PITYRIASIS ROSEA

By Group 3
Saul Sagita T Selang
Shandy Shanaya
Muh. Dien Hidayatullah
Uswah Sudirman
Hasni
Supervisior : Dr. dr. Khaeruddin Djawad, Sp.KK (K)
Residen : dr. Evi Arisandi

INTRODUCTION
The term pityriasis rosea (PR) was first used by Gibert in 1860
PR means pink (rosea), scales (pityriasis).
PR is acommon acute, self-limited skin eruption
Asymptomatic
Begins as a single thin oval scaly plaque on the trunk (herald

patch)
The initial lesion is followed several days to weeks later by the
appearance of numerous similar-appearing smaller lesions
located along the lines of cleavage of the trunk (a so-called
Christmas tree pattern).

Figure 42-2 A nonscaly purpuric primary plaque

(herald patch) of pityriasis rosea demonstrating
an oval shape and find scale inside the periphery
of the plaque

ETIOPATHOGENESIS
Etiology PR is unknown surely
Suspect bacteria, fungus and viruses (uncertain)
Hipotesa is viruses (self limiting disease)
Drago and colleagues in 1997, most recent PR etiologic

and pathogenic studies have been focused on two

ubiquitous viruses: HHV-7 and HHV-6.

CLINICAL MANIFESTATION
Classic PR Usually describe a single

truncal skin lession after several days to

weeks appear numerous smaller lession on
the trunk.
25% patients pruritus
Minority patients Flu-like symptomps
(General malaise, headache, nausea, loss of
appetite, fever and artralgia)

CLINICAL MANIFESTATION
PRIMER PLAQUE (HERALD PATCH)
Found in 50 90 % cases
Diameter 2 4 cm
Oval or round
Salmon coloured, erythematous or hiperpigmented

(especially in individuals with darker skin) and smooth

scales inside the periphery of the plaque.
If irritation persists papulovesikular eksematous

CLINICAL MANIFESTATION
Plak primer predileksion on the trunk in areas

covered by clothes.
Sometimes on the neck or proximal ekstremities.
Localization on the face or penis is rare.

PLAQUE PRIMER (HERALD PATCH)

A nonscaly purpuric primary plaque of pityriasis rosea.

A double herald patch of pityriasis rosea.

SECONDARY ERUPTION
Interval between the appearance of the primary plaque

and the secondary eruption 2 days to 2 months.

The secondary eruption occurs in crops at intervals of a
few days and reaches its maximum in aproximately 10
days
The lession may appear at the same primary lession but
only smaller
Sometimes, new lessions continues to develop for several
weeks.

SECONDARY ERUPTION
The symetric eruption Predilection mainly to the

trunk, adjacent regions of the neck and proximal

extremities
The most pronounced lesions extend over the
abdomen and anterior surface of the chest
Lesions distal to the elbows and knees can occur.

Main Types of Secondary Lessions

(1) Small plaques resembling the primary plaque

in miniature, aligned with their long axes

along lines of cleavage and distributed in a
Christmas tree pattern
(2) Small, red, usually nonscaly papules that
gradually increase in number and spread
peripherally.
The two types of lesions may coexist.

Predilection
herald patch

Figure 42-4 Schematic diagram of the primary plaque

(herald patch) and the typical distribution of secondary
plaques along the lines of cleavage on the trunk in a
Christmas tree pattern.

Primary Lessions

Fig. 33.32 Pityriasis rosea: (a) with herald patch on

right of abdomen, shown in close-up in (b) (courtesy
of York District Hospital, UK); (c) with herald patch
on right of chest (courtesy of Dr A.S. Highet, York
District Hospital, UK).

Secondary Lessions

Figure 42-5 Typical distribution of secondary plaques

along the lines of cleavage on the back in a Christmas
tree pattern.

Figure 42-6 Typical distribution of secondary plaques

along the lines of cleavage on the chest of a black individual.

Classification for Atypic Pityriasis Rosea

1. Atypical morphology of lesions
Atypical rash morphology includes rashes in vesicular,
purpuric, haemorrhuagic and urticarial forms.
Usually occurs in children and young adults.
Severely pruritic and extensive.

Figure 42-7 Vesicular pityriasis rosea, showing

typical
primary
plaque
and
secondary
papulovesicles. Note Christmas tree distribution.

2. Atypical size of lesions : The clinical course is similar to

typical pityriasis rosea
3. Atypical distribution of lesions : Pityriasis rosea inversa
presents with more lesions on the extremities, flexural areas and
face
4. Atypical number of lesions : Pityriasis circinata et marginata
is sometimes considered a special form of pityriasis rosea. Seen
in adults and larger lesions often localized to the axillae or
inguinal region

5. Atypical site of lesions : Involvements of the face, scalp,

hands and feet are not rare in pityriasis rosea
6. Atypical severity of symptoms : Pityriasis rosea is usually
nonpruritic. The term pityriasis rosea irritata is sometimes
coined to describe patients complaining of severe itch, pain and
a burning sensation
7. Atypical course of the eruption : Recurrent or
relapsed cases

8. Drug-induced pityriasis rosea-like rashes : Many

drugs, including captopril, gold, isotretinoin,
nonsteroidal
anti-inflammatory
agents,
omeprazole, terbinafine and tyrosine kinase
inhibitor have been implicated in causing
pityriasis rosea-like rashes

DIAGNOSIS
The diagnosis of pityriasis rosea is clinical.
Plaque primary appear after several days to weeks appear

numerous smaller lession.

Efloresensy is plaque primer (Herald Patch), Salmon
coloured, erythematous or hiperpigmented (especially in
individuals with darker skin) and smooth scales inside the
periphery of the plaque.
Secondary Plaque gives an overview like the fir tree or
Christmas tree distribution

DIAGNOSIS
The edges of lession were more active, erythematous

with the middle of the form

Not itch
Predileksion on the trunk (areas covered by clothes)
VDRL test and fluorescent antibody trepenomal do to

eliminate sifilis.
Biopsy usually is not indicated in the evaluation of
patients with suspected pityriasis rosea

DIFFERENTIAL DIAGNOSIS
Secondary Syphilis

Tinea Corporis
T.Rubrum,
M.Canis

T.Tonsurans,

Pityriasis Versicolor

Etiology

Treponema Pallidum

Malassezia Furfur

Onset

6 8 weeks after appear

syphilis primary

Predilection

lesions typically involve

palms and soles,

Glabrous skin

Upper
body,
neck,
abdomen,
extremity
proximal, sometimes in
face, scalp, axilla, groin 7
genetalia.

History & Clinical Sign

History of primary chancre.

Rashes have 3 common
features : not itch, coppery
red,
the
lesions
are
symmetrically
distributed.
Serological tests are always
positive in immunocompetent

Scale
is
usually
at
periphery of plaques, not
oval & distributed along
lines of cleavage, KOH
examination (+)

Generally not acoompanied

by subjective symptomps.
Only cosmetic complain.

Effloresency

Rashes,
Nodul,
Plaque
granulomaous,
papulosquamos lession

Erytem, scale, sometimes

vesicel and papul in perifer

Macular
demarcated,
hipopigmentation
or
hiperpigmentation,
sometimes
eritematous,
pitiriasiformis.

TREATHMENT
PR is self-limited, there is no need to treat uncomplicated cases.
For all patients, education about the disease process and

reassurance.
For patients with associated pruritus, topical corticosteroids.
For patients early in the disease course who demonstrate associated

flu-like symptoms and/or extensive skin disease, oral acyclovir 800

mg five times daily for 1 week (or equivalent acyclovir derivative)
may hasten recovery from disease.
For selected patients, phototherapy may be useful.

Thank You