Acta Dermato-Venereologica 99-7CompleteContent

664 INVESTIGATIVE REPORT Pityriasis Rosea Recurrence is Much Higher than Previously Known: A Prospective Study Mavise YUKSEL Department of Dermatology, Istanbul Medipol University, Medical Faculty, Istanbul, Turkey Pityriasis rosea is a common acute exanthema of un known aetiology, which causes severe anxiety. In this study, the demographic data of pityriasis rosea pa- tients, who presented to our clinic between 2013 and 2017, were prospectively recorded. The patients with a confirmed pityriasis rosea diagnosis were followed up for 4 years in order to investigate the recurrence rate. Of the clinically suspected patients, having a typi- cal history of pityriasis rosea manifestations, a herald patch, and/or secondary coloured squamous lesions, 400 were confirmed by biopsy to have pityriasis rosea. The 4-year follow-up was completed in 212 patients, of whom 136 (64.2%) were female and 76 (35.8%) were male. The recurrence rate was determined as 25.9% at the end of the 4-year follow-up period. Key words: pityriasis rosea; recurrence; prospective studies. Accepted Mar 8, 2019; E-published Mar 8, 2019 Acta Derm Venereol 2019; 99: 664–667. Corr: Mavise Yuksel, Department of Dermatology, Istanbul Medipol University, Medical Faculty, Istanbul, Turkey. E-mail: mavisey107@gmail. com P ityriasis rosea (PR) is a self-limiting acute exanthema of unknown aetiology. Despite this fact, infectious agents are considered responsible for the pathogenesis of PR, with the most implicated infectious factors being human herpes virus (HHV)-6 and HHV-7. The role of HHV-7 in the pathogenesis of PR was first demonstra- ted by Drago et al. in 1997 (1). In addition to the proof that PR is associated with the endogenous reactivation of HHV-6 and HHV-7 (2), there are also studies which suggest that it is an active, systemic, infectious disease caused by these viruses (1). In 15–90% of cases, typical PR begins with a medal- lion-like erythematous plaque, called a herald patch (3). A herald patch is an ovoid, erythematous, slightly raised patch 2–10 cm in diameter, typically with a coloured squamous edge. A few days to weeks after the herald patch appearance, smaller, salmon-coloured, ovoid, slightly raised lesions 5–10 mm in diameter are observed and some also present with coloured squamous edges. These secondary lesions take the shape of a Christmas tree when they are arranged along the Langer’s lines on the back (4). Papulosquamous lesions in PR are usually located on the trunk and proximal extremities (5). Ex- anthema spreads and peaks within two weeks. This dis- seminated phase generally begins to decline within 2 to 4 doi: 10.2340/00015555-3169 Acta Derm Venereol 2019; 99: 664–667 SIGNIFICANCE Pityriasis rosea is a self-limiting acute exanthem of unkown causes. Pityriasis rosea is known to recur in some patients. In two retrospective studies involving large case series, the frequency of recurrence was reported as 3.7% and 2.8%. Between the years of 2013–2017, 212 patients admitted to the dermatology outpatient clinic of Istanbul Medipol Uni- versity were included in the study. In the current prospec- tive study, we found this rate to be 25.9%. It is considered that the rate of pityriasis rosea recurrence is actually grea- ter than reported in the literature. weeks; however, in some cases, it may take more than 3–5 months (6). Itching is variable, with moderate to severe itching occurring in 25% of the patients (4). Prodromal symptoms and upper respiratory tract findings, such as sore throat, weakness, loss of appetite, and mild fever are present in more than 69% of patients before or during the eruption phase (3). PR can be seen all year round, but it is more frequent in winter, spring and autumn. Mucous membrane lesions occur in 16% of patients, but are usually overlooked or rarely reported since they are mostly asymptomatic (7). Although oral mucous lesions mostly present in the form of ulcerations, they may also occur as erythematous macules or plaques, and punctate haemorrhagic or erythematous lesions (3). Involvement of the oral mucosa is more commonly seen in paediatric, pregnant, relapsing and persistent cases than in classical PR (8). In adults, hands and feet are generally spared (6). METHODS A total of 400 patients presented to the Istanbul Medipol Mega University Hospital Dermatology Clinic between 2013 and 2017 and were diagnosed with PR. Of these, 212 patients completed the 4-year follow-up with the same physician and were included in the study. Detailed anamnesis was obtained from the patients. Age, sex, history of atopy, stress level before the disease, history of upper respiratory tract infection that might trigger the disease, and the duration of complaints were recorded. The diagnosis of PR was based on patients’ detailed medical history and the findings on physical examination. This study was approved by the ethics committee of Istanbul Medipol University Hospital (number: 10840098, date: March 10, 2017). Diagnostic criteria In this study, the following diagnostic criteria proposed by Chuh were used for a PR diagnosis (9): This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica.

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