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      Reply: Commentary on letter to the editor from Drago et al

      , MD, , MD

      JAAD Case Reports

      Elsevier

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          Abstract

          To the Editor: We appreciate the opportunity to respond to the letter by Drago et al, regarding our recently published report, “Ibrutinib-associated pityriasis rosea-like rash.” 1 The comments raised 3 important points regarding the differentiation between classic pityriasis rosea (PR) and PR-like eruption that were not detailed in our report. Human herpes viruses (HHV) 6 and 7 have been linked to the pathogenesis of classic PR but not to PR-like eruptions. 2 Unfortunately, we did not evaluate our patient for the presence of HHV-6/7 serum antibodies or plasma DNA during the acute phase of the eruption.3, 4, 5, 6 Regarding peripheral eosinophilia, our patient had transient eosinophilia with absolute eosinophil count of 880. The presence of eosinophilia might support a drug-induced eruption; however, most of the PR-like eruptions present with normal eosinophil count. 2 Drago et al 2 also questioned the resolution of the eruption without discontinuation of the culprit medication. We did not advocate for discontinuation of the medication because the patient's chronic lymphocytic leukemia was responsive to ibrutinib. 1 The risk of discontinuing ibrutinib outweighed the benefit. We appreciate the comparison table that outlines the clinical, histopathologic, and virologic criteria, which can serve as a guide when evaluating patients for suspected PR or PR-like eruptions caused by a drug. 7

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          Most cited references 7

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          Pityriasis Rosea: A Comprehensive Classification

           Francesco Drago,  Giulia Ciccarese (corresponding) ,  Alfredo Rebora (2016)
          Pityriasis rosea (PR) is an acute, self-limiting exanthematous disease associated with the endogenous systemic reactivation of human herpesvirus (HHV)-6 and/or HHV-7. The disease typically begins with a single, erythematous plaque followed by a secondary eruption with lesions on the cleavage lines of the trunk (configuration of a ‘Christmas tree'). The duration may vary from 2 weeks to a few months. Besides the typical presentation of PR, atypical forms have been described. The previous classifications of PR are mainly based on its atypical morphological features rather than on the pathogenetic mechanisms that underlie the different presentations of the disease. Notably, most of the morphologically atypical forms follow a course amenable to the classic form. The classification that we propose, taking into account the pathogenesis, clinical features, and course of the disease, is easy and intuitive and may be helpful in identifying the atypical forms of PR in order to avoid misdiagnosis and establish the best treatment options. Finally, this classification provides indications for managing potentially harmful forms of PR (such as PR in pregnancy) and PR-like eruptions.
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            Pityriasis rosea and pityriasis rosea–like eruptions

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              Pityriasis rosea and pityriasis rosea-like eruption: can they be distinguished?

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                Author and article information

                Contributors
                Journal
                JAAD Case Rep
                JAAD Case Rep
                JAAD Case Reports
                Elsevier
                2352-5126
                18 September 2018
                September 2018
                18 September 2018
                : 4
                : 8
                : 817
                Affiliations
                Department of Dermatology, Tulane University, New Orleans, LA
                Author notes
                []Correspondence to: Andrea Murina, MD, Department of Dermatology, Tulane University School of Medicine, 1430 Tulane Ave, No. 8036, New Orleans, LA 70112 amurina@ 123456tulane.edu
                Article
                S2352-5126(18)30100-0
                10.1016/j.jdcr.2018.04.001
                6160618
                © 2009 Elsevier Inc.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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