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Pityriasis rosea in Child
Other Resources UpToDate PubMed

Pityriasis rosea in Child

Contributors: Negar Esfandiari MD, Connie R. Shi MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Pityriasis rosea is a common and typically self-limited and benign cutaneous eruption. Classically, a herald patch, a solitary 2-5 cm scaly, pink or skin-colored plaque with mild central clearing and a raised border appears first, often on the trunk. In children, the herald patch appears about 4 days prior to the widespread rash. The ensuing eruption consists of multiple discrete, oval, erythematous, and scaly plaques and patches oriented along skin cleavage lines (Langer's lines), most commonly on the trunk, abdomen, and neck. The extremities and face are usually spared. New lesions may continue to arise for 2-3 weeks.

Pityriasis rosea is usually pruritic in pediatric patients, although it may also be asymptomatic. Constitutional symptoms may precede the eruption, including irritability, fever, headache, sore throat, and cough. In most pediatric patients, the rash typically resolves within 2-6 weeks. Recurrence is rare.

Adolescents and young adults are most commonly affected. Pityriasis rosea is less common in children younger than 10 years, and it is rare in children younger than 2 years. An atypical form of pityriasis rosea, characterized by papular lesions and facial and scalp involvement, is more prevalent in Black children. In individuals with darker skin colors, hyperpigmentation can result upon resolution.

While the exact cause remains unclear, pityriasis rosea in children is thought to be associated with primary infection or systemic reactivation of human herpesvirus 6 and 7 (HHV-6 and HHV-7).

Certain drugs can cause a pityriasiform eruption that resembles pityriasis rosea. Drug-related pityriasis rosea-like lesions may appear more red-violet in color, typically do not present with a herald patch, and may be associated with eosinophilia. Pityriasis rosea may also occur after vaccines, such as the COVID-19, smallpox, tuberculosis, and human papillomavirus (HPV) vaccines.

Codes

ICD10CM:
L42 – Pityriasis rosea

SNOMEDCT:
77252004 – Pityriasis rosea

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Exanthematous drug eruption
  • Tinea corporis
  • Tinea versicolor
  • Nummular dermatitis (nummular eczema) – very pruritic
  • Guttate psoriasis – smaller size, thicker scale
  • Erythema multiforme
  • Urticaria
  • Cutaneous mastocytosis (Diffuse cutaneous mastocytosis, Urticaria pigmentosa)
  • Secondary syphilis
  • Scarlet fever
  • Granuloma annulare
  • Other conditions with a "Christmas tree" distribution, including Pityriasis lichenoides chronica, Ashy dermatosis (ashy dermatosis), and, often, drug-induced Lichen planus.
  • Aggressive AIDS-associated Kaposi sarcoma may show a pityriasis rosea-like pattern with oval violaceous papules and nodules.

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:11/16/2023
Last Updated:12/05/2023
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Pityriasis rosea in Child
A medical illustration showing key findings of Pityriasis rosea : Oval configuration, Pink color, Primarily truncal distribution, Widespread distribution, Pruritus
Clinical image of Pityriasis rosea - imageId=3696704. Click to open in gallery.  caption: 'Multiple erythematous papules and a larger annular plaque ("herald patch") on the chest.'
Multiple erythematous papules and a larger annular plaque ("herald patch") on the chest.
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