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Pityriasis rosea in Adult
Other Resources UpToDate PubMed

Pityriasis rosea in Adult

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 cutaneous eruption. Classically, a herald patch, a 1-3 cm solitary scaly, pink or skin-colored plaque with mild central clearing and a raised border appears first, often on the trunk, up to 2 weeks prior to the widespread rash. The ensuing eruption consists of multiple discrete oval, erythematous, and scaly plaques and patches oriented along skin cleavage lines, most commonly on the trunk, upper extremities, and upper thighs. The face, scalp, forearms, palms, legs, and soles are usually spared. More lesions may erupt for up to 6 weeks.

Pityriasis rosea is usually pruritic but may also be asymptomatic. Constitutional symptoms may precede the eruption, including fever, headache, cough, and arthralgia. In most patients, the rash typically resolves within 12 weeks. Recurrence is rare.

Adolescents and young adults are most commonly affected, and it rarely occurs in children younger than age 10 years. Of note, pityriasis rosea occurring during pregnancy has been associated with increased risk of fetal demise and miscarriage, particularly if the lesions appear within the first 15 weeks of gestation. In pregnant individuals, the eruption may present in a more widespread distribution compared with classic pityriasis rosea and may be associated with systemic symptoms such as fatigue, headache, and loss of appetite. Close obstetric follow-up of pregnant patients with pityriasis rosea is recommended.

While the exact cause remains unclear, pityriasis rosea is thought to be associated with human herpesvirus 6 and 7 (HHV-6 and HHV-7) infection.

Certain drugs, such as captopril, clonidine, omeprazole, NSAIDs, metronidazole, terbinafine, lamotrigine, ibrutinib, domperidone, and dupilumab, among many others, 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. Eruptions 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
  • Small plaque parapsoriasis
  • Secondary syphilis – Genital and palmoplantar lesions. Systemic symptoms are more pronounced, including lymphadenopathy, fevers, history of Chancroid, condyloma lata. If remotely suspicious, check syphilis serologies.
  • Erythema multiforme
  • Urticaria
  • Lichen planus
  • Polymorphic eruption of pregnancyy and Atopic eruption of pregnancy
  • 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:12/04/2023
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Pityriasis rosea in Adult
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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