it also affects
older adults and children.
 Etiologi
The etiology of Pitiriasis rosea remains unexplained. Many characteristics and
epidemiology suggest considering the infective agent as an etiologic factor.
Pityriasis rosea includes herald patches/patches as sites of inoculation, spread of
lesions that appear after a certain period, mild constitutional symptoms, limited
course, and relatively infrequent recurrence are characteristic characteristics of
infectious disease.
Patofisiologi

Increased numbers of CD4 T cells and

Langerhans cells are present in the dermis,
possibly reflecting the processing and
presentation of viral antigens. Anti-
immunoglobulin M (IgM) keratinocytes have
been found in patients with pityriasis rosea. This
may be related to the exanthema phase of the
viral infection
Manifestasi klinis
Constitutional symptoms are generally absent. A minority of patients may develop
flu-like symptoms including malaise, headache, nausea, loss of appetite, fever
and arthralgia. Some patients complain of mild itching.

The disease begins with the first lesion (herald patch), generally on the body,
solitary, oval and annular in shape, about 3 cm in diameter. The rash consists of
erythema and fine scales at the edges. It lasts from a few days to a few weeks.
Subsequent lesions appear 4-1O days after the first lesion, giving a characteristic
appearance, the same as the first lesion only smaller

A place of predilection on the body, proximal upper arms and upper limbs, so that
it resembles ancient women's swimsuits
 Diagnosis

History1
• Mainly occurs in healthy adolescents and young adults, age group 10-35 years. More
experienced by women.
• Subjective symptoms are usually absent, but may be accompanied by mild or moderate
itching.
• Skin disorders begin with primary lesions followed by secondary lesions.
• The appearance of secondary lesions varies from 2 days to 2 months after the primary
lesion, but usually within 2 weeks. Sometimes primary and secondary lesions occur
simultaneously.
• Can also be found a fever that is not too high or weak body.
Physical examination

• The clinical picture begins with the appearance of primary lesions in the form of
skin-colored/pink/salmon-colored2/hyperpigmented macules/plaques1 that are well-defined, generally 2-4 cm in
diameter1,2 and oval or round in shape. The center of the lesion has a characteristic fine scale, and on the inner edge there
is a clearer scale forming a cholaret scale appearance.
• Primary lesions are usually on the body covered with clothing, but are occasionally found on the neck or proximal
extremities1 such as the upper thighs or upper arms.3 Primary lesions are rarely found on the face, penis, or hairy scalp.
• Symmetrical eruption mainly on trunk, neck and proximal extremities.
• Secondary lesions are pink3 macules/plaques, multiple, smaller than the primary lesion, round or oval in shape,
following Langer lines to form a Christmas-tree pattern on the back.
• Can be found enlarged lymph nodes.
 Diagnosis banding
1. Tinea corporis: this disease is often mistaken for fungus by patients, as well as doctors
often make the diagnosis as tinea corporis. The clinical picture is indeed similar to that of
tinea corporis because there is erythema and scales at the edges of the lesion and is
annular in shape. The difference is in pityriasis rosea, itching is not as severe as in tinea
corporis, with fine scales, whereas in tinea corporis it is rough.
2. Secondary syphilis: secondary syphilis has a history of chancre and no herald patch
history. In secondary syphilis there is involvement of the palms and soles, enlarged lymph
nodes, condylomata lata, and positive syphilis serologic tests.
3. Numular dermatitis: in nummular dermatitis the plaques are usually circular, not oval as
in pityriasis rosea. Lesions are more common on the lower limbs or the backs of the
hands, which are rare in pityriasis rosea.
4. Guttate psoriasis: guttate psoriasis is usually smaller than pityriasis rosea and is not
arranged according to skin folds, and the scales are thick. If there is any doubt, a biopsy can
be done

5. Seborrheic dermatitis: there is no herad patch in seborrheic dermatitis, the lesions develop
slowly, mostly on the upper body, neck and scalp, darker in color, thicker and oily scales. The
disorder will persist if not treated. Drug eruption resembling pityriasis rosea: clinical features
may resemble pityriasis
 Penatalaksanaan

• For patients diagnosed early, oral high-dose acyclovir may be given for 7 days.
• Oral erythromycin can be given for 14 days
• For cases with limited number of lesions, moderate potency topical corticosteroid, twice daily.
• If disseminated PR is diagnosed early, high-dose oral acyclovir may be given for 7 days.
• If a patient with disseminated PR is diagnosed with delay, UVB or UVA1 phototherapy may be
recommended.

Treatment is symptomatic, for the itching, sedatives can be given, while as a topical medication, salicylic
acid powder spiked with 1% menthol can be used. If there are flu-like symptoms and / or widespread skin
disorders, acyclovir 5x800 mg per day can be given for 1 week. This treatment can speed healing.
 Prognosis

The prognosis is good because the disease resolves spontaneously, usually within 3-8 weeks.
Some cases persist for up to 3 months. There may be transient postinflammatory hypo or
hyperpigmentation that usually goes away without a trace. Pityriasis rosea rarely recurs, but
recurrence can occur in 2% of cases
 Komplikasi

Although pityriasis rosea can heal on its own, this skin disease can cause discomfort and reduce
the sufferer's confidence. If not treated properly, pityriasis rosea can cause a dark discoloration
of the skin after it heals.
Thank you