Pityriasis rosea-like rash after COVID-19 vaccination with Oxford-AstraZeneca: a possible trigger?

Scholars around the world have dedicated themselves to developing an effective vaccine against SARS-CoV-2. However, vaccines have produced adverse effects in some patients. We report the case of a 44-year-old man who developed a pruritic papulosquamous rash on the trunk with a characteristic pattern known as Christmas tree after receiving the first dose of the Oxford-AstraZeneca COVID-19 vaccine, similar to pityriasis rosea (PR). He had no previous symptoms of viral infection and tested negative for neutralizing antibodies (enzyme immunoassay) against COVID-19. There are few reports in the literature about the relationship between the onset of cutaneous adverse reactions and the Oxford-AstraZeneca vaccine, therefore, the dissemination of this case is of paramount importance.

Pitiriasis rosada como manifestación dermatológica de infección por SARS-CoV-2: a propósito de un caso / Pityriasis rosea as a cutaneous manifestation associated with SARS-CoV-2 infection: case report

Las manifestaciones cutáneas relacionadas a la infección por el coronavirus SARS-CoV-2, causante de COVID-19, se han descrito entre el 0,2% y 20,4% de las personas que cursan con esta enfermedad. Las más frecuentemente descritas son: lesiones maculopapulares (47%), lesiones acrales eritematosas con vesículas o pústulas (pseudoperniosis) (19%), urticariales (19%), lesiones vesiculosas (9%) y livedo/necrosis (6%). En particular, la pitiriasis rosada es una dermatosis autolimitada de etiología desconocida, sin embargo, se ha visto asociada a la infección por SARS-CoV-2, con algunos reportes de casos en la literatura. El mecanismo fisiopatológico de las lesiones cutáneas en COVID-19 no es claro, y se han planteado algunas teorías, entre las cuales está el papel que juega la enzima convertidora de angiotensina 2 (ACE2) utilizada por el virus para infectar las células, los infiltrados linfocíticos, los depósitos de factores del complemento en la piel, y la reactivación de virus latentes como los herpes virus humanos. Se presenta el caso de una paciente con pitiriasis rosada asociada a COVID-19 y se describen los casos reportados hasta la fecha

Subsets of T lymphocytes in the lesional skin of pityriasis rosea

Abstract: Background: Pityriasis rosea is a common papulosquamous disorder. However, its etiology and pathogenesis remain unclear. Objective: We investigate the types of inflammatory cells infiltrating the lesional skin of pityriasis rosea and demonstrate whether T-cell-mediated immunity is involved in the pathogenesis of this condition or not. Methods: The biopsies were taken from the lesional skin of 35 cases of patients diagnosed with pityriasis rosea. The specimens were prepared in paraffin sections, then submitted to routine immunohistochemistry procedures using monoclonal antibodies directed against CD3, CD4, CD8, CD20 and CD45RO and horseradish peroxidase-labeled goat anti-human antibodies. The positive sections were determined by the ratio and staining intensity of positive inflammatory cells. Results: The mean score of positive CD3, CD4, CD8, and CD45RO staining was respectively 3.74±3.88, 5.67±4.40, 2.94±3.42 and 7.68±4.33 in these pityriasis rosea patients (P<0.001). The percentage of positive staining was 54.29% (19/35), 69.7% (23/33), 40% (14/35) and 79.41% (27/34) (P<0.05). However, the staining of CD20 was negative in all samples. The mean score of CD3 staining in patients with time for remission ≤60 days (4.90±4.21) was higher than that in patients with time for remission >60 days (2.00±2.5) (P<0.05), whereas no statistical difference in the mean score of CD4, CD8 and CD45RO staining was observed. study liMitations: The sample size and the selected monoclonal antibody are limited, so the results reflect only part of the cellular immunity in the pathogenesis of pityriasis rosea. Conclusion: Our findings support a predominantly T-cell mediated immunity in the development of pityriasis rosea.

Effectiveness of acyclovir in the treatment of pityriasis rosea. A systematic review and meta-analysis

Abstract: Background: There is a lack of evidence to support acyclovir administration in pityriasis rosea. Objective: To determine the efficacy of acyclovir in patients with typical pityriasis rosea. Methods: A systematic review and meta-analysis of experimental studies was performed in MEDLINE, SCOPUS, EMBASE and others, from January 1990 to October 2016 on acyclovir for pityriasis rosea. Random effect model was used to find the pooled Risk Ratio. Outcomes, evaluated between weeks 1 to 8, were regression of lesions, cessation of lesions, decrease of symptoms and duration of disease. Comparisons were acyclovir vs. placebo; acyclovir vs. symptomatic treatment; acyclovir vs. antibiotic; acyclovir vs. observation and combined therapy (acyclovir plus symptomatic treatment) vs. symptomatic treatment alone. Results: Seven papers were analyzed with 324 participants, of which 159 received acyclovir and 165 were controls. Acyclovir was superior to placebo for complete regression of lesions at week 1 (Risk Ratio 5.72, CI95% 2.36-13.88). However, combined therapy was not superior to symptomatic treatment at week 4 (Risk Ratio 1.46, CI95% 0.93-2.29). Individual studies showed the superiority of acyclovir for the control of symptoms and pruritus. Study limitations: We faced differences designs of trials and inconsistency between reports. Conclusion: Symptomatic treatment is a reasonable option for pityriasis rosea, and the addition of acyclovir is justified for the control of symptoms and pruritus.

Pitiriasis rosada en el embarazo: reporte de caso / Pityriasis rosea in pregnancy: case report

RESUMEN A pesar de que la Pitiriasis Rosada se considera una condición cutánea benigna, en el marco del embarazo, hay estudios que relacionan la aparición de esta patología con complicaciones asociadas en el feto. Metodología: Se realiza un reporte de caso, prospectivo, a una mujer de 36 años chilena que presentó esta patología durante la semana 12 de gestación. El objetivo fue describir, la evolución y control y contrastar su evolución con la evidencia científica actual sobre esta temática. Resultados: Paciente presenta placas eritematodescamativas concordantes con diagnóstico de pitiriasis rosada (superficie afectada menos al 50% de su cuerpo), sin presentar enantema, ni síntomas sistémicos. Tuvo un recién nacido sano a las 38 semanas de gestación, sin presentar ningún efecto adverso de los que relaciona la literatura analizada. Conclusiones: Distintos estudios han estudiado los posibles efectos adversos en el feto en madres que han presentado Pitiriasis Rosada en el embarazo, sin embargo, en este reporte de caso no se presentaron complicaciones asociadas. Faltan estudios realizados en mayor cantidad de pacientes.

ABSTRACT Although Pityriasis Rosea is considered a benign cutaneous condition, in the context of pregnancy, there are studies that relate the appearance of this pathology with associated complications in the fetus. Methodology: A prospective case report was made to a 36-year-old Chilean woman who presented this pathology during the twelve weeks of pregnancy. The objective was to describe, the evolution and control and to contrast its evolution with the current scientific evidence on this subject. Results: Patient presents concordant erythematous-desquamative plaques with diagnosis of Pityriasis Rosea (surface affected less than 50% of his body), without presenting enanthem, nor systemic symptoms. Had a healthy newborn at 38 weeks of gestation, without presenting any adverse effect related to the analyzed literature. Conclusions: Different studies have studied the possible adverse effects on the fetus in mothers who have presented pityriasis rosea in pregnancy, however in this case report there were no associated complications. Missing studies in a greater number of patients.

Comments to "A Case of Pityriasis Rosea Associated with Leuprolide Acetate" / 대한피부과학회지

No abstract available.

Removal of corns by punch incision: A retrospective analysis of 15 patients.

Background: Macrolides are prescribed in the treatment of pityriasis rosea despite conflicting results of the limited number of studies evaluating their role in its treatment. Aim: A randomized double-blind placebo-controlled trial was conducted to evaluate the effect of azithromycin on the clinical course of pityriasis rosea. Methods: Seventy patients of pityriasis rosea were given either azithromycin (n = 35) or placebo (n = 35) and were followed-up at 2, 4 and 6 weeks. Pruritus was assessed in both groups using the visual analogue scale (VAS) . Change in the pityriasis rosea severity score (PRSS) and in the VAS were recorded as outcome measures and were compared statistically. Results: The decrease in PRSS from baseline through 2, 4 and 6 weeks within both treatment (P < 0.001) and placebo (P < 0.001) arms was found to be statistically significant; however, this change was not significantly different in the two groups (P = 0.179). Similarly, the decrease in VAS was found to be statistically significant within both groups (P < 0.001); however, the change was comparable between the two groups (P < 0.937). Analysis by Fisher's exact test did not find a significant difference between the two groups for PRSS and VAS. Conclusion: Azithromycin is not effective in pityriasis rosea and the use of macrolides for this disease should not be encouraged in clinical practice.

The efficacy of azithromycin in pityriasis rosea: A randomized, double-blind, placebo-controlled trial.

Background: Macrolides are prescribed in the treatment of pityriasis rosea despite conflicting results of the limited number of studies evaluating their role in its treatment. Aim: A randomized double-blind placebo-controlled trial was conducted to evaluate the effect of azithromycin on the clinical course of pityriasis rosea. Methods: Seventy patients of pityriasis rosea were given either azithromycin (n = 35) or placebo (n = 35) and were followed-up at 2, 4 and 6 weeks. Pruritus was assessed in both groups using the visual analogue scale (VAS) . Change in the pityriasis rosea severity score (PRSS) and in the VAS were recorded as outcome measures and were compared statistically. Results: The decrease in PRSS from baseline through 2, 4 and 6 weeks within both treatment (P < 0.001) and placebo (P < 0.001) arms was found to be statistically significant; however, this change was not significantly different in the two groups (P = 0.179). Similarly, the decrease in VAS was found to be statistically significant within both groups (P < 0.001); however, the change was comparable between the two groups (P < 0.937). Analysis by Fisher's exact test did not find a significant difference between the two groups for PRSS and VAS. Conclusion: Azithromycin is not effective in pityriasis rosea and the use of macrolides for this disease should not be encouraged in clinical practice.

Recurrent and persistent pityriasis rosea: an atypical case presentation

We report a case of atypical pityriasis rosea in a 24-year-old Malay man. He presented with an 11-month history of three recurrent and persistent episodes of pityriasis rosea associated with oral ulcers. The first episode lasted for one month and recurred within 14 days. The second episode lasted for three months and recurred within nine days. The third episode lasted for seven months. Although all three episodes were not preceded by any prodromal symptoms, a herald patch was noted on three different sites (the left iliac fossa, abdomen and chest) on each successive episode. Recurrent pityriasis rosea and its association with oral ulcers, although quite uncommon, have been reported in the literature. However, reports of multiple recurrences, with prolonged duration of each episode and very short remissions in between, have not been made. To the best of our knowledge, this is the first report of such unique presentation.

Association of pandemic H1N1 influenza and pityriasis rosea - a case report

Pityriasis rosea [PR] is an inflammatory papulosquamous disease of unknown etiology. Different viral infections have been implicated as causative agents for PR. We herein report an adult male patient who clinically manifested as pityriasis rosea [PR] during an episode of infection caused by pandemic H1N1 influenza virus, in whom the clinical progression and regression of both the diseases were in tandem

Decreased Serum Level of Interferon-gamma in Patients with Pityriasis Rosea

No abstract available.

A Case of Pityriasis Rosea Associated with Leuprolide Acetate / 대한피부과학회지

No abstract available.

Clinical study of a typical Pityriasis rosea in patients attending the department of dermatology and venereology at Rizgary Teaching Hospital in Erbil city

The aim of this study was to measure the rate of a typical cases of pityriasis rosea among dermatological visit and to outline the various clinical presentations of a typical pityriasis rosea disease. This descriptive study was conducted for a period extended from October 2007 through June 2008. 88 patients who diagnosed to have pityriasis rosea were enrolled in this study. The diagnosis was based on history and clinical examination; questionnaire was designed to provide relative data and all patients' data were recorded at time of diagnosis. Investigations in certain cases were done to aid in the diagnosis. A typical pityriasis rosea was found in 38.5% patients. Absence of herald patch in 17% of patients, papular rosea in 8%, inverse pityriasis rosea in 6.8%, localized pityriasis rosea in 4.5%, unilateral/inverse in 1.1% and urticarial in 1.1% of patients A typical pityriasis rosea is not uncommon and different forms of a typical pityriasis rosea exist. Investigations are sometimes needed to confirm the diagnosis

Atypical Pityriasis Rosea with Palmoplantar Involvement / 대한피부과학회지

Pityriasis rosea, first described by Gilbert in 1860, is a fairly common dermatosis. The exact cause of pityriasis rosea is not known. The earliest clinical finding of a typical case is a herald patch, which is usually on the trunk, and scaly and erythematous daughter macules, which is distributed along the skin cleavage line, such as the 'Christmas tree pattern'. This may be accompanied by Itching. Atypical cases of pityriasis rosea, such as palmoplantar, unilateral, vesicular and inverse forms, have also been reported. There is no difference between typical and atypical cases regarding the presence of a herald patch and/or symptoms. Differences between typical and atypical cases lie in the distribution of skin lesions and the characteristics of daughter macules. Hands and feet, including palms and soles, are rarely involved in pityriasis rosea. Moreover, there are no reported pathologic findings of pityriasis rosea of the palms and soles, even in atypical distributed pityriasis rosea case reports. Here, we report atypical case of pityriasis rosea with palmoplantar involvement with pathologic reports.

Pityriasis rosea-like Drug Eruption Induced by Imatinib Mesylate (Gleevec(TM))

Imatinib mesylate (Gleevec(TM), STI571), a selective inhibitor of BCR-ABL, c-Kit, and platelet-derived factor receptor, has been used to treat chronic myelogenous leukemia (CML) and gastrointestinal stromal tumors. Although its use has been associated with various adverse cutaneous reactions, pityriasis rosea-like drug eruptions are rare. Here, we report a case of pityriasis rosea-like drug eruption that developed following the administration of imatinib mesylate to treat CML.

Granuloma Annulare Induced by Adalimumab / 대한피부과학회지

Adalimumab is the first fully humanized monoclonal anti-tumor necrosis factor alpha (TNF-alpha) antibody. This drug has been shown to be of benefit in patients with inflammatory diseases in which TNF-alpha is involved, such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and Crohn's disease. As the use of adalimumab is becoming more widespread, cutaneous side effects are being increasingly reported. Various dermatologic adverse events have been reported in the literature, including injection site reactions, psoriasis-like eruption and pityriasis rosea. Herein, we describe a case of GA associated with adalimumab treatment for adult-onset Still's disease, which has not been reported in Korea.

A Clinical and Histologic Study of Pityriasis Rosea during the Last 5-Year Period / 대한피부과학회지

BACKGROUND: Pityriasis rosea is an acute inflammatory dermatosis with an unproven etiology. The typical clinical feature consists of an initial, single herald patch followed by the development of smaller, disseminated, papulosquamous and ovoid macules. OBJECTIVE: The aim of this study was to evaluate the clinical manifestations of pityriasis rosea. METHODS: We examined a total of 101 patients with pityriasis rosea who visited the Department of Dermatology in Chung-Ang University Medical Center from March of 2005 to February of 2010. RESULTS: There were 1.53 times more women (61 patients) than men (40 patients) among the study subjects. The age of onset varied from 4 years to 71 years with a mean age of 28.7 years and 60% of the cases were 20 years to 39 years old. The percentage of seasonal variation was 34% in winter, 24% in summer, 22% in spring and 21% in autumn. A herald patch was found in 43% and the main predilection sites were the trunk and the thigh. Secondary eruptions could be classified into the macular type (67%), papular type (30%), urticarial type (2%) and purpuric type (1%). They appeared on the back, the chest, the abdomen, the upper arms, the thighs, the neck, the forearm, the lower legs, the face, the hands and the feet. The histopathological findings of all the types of lesions were focal parakeratosis, intraepidermal vesicles and papillary dermal edema. As compared to the macular type, hyperkeratosis, parakeratosis and exocytosis of lymphocytes were less commonly observed in the papular type. CONCLUSION: Most of the study results were compatible with those of other previous studies. However, the number of patients with papular type pityriasis rosea was currently increasing.