From the Journals

Don’t discount rare pityriasis rosea for kids with persistent itch


 

FROM PEDIATRICS

Persistent cases of small erythematous lesions could be the rare condition of relapsing pityriasis rosea, based on data from a case report of an 11-year-old girl.

Unlike standard pityriasis rosea (PR), relapsing cases tend to present with fewer, smaller lesions, Ilka Engelmann, MD, of the Centre P Boulanger Hôpital A Calmette in Lille, France, and colleagues wrote in Pediatrics.

“A viral etiology of PR is strongly suspected because human herpesvirus 7 (HHV-7) DNA is frequently detected in blood and saliva of patients with PR,” they said. Infection with the HHV-7 virus generally occurs in childhood and remains a lifelong latent condition with the potential for multiple recurrences, they added.

The authors described the case of an 11-year-old white girl who presented with pruritic, erythematous, oval-shaped lesions that began on the right side of her trunk and spread across the trunk over the next few days. The patient had no other symptoms or physical abnormalities on examination and was not taking any medications, although she reported some trouble sleeping.

The treating clinicians identified HHV-7 in a blood sample and diagnosed PR. The lesions resolved in approximately 2 months with no treatment, but, 2 years after the initial presentation, the patient developed similar lesions on her legs, which also resolved without treatment. Over the next 5 years, she presented with similar lesions in different locations approximately three times per year, and these episodes were usually associated with times of stress, such as school examinations. Some saliva specimens taken during the episodes tested positive for HHV-7. The lesions persisted for 4-8 weeks and resolved without treatment, but they were reduced in size and number after the third recurrence. The change in size and location are characteristic of relapsing PR, the authors said, but more than three relapses is rare. “To our knowledge, this is the first report of a case with frequently relapsing PR for 7 years, with several episodes per year,” they said.

The occurrence of the relapses during stressful periods “is consistent with the hypothesis of viral reactivation because stress has been described as a stimulus inducing the reactivation of Herpesviridae from latency,” they noted.

A differential diagnosis of PR includes other infectious diseases and medication-induced skin reactions, but a medication history and virologic tests can help make or rule out a relapsing PR diagnosis, the authors said.

The authors had no financial conflicts to disclose.

SOURCE: Engelmann I et al. Pediatrics. 2018 Apr 19; doi: 10.1542/peds.2017-3179.

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