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Year : 1998  |  Volume : 64  |  Issue : 4  |  Page : 185-186

Pityriasis Rosea with Unsusual Herald Patch

Correspondence Address:
Kiran Dambalkar

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Source of Support: None, Conflict of Interest: None

PMID: 20921759

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A case of pityriasis rosea is reported in a 15-year old boy. The herald patch was unusual being multiple and located in crural areas and armpit. The other features of the disease were however expressed classically.

How to cite this article:
Dambalkar K. Pityriasis Rosea with Unsusual Herald Patch. Indian J Dermatol Venereol Leprol 1998;64:185-6

How to cite this URL:
Dambalkar K. Pityriasis Rosea with Unsusual Herald Patch. Indian J Dermatol Venereol Leprol [serial online] 1998 [cited 2020 Feb 25];64:185-6. Available from: http://www.ijdvl.com/text.asp?1998/64/4/185/4688

  Introduction Top

Pityriasis rosea is a fairly common entity. In the majority of cases a herald patch precedes the eruption by a few days. The patch is usually solitary, often located on the trunk, thighs or upper arm[1], with the commonest site being the anterior chest.[2] A case with multiple herald patches situated in flexures is reported.

  Case Report Top

A 15-year-old boy presented in mid winter season with slightly itchy skin lesions in the crural areas and right axilla of 10 days duration along with similar but smaller lesions over the trunk for the past 2 days. There was no prior history of drug intake or of any febrile episode. Examination revealed sharply demarcated, erythematous areas of 12-15 cm size in both crural areas and right axilla with fine white linear scaling about 2-3 cm inside the border. Lesions on trunk revealed similar plaques but of smaller size varying from 0.5-2 cms. and a collarette of scaling half way inside the border. Hair, nails and mucosal surfaces appeared normal.

A presumptive diagnosis of pityriasis rosea was made. Scrapings in 10% KOH for fungus from flexures were negative and VDRL test was non-reactive. In the meantime crops of similar lesions appeared on trunk, whole of limbs including dorsum of hand, face and neck. Patient was advised oral antihistaminics and bland emollient applications which relieved the irritation in the lesions. The lesions resolved completely over 6-7 weeks.

  Discussion Top

Whereas the age, morphological appearance and resolution of the lesions in this case were classical for PR, there were however a few exceptional features. Occurrence of this ailment in winter months seems unusual as the disease is commonly reported in autumn and spring seasons.[1] The herald patch presented at multiple sites in the flexures, a situation exceptionally mentioned in the literature.[3] The variant of the disease with the herald patch preferring the girdles is described as girdle type of PR.[4] This may cause confusion with intertrigo, flexural psoriasis and erythrasma.

The features however leave one wondering whether it was a special form of PR reported by Aquilera in 1968 and named as pityriasis circinata et marginata of Vldal.[3]

  References Top

1.Arnold HL, Odom RB, James WD. Andrew's Diseases of Skin, 8th Edition, WB Saunders Co 1990;231-233.  Back to cited text no. 1    
2.Gibson LE, Perry HO. Papulosquamous eruptions and exfoliative dermatitis, In: Dermatology, Vol l, Third edition, Editors Moschella SL, Hurley HJ, WB Saunders Co, 1992;622-625.  Back to cited text no. 2    
3.Naginston J, Rook A, Highet SA. Virus and related infections In: textbook of Dermatology Vol.1 Fourth edn Editors Rook A, Ebling FJG, Champion RH et al. University Press, Oxford 1987;720-723.  Back to cited text no. 3    
4.Bjornberg A. Pityriasis rosea In: Dermatology in General Medicine Vol.1 Third edn, Edited by Fltzpatrick TB, Eisen AZ Wolff K et al, MC. Graw Hill, 1992;1117-1123.  Back to cited text no. 4    


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