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      Childhood Pityriasis rosea inversa without Herald Patch Mimicking Cutaneous Mastocytosis

      case-report

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          Abstract

          Background

          Pityriasis rosea is a self-limited inflammatory condition of the skin that mostly affects young adults. Several less common atypical presentations have been reported.

          Case Presentation

          A 6-year old girl with red-brown maculopapular eruption sized 0, 5–1 cm in diameter localized on neck, trunk and popliteal region visited our general pediatric outpatient clinic. The eruption was wide spread especially on flexural areas. After consulting dermatologist skin biopsy was performed. According to clinical and histopathological findings as inverse (flexural) pityriasis rosea was diagnosed. For treatment, systemic antihistamine, topical corticosteroid cream and emollient were applied. The lesions healed in two months. Spontaneous healing of the eruption also confirmed the diagnosis of pityriasis rosea.

          Conclusion

          We present this interesting pediatric case to show and discuss pityriasis rosea, atypical presentations, differential diagnosis and the importance of dermatological examination and importance of dermatologic consultation for pediatric patients with skin eruption.

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          Most cited references17

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          Additional evidence that pityriasis rosea is associated with reactivation of human herpesvirus-6 and -7.

          Francesco Drago, M Malnati, Paolo Lusso … (2005)
          To elucidate the role of human herpesvirus (HHV)-6 and -7 (HHV-7) in pityriasis rosea (PR), we measured their DNA load in plasma, peripheral blood mononuclear cells (PBMC), and tissues using a calibrated quantitative real-time PCR assay. We also studied HHV-6- and HHV-7-specific antigens in skin by immunohistochemistry and anti-HHV-7 neutralizing activity using a syncytia-inhibition test. Plasma and PBMC were obtained from 31 PR patients (14 children, 17 adults), 12 patients with other dermatites, and 36 blood donors. Skin biopsies were obtained from 15 adults with PR and 12 with other dermatites. HHV-6 and HHV-7 DNA were detected in 17% and in 39% of PR plasmas, respectively, but in no controls. HHV-7 viremia was associated with a higher PBMC load and, in adults, with systemic symptoms. HHV-7, but not HHV-6, levels in PBMC were higher in PR patients than in controls. HHV-6 and HHV-7 antigens were found only in PR skin (17% and 67% of patients analyzed, respectively), indicating a productive infection. Syncytia-neutralizing antibodies were found in PR patients and controls, but their titers were lower in patients with HHV-7 viremia. These data confirm the causal association between PR and active HHV-7 or, to a lesser extent, HHV-6 infection.
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            Atypical presentations of pityriasis rosea: case presentations.

            Antonio A. T. Chuh, S Lee, V P Zawar (2004)
            Atypical cases of pityriasis rosea (PR) are fairly common and less readily recognized than typical eruptions. We present four patients for whom we believe atypical PR is the most likely diagnosis. A 33-year-old man had purpuric lesions bilaterally on the legs with classical rash on the trunk. A 28-year-old woman had intensely pruritic and urticarial lesions. A 10-year-old girl had hundreds of small papular lesions 1-3 mm in size. A pregnant woman aged 26 had oral haemorrhagic ulcers with classical PR eruption on her trunk. The oral ulcers erupted and remitted at the same time as the generalized eruption. We reviewed the literature and proposed a classification based on rash morphology, rash size, rash distribution, number of lesions, site of lesions, severity of symptoms and course of the eruption. We believe that it is difficult to make a clear division to define typical and atypical PR, and that it is important not to ascribe any unusual or atypical skin eruption with PR unless other dermatoses have been excluded.
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              The natural history of pityriasis rosea in black American children: how correct is the "classic" description?

              Ranya Amer, Agneta H. Fischer, Xiaoming Li (2007)
              To delineate the natural history of pityriasis rosea in black children and to compare our findings with those of the American, European, and African literature on pityriasis rosea. Textbook and journal article descriptions of pityriasis rosea usually offer information about the presentation and clinical course of this condition in white patients. Prospective observational study. The general pediatric clinic, adolescent clinic, and emergency department of Children's Hospital of Michigan, Detroit, from June 2003 through May 2005. We followed up 50 black children with pityriasis rosea from the time of diagnosis through follow-up visits at 1, 2, and 4 weeks. Detailed observations were made and digital photographs taken at each visit. Duration of illness and pigmentary sequelae. Similarities with the medical literature were found regarding season of onset and prevalence of pruritus and of a herald patch. Our patients had more frequent facial involvement (30%) and more scalp lesions (8%) than usually described in white populations. One third had papular lesions. The disease resolved in nearly one half of patients within 2 weeks. Residual hyperpigmentation was seen in 48% of patients. Hypopigmentation developed in 29% of patients with purely papular or papulovesicular lesions. Pityriasis rosea in black children differs in several ways from textbook descriptions. Physicians may use this information to better counsel patients about the course and potential sequelae of this condition.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Iran J Pediatr
                Journal ID (iso-abbrev): Iran J Pediatr
                Journal ID (publisher-id): IJPD
                Title: Iranian Journal of Pediatrics
                Publisher: Tehran University of Medical Sciences
                ISSN (Print): 2008-2142
                ISSN (Electronic): 2008-2150
                Publication date (Print): June 2010
                Volume: 20
                Issue: 2
                Pages: 237-241
                Affiliations
                [1 ]Celal Bayar University, Faculty of Medicine, Departments of Dermatology, Manisa, Turkey
                [2 ]Celal Bayar University, Faculty of Medicine, Departments of Pediatrics, Manisa, Turkey
                [3 ]Celal Bayar University, Faculty of Medicine, Department of Pathology, Manisa, Turkey
                Author notes
                [* ] Corresponding Author: Address: Celal Bayar Üniversitesi TIp Fakültesi Dermatoloji Anabilim DalI 45010 Manisa, TÜRKIYE. E-mail: draylinturel@ 123456hotmail.com
                Article
                Publisher ID: IJPD-20-237
                PMC ID: 3446019
                PubMed ID: 23056712
                SO-VID: 9d4b615c-260f-4a89-8b2f-101dd4e9924d
                Copyright © © 2010 Iranian Journal of Pediatrics & Tehran University of Medical Sciences
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0), which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

                History
                Date received : 16 April 2009
                Date revision received : 07 September 2009
                Date accepted : 15 October 2009
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Pediatrics
                Keywords: pityriasis rosea,cutaneous mastocytosis,parakeratosis,fir tree
                Data availability:
                ScienceOpen disciplines: Pediatrics
                Keywords: pityriasis rosea, cutaneous mastocytosis, parakeratosis, fir tree

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