La Pitiriasis Rosada y El herpes virus Humano !!! La sexta enfermedad ?
The Pityriasis Rosea and The Human Herpes Virus !!! The sixth disease ?
PUBLICADO 2.022 ACTUALIZADO 2.023
===================
Hola amigos de la red, DERMAGIC de nuevo con ustedes con el tema: PITIRIASIS ROSADA ACTUALIZACION. La pitiriasis Rosada es una de esas enfermedades ancestrales, descrita por primera vez por GIBERT, en 1860.
Otros Autores la han descrito con otros nombres, entre ellos: Eritema
Anulatum (Rayer), Herpes tonsurans maculoso y escamoso (Hebra), Liquen
annulatum serpiginoso (Wilson), pitiriasis circinada (Honrad), Pitiriasis
diseminada (Hardy), Pitiriasis marginada y circinada ((Vidal), Pitiriasis
Rubra aigu disseminee (Bazin), Seudoexantema eritemato descamativo
(Besnier), Roseola Annulata (Wilan), Roseola furfuracea herpetiforme
(Beherend) y Roseola escamosa (Nicolas y Chapard).
Hoy en día han pasado mas de 140 años desde la época que inmortalizo a
GIBERT, y se discuten los probables agentes causales de la enfermedad, entre
ellos bacterias y virus de la familia herpes, siendo estos últimos los virus
HERPES 6 y 7 los mas asociados con la enfermedad.
Es de notar que hay estudios donde se demuestra la efectividad de la
ERITROMICINA en el tratamiento de la enfermedad, yo particularmente he
obtenido buenos resultados en muchos casos con el antibiótico CEFALOSPORINAS
y en otros casos el antiviral VALACICLOVIR también ha resultado
exitoso.
La pitiriasis rosada tiene un comportamiento netamente ESTACIONAL, donde en
una época del año (otoño e invierno) ocurren la mayoría de los casos, es más
frecuente en la mujer, y aunque CLÁSICAMENTE no produce lesiones en cara,
palmas y plantas, yo he visto tales manifestaciones y están descritas en la
literatura.
La clásica mácula o PLACA HERÁLDICA representa el inicio de la enfermedad y
luego se presenta el brote metamérico en "árbol de navidad" clásico de tal
enfermedad, por lo general son placas ovales, pero se han descrito
variantes, VESICULARES, PAPULARES Y PURPÚRICAS de la misma afección.
Un dato interesante es que en la mayoría de los casos NO REPITE LA
ENFERMEDAD, aunque en algunos casos a los años puede presentarse una segunda
manifestación IGUAL a la primera vez. Pero por lo general deja INMUNIDAD
DEFINITIVA. También se han descrito erupciones PITIRIASIS ROSADA LIKE,
inducida por medicamentos.
Si tomamos como válida la RECIENTE afirmación que la PITIRIASIS ROSADA esta
asociada a los HERPES VIRUS 6 Y 7, y que estos pueden encontrarse en la
saliva de personas sanas, podríamos LANZAR la TEORÍA de que EL CAMBIO
ESTACIONAL (otoño, invierno) ACTIVA la virulencia de estos virus, provocando
la enfermedad, al cambiar el clima de nuevo (verano), LOS VIRUS PIERDEN
ACTIVIDAD y disminuye el porcentaje de casos.
Porque NO TODOS MANIFIESTAN LA ENFERMEDAD, ?? como TODAS las clásicas
eruptivas ??, se explicaría por el grado de protección inmunológica que
tienen las PERSONAS CONTRA ESTOS HERPES VIRUS. TAMBIÉN EXISTEN PERSONAS A
LAS CUALES NUNCA LES DIO ALGUNA DE LAS CLÁSICAS ERUPTIVAS !!! con o sin
inmunización !!!
La clásica PITIRIASIS ROSADA se comporta CASI igualmente en todos los
pacientes, con un RASH eruptivo luego de un tiempo de incubación marcado por
la placa HERÁLDICA, se han descrito casos de lesiones en mucosas (boca), más
del 98% de los casos deja inmunidad definitiva y ahora se le ha comprobado
su ETIOLOGÍA INFECCIOSA ( principalmente VIRAL)
En base a estos HECHOS, particularmente PROPONDRÍA reclasificarla y
colocarla en el GRUPO de las enfermedades ERUPTIVAS, la SEXTA enfermedad
después de el SARAMPION, RUBEOLA, VARICELA, EXANTEMA SÚBITO (Roséola
infantil) y el ERITEMA INFECCIOSO (quinta enfermedad).
Recordemos que el ERITEMA INFECCIOSO ha sido asociado al VIRUS
parvovirus B19, y el EXANTEMA SÚBITO al VIRUS HERPES 6. De manera me parece
LÓGICO colocar a la pitiriasis ROSADA DENTRO de este grupo, me refiero a la
clásica enfermedad, NO A LA INDUCIDA por medicamentos u otros agentes, QUE
REALMENTE son eccemas similares (LIKE) a la Pitiriasis. Rosada.
La pitiriasis rosada puede durar hasta 90 días en algunos casos luego
de aparecer la mancha Heráldica, con o sin tratamiento y en algunos casos
desaparece sola. Pero lo recomendable es acudir al dermatólogo para
su tratamiento adecuado.
En las referencias los hechos
Saludos !!!
Dr José Lapenta R.
Dr. José M. Lapenta.
ENGLISH EDITORIAL
===================
An interesting fact is that in most of the cases it doesn't REPEAT THE ILLNESS, although in some cases some years after a second manifestation SIMILAR to the first time can be presented. But in general she leaves DEFINITIVE IMMUNITY. Also PITYRIASIS ROSEA drug-induced rashes have also been reported.
In the references the facts.
Greetings !!!
Dr José Lapenta
Dr. Jose M Lapenta
===========================================================
REFERENCIAS BIBLIOGRAFICAS/ BIBLIOGRAPHICAL REFERENCES
===========================================================
1.) Papular pityriasis rosea.
2.) Human herpes virus-like particles in pityriasis rosea lesions: an electron microscopy study.
3.) Human herpesviruses 6 and 7.
4.) Human herpesvirus 7 in dermatology: what role does it play?
5.) [Myerson nevus as a primary patch of Gibert pityriasis rosea. A case report]
6.) Rash orientation in pityriasis rosea: a qualitative study.
7.) Skin diseases associated with human herpesvirus 6, 7, and 8 infection.
8.) Collarette scaling in pityriasis rosea demonstrated by digital epiluminescence dermatoscopy.
9.) [Etiopathogenic importance of human herpes viruses type 6, 7 and 8 in manifestations of certain skin diseases]
10.) Prospective case-control study of chlamydia, legionella and mycoplasma infections in patients with pityriasis rosea.
11.) Pityriasis rosea is associated with systemic active infection with both human herpesvirus-7 and human herpesvirus-6.
12.) Detection of human herpesvirus 7 in pityriasis rosea by nested PCR.
13.) An epidemiological study of pityriasis rosea in the Eastern Anatolia.
14.) Human herpesvirus 7 in patients with pityriasis rosea. Electron microscopy investigations and polymerase chain reaction in mononuclear cells, plasma and skin.
15.) A pityriasis rosea-like eruption secondary to bacillus Calmette-Guerin therapy for bladder cancer.
16.) UVB phototherapy for pityriasis rosea: a bilateral comparison study.
17.) Pityriasis rosea Gibert: detection of Legionella micdadei antibodies in patients.
18.) Pityriasis rosea-like eruption after bone marrow transplantation.
19.) Tongue and cheek: oral lesions in pityriasis rosea.
20.) Pityriasis rosea and discoid eczema: dose related reactions to treatment with gold.
21.) [Pityriasis rosea-like skin eruptions caused by captopril]
22.) Recurrent pityriasis rosea. New episodes every year for five years. A case report.
23.) Pityriasis rosea-like eruption associated with BCG vaccination.
24.) [Vesicular pityriasis rosea]
25.) [Benign familial chronic pemphigus and pityriasis rosea. Clinical aspects and histology of the coexistence of both dermatoses]
26.) Human herpesvirus 6 and 7 DNA in peripheral blood leucocytes and plasma in patients with pityriasis rosea by polymerase chain reaction: a prospective case control study.
27.) The human herpesviruses and pityriasis rosea: curious covert companions?
28.) Pityriasis rosea is not associated with human herpesvirus 7.
29.) Association of pityriasis rosea with human herpesvirus-6 and human herpesvirus-7 in Taipei.
30.) Epidemiological study of human herpesvirus-6 and human herpesvirus-7 in pityriasis rosea.
31.) Lack of evidence of active human herpesvirus 7 (HHV-7) infection in three cases of pityriasis rosea in children.
32.) Pityriasis rosea associated with herpesvirus 7 DNA.
33.)Pityriasis rosea: one virus, two viruses, more viruses?
34.) Reactivation of human herpesvirus 6 in pityriasis rosea.
35.) Absence of picornavirus genome in pityriasis rosea.
36.) Human herpesvirus 7 in pityriasis rosea.
37.) Detection of human herpesvirus 7 in patients with pityriasis rosea and healthy individuals.
38.) The association of pityriasis rosea with cytomegalovirus, Epstein-Barr virus and parvovirus B19 infections - A prospective case control study by polymerase chain reaction and serology.
39.) Pityriasis rosea associated with imatinib (STI571, Gleevec).
40.) Erythromycin in pityriasis rosea: A double-blind, placebo-controlled clinical trial.
41.) A Remarkable Result of a Double-Masked, Placebo-Controlled Trial of Erythromycin in the Treatment of Pityriasis Rosea.
42.) Case Clustering in Pityriasis Rosea
A Multicenter Epidemiologic Study in Primary Care Settings in Hong Kong
43.) Pityriasis rosea--a virus-induced skin disease? An update.
======================================================
HERPES VIRUS 6, 7 AND 8 … MORE
======================================================
======================================================
44.) Association between human herpesvirus type 6 and type 7, and cytomegalovirus disease in heart transplant recipients.
45.) Invasion by human herpesvirus 6 and human herpesvirus 7 of the central nervous system in patients with neurological signs and symptoms.
46.) Association of human herpesvirus 6 and human herpesvirus 7 with demyelinating diseases of the nervous system.
47.) [Detection of human herpesvirus type 6, human herpesvirus type 7, cytomegalovirus and human papillomavirus in cutaneous AIDS-associated Kaposi's sarcoma]
48.) Influenza encephalopathy associated with infection with human herpesvirus 6 and/or human herpesvirus 7.
49.) Human herpesvirus 6 and human herpesvirus 7 infections in renal transplant recipients and healthy adults in Turkey.
50.) Detection of human herpesvirus-6 DNA in peripheral blood and saliva.
51.) Human herpesvirus-6 and human herpesvirus-7 in the bone marrow from healthy subjects.
52.) Lymphomatoid papulosis and human herpesviruses--A PCR-based evaluation for the presence of human herpesvirus 6, 7 and 8 related herpesviruses.
53.) Presence of human herpesvirus 6 variants A and B in saliva and peripheral blood mononuclear cells of healthy adults.
54.) Detection of human herpesvirus 6 DNAs in samples from several body sites of patients with exanthem subitum and their mothers by polymerase chain reaction assay.
55.) Human herpesvirus-6 and human herpesvirus-7 infections in bone marrow transplant recipients.
56.) High prevalence of HHV-6 DNA in peripheral blood mononuclear cells of healthy individuals detected by nested-PCR.
57.) Clinical features and viral excretion in an infant with primary human herpesvirus 7 infection.
58.) Gestational Pityriasis Rosea: Suggestions for Approaching Affected Pregnant Women.
=======================================================
=======================================================
1.) Papular pityriasis rosea.
=======================================================
Cutis 2002 Jul;70(1):51-5; quiz 48
Bernardin RM, Ritter SE, Murchland MR.
David Grant Medical Center, Travis Air Force Base, Fairfield, California, USA.
Pityriasis rosea (PR) is a seasonal papulosquamous disorder that can be easily confused with a wide variety of similar appearing cutaneous disorders. This is particularly evident in its atypical papular form. We present a case report of atypical papular PR, along with a discussion of clinical presentation, histologic criteria, proposed etiology, and treatment options. Papular PR is atypical, presenting in a minority of patients, and may pose a diagnostic challenge. Being familiar with these atypical characteristics will facilitate accurate and timely diagnosis.
=======================================================
2.) Human herpes virus-like particles in pityriasis rosea lesions: an electron microscopy study.
=======================================================
J Cutan Pathol 2002 Jul;29(6):359-61
Drago F, Malaguti F, Ranieri E, Losi E, Rebora A.
Section of Dermatology, Department of Health Sciences, DiSEM, University of Genoa, Viale Benedetto XV 7, 16132 Genoa, Italy. rebdermo@unige.it
BACKGROUND: In a previous study we detected virions with electron microscopy features of human herpes viruses in the supernatant of cocultured mononuclear cells from patients with acute pityriasis rosea. Because of their morphology and of polymerase chain reaction studies, we ascribed them to human herpes virus 7. OBJECTIVE: To find such virions in the lesional skin of pityriasis rosea patients. METHODS: Skin specimens from lesions of 21 patients with acute pityriasis rosea were examined by elecron microscopy. RESULTS: In 15 (71%) patients, human herpes virus particles in various stages of morphogenesis were detected. Mature enveloped virions appeared as typical human herpes virus virions, measuring about 160-200 nm in diameter and containing an electrodense cylindrical core, a capsid, an envelope with typical spikes and a very distinct tegument layer between the capsid and the envelope. They were very similar to those we reported in the supernatant of co-cultured circulating mononuclear cells from patients with pityriasis rosea. CONCLUSION: Our results confirm our previous findings and provides further evidence of a viral etiology for pityriasis rosea.
=======================================================
3.) Human herpesviruses 6 and 7.
=======================================================
Dermatol Clin 2002 Apr;20(2):301-6
De Araujo T, Berman B, Weinstein A.
Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, FL 33136, USA.
Human herpesviruses 6 and 7 are newly discovered viruses that belong to the genus Roseolavirus within the subfamily Betaherpesvirinae. These ubiquitous viruses may cause primary or chronic persistent infection or remain in a state of latency for many years, until a decrease in the immunologic state of the host leads to reactivation of infection. Several diseases have been linked with HHV-6 and HHV-7. In the dermatologic arena, a definite association has been proven only for HHV-6 and exanthema subitum (roseola infantum), whereas the role of HHV-7 in the pathogenesis of pityriasis rosea remains a matter of debate.
=======================================================
4.) Human herpesvirus 7 in dermatology: what role does it play?
=======================================================
Am J Clin Dermatol 2002;3(5):309-15
Kempf W.
Department of Dermatology, University Hospital, Zurich, Switzerland. kempf@derm.unizh.ch
Human herpesvirus 7 (HHV-7) was discovered in 1989 as a new member of the beta-herpesvirus subfamily. Primary infection occurs early in life and manifests as exanthema subitum, or other febrile illnesses mimicking measles and rubella. Thus, HHV-7 has to be considered as a causative agent in a variety of macular-papular rashes in children. In addition, HHV-7 was found in some cases of other inflammatory skin disorders, such as psoriasis. There are controversial data on the detection of HHV-7 in pityriasis rosea, but so far there is not enough evidence for a pathogenetic association of HHV-7 with this exanthematic skin disease. Although HHV-7 can be found in some cases of Hodgkin's disease, there are no data supporting a direct causative role in this lymphoma type nor in other nodal or primary cutaneous lymphomas. In various epidemiologic forms of Kaposi's sarcoma, infection of monocytic cells with HHV-7 was demonstrated, which may indirectly influence tumor biology. In the context of immunosuppression, HHV-7 has recently been identified as an emerging pathogen in transplant recipients and may exacerbate graft rejection in renal transplant recipients. The ability of HHV-7 to induce cytokine production in infected cells could make HHV-7 an important pathogenetic co-factor in inflammatory and neoplastic disorders. Moreover, the restricted cellular tropism of HHV-7 may render this virus an interesting vector for gene therapy. Thirteen years after the discovery of HHV-7, there has been considerable progress in characterizing its genetic structure, virus-induced effects on infected host cells and in the development of diagnostic tools. Nevertheless, the role of HHV-7 in various skin diseases and the clinical manifestations of reactivation of HHV-7 infection have still to be defined.
=======================================================
5.) [Myerson nevus as a primary patch of Gibert pityriasis rosea. A case report]
=======================================================
Hautarzt 2002 May;53(5):338-41
[Article in German]
Hofer T.
Dermatologie FMH, Winkelriedstrasse 10, CH-5430 Wettingen. thomas.hofer@active.ch
There are only few articles in literature which discuss the association between Meyerson's naevi and Pityriasis rosea. And when so, the discussion is done in a controversial way. Here an 18 year old man is presented who visits the outpatient clinic. He has a ten day history of a solitary Meyerson's naevus on his back. Over the next three weeks this naevus will develop to the typical herold patch followed by the classical exantheme of Pityriasis rosea. CONCLUSION: Halo dermatitis associated with Pityriasis rosea don't represent Meyerson's naevi. But they reflect the rare "nevocentric" property of a not so rare dermatose.
=======================================================
6.) Rash orientation in pityriasis rosea: a qualitative study.
=======================================================
Eur J Dermatol 2002 May-Jun;12(3):253-6
Chuh AA.
University of Hong Kong, Shop B5, Ning Yeung Terrace, 78 Bonham Road, Ground Floor, Hong Kong. achuh@iohk.com
Rash orientation in pityriasis rosea (PR) has been described as Christmas-tree pattern, inverted Christmas-tree pattern, fir tree pattern, parallel to the ribs or along skin cleavage lines. We retrieved clinical photographs of 11 patients diagnosed as having PR over a two-year period for qualitative study of rash orientation. We found that Langer's cleavage lines are the most appropriate description. All three components of these lines on the trunk, i.e. V-shaped pattern on upper chest and upper back, circumferential pattern around the shoulders and hips, and transverse pattern on the lower anterior trunk and lower back, are demonstrated by most patients. We believe with the present state of knowledge, the mechanism for PR following Langer's lines is best considered unknown. We advocate abandoning other descriptions which might cause confusion to students and trainee physicians.
=======================================================
7.) Skin diseases associated with human herpesvirus 6, 7, and 8 infection.
=======================================================
J Investig Dermatol Symp Proc 2001 Dec;6(3):197-202
Blauvelt A.
Dermatology Branch, National Cancer Institute, Bethesda, Maryland 20892-1908, USA. blauvelt@mail.nih.gov
Relatively recently, the discovery and analysis of three new human herpesviruses, human herpesvirus (HHV)-6, HHV-7, and Kaposi's sarcoma-associated herpesvirus (KSHV), also known as HHV-8, has contributed greatly to our understanding of the pathogenesis of several common dermatoses. HHV-6 and HHV-7 are closely related beta-herpesviruses that have been linked with roseola (mostly HHV-6), severe drug eruptions (HHV-6), and pityriasis rosea (mostly HHV-7). KSHV is a gamma-herpesvirus that is now believed to be the long sought after etiologic agent of Kaposi's sarcoma. The evidence for these skin disease associations and key findings from recent basic science investigations on viral pathogenesis are discussed in this review. In addition, possible therapeutic implications of these research studies are explored.
=======================================================
8.) Collarette scaling in pityriasis rosea demonstrated by digital epiluminescence dermatoscopy.
=======================================================
Australas J Dermatol 2001 Nov;42(4):288-90
Chuh AA.
Department of Medicine, University of Hong Kong, Hong Kong, ROC. achuh@iohk.com
Collarette scaling is a characteristic sign in pityriasis rosea. The use of digital epiluminescence dermatoscopy is proposed to assist in the recognition of this sign as this technique can magnify the lesions, eliminate other epidermal changes, and demonstrate the morphology and direction of scaling.
=======================================================
9.) [Etiopathogenic importance of human herpes viruses type 6, 7 and 8 in manifestations of certain skin diseases]
=======================================================
Med Pregl 2001 Sep-Oct;54(9-10):459-63
[Article in Serbo-Croatian (Roman)]
Poljacki M, Rajic N, Matic M.
Klinika za kozno-venericne bolesti, 21000 Novi Sad, Hajduk Veljkova 1-3. cojans@eunet.yu
INTRODUCTION: In the past few years new human herpes viruses (HHV): HHV-6, -7 and -8 have been discovered. According to the most recent literature, they might have an important role in etiopathogenesis of some dermatological diseases. HUMAN HERPESVIRUS 6: HHV-6 was isolated in 1984 from peripheral blood lymphocytes of AIDS patients and patients with different lymphoproliferative diseases. Up to now, two variants of this virus have been identified, A and B, which differ in genetic, biological and immunological characteristics. The etiological importance of variant A, has not yet been clarified, while variant B is considered to be the major cause of many diseases, such as exanthema subitum in infants. In many cases primary infection is associated with elevated temperature, without rash. HUMAN HERPESVIRUS 7: HHV-7 was isolated in 1990 from activated peripheral blood CD4+ T cells of healthy persons. The virus is ubiquitous and more than 80% of babies and infants are affected. Presence of DNA sequences of this virus in mononuclear cells of peripheral blood, skin and plasma of pityriasis rosea patients, points to possible connection between this illness and HHV-7 infection. HUMAN HERPESVIRUS 8: HHV-8 was first identified in tissue samples of patients with Kaposi's sarcoma associated with AIDS in 1994. DNA virus sequences were also isolated in HIV negative persons with Kaposis's sarcoma. Presence of virus can be established in mononuclear cells of peripheral blood, endothelial cells that cover vascular spaces and spindle cells within skin changes. Modes of transmission are still not clarified. However, HHV-8 was identified in some other dermatological diseases as well.
=======================================================
10.) Prospective case-control study of chlamydia, legionella and mycoplasma infections in patients with pityriasis rosea.
=======================================================
Eur J Dermatol 2002 Mar-Apr;12(2):170-3
Chuh AA, Chan HH.
The Bonham Surgery, Shop B5, Ning Yeung Terrace, 78 Bonham Road, Ground Floor, Hong Kong, China. achuh@iohk.com
A double-blind placebo-controlled trial reported the benefit of erythromycin in treating pityriasis rosea (PR), a postulated mechanism being the eradication of bacteria susceptible to erythromycin. The aim of this study was to investigate the association between PR and Chlamydia pneumoniae, C. trachomatis, Legionella longbeachae, L. micdadei, L. pneumophila, and Mycoplasma pneumoniae infections. We recruited 13 patients aged seven to 46 years (mean: 26.8 years) diagnosed to have PR in a primary care setting in 18 months. Lesional histopathology was arranged for atypical cases. Clotted blood was collected at initial presentation and four weeks later. Controls were 13 paired age-and-sex-matched patients requiring blood collection for non-dermatological diseases. Serology tests were performed in parallel but were read "blinded" on the acute and convalescent specimens of patients and the control subjects. The serology profiles were not diagnostic of active infection by any of the bacteria studied for all 13 patients. Two patients had four-fold increase in IgG titres against C. pneumoniae, with IgM being negative. Two patients had IgM detectable against L. pneumophila serotype 6 and M. pneumoniae respectively, with no significant rise of the specific IgG. These patients had no symptom or sign of chest infection. The seroprevalence and IgG titres of the study patients for the bacteria investigated were insignificantly different from those of control subjects. We conclude that the bacteria investigated in this study do not play a significant role in the pathogenesis of PR. We believe that anti-inflammatory and immunomodulatary effects might contribute towards the action of erythromycin, if any, in PR.
=======================================================
11.) Pityriasis rosea is associated with systemic active infection with both human herpesvirus-7 and human herpesvirus-6.
=======================================================
J Invest Dermatol 2002 Oct;119(4):793-7
Comment in:
J Invest Dermatol. 2002 Oct;119(4):779-80.
Watanabe T, Kawamura T, Jacob SE, Aquilino EA, Orenstein JM, Black JB, Blauvelt A.
Dermatology Branch and Division of Cancer Treatment and Diagnosis, Center for Cancer Research, National Cancer Institute, Howard Hughes Medical Institute, NIH Medical Research Scholar Program, Bethesda, Maryland, USA.
Pityriasis rosea is a common skin disease that has been suspected to have a viral etiology. We performed nested polymerase chain reaction to detect human herpesvirus-7, human herpesvirus-6, and cytomegalovirus DNA in lesional skin, nonlesional skin, peripheral blood mononuclear cells, serum, and saliva samples isolated from 14 pityriasis rosea patients. Viral mRNA expression and virion visualization within lesional skin were studied by in situ hybridization and transmission electron microscopy, respectively. By nested polymerase chain reaction, human herpesvirus-7 DNA was present in lesional skin (93%), nonlesional skin (86%), saliva (100%), peripheral blood mononuclear cells (83%), and serum (100%) samples, whereas human herpesvirus-6 DNA was detected in lesional skin (86%), nonlesional skin (79%), saliva (80%), peripheral blood mononuclear cells (83%), and serum (88%) samples. By contrast, cytomegalovirus DNA was not detected in these tissues. Control samples from 12 healthy volunteers and 10 psoriasis patients demonstrated rare positivity for either human herpesvirus-7 or human herpesvirus-6 DNA in skin or serum. By in situ hybridization, infiltrating mononuclear cells expressing human herpesvirus-7 and human herpesvirus-6 mRNA were identified in perivascular and periappendageal areas in 100% and 75% pityriasis rosea skin lesions, respectively, compared to herpesviral mRNA positivity in only 13% normal skin and psoriasis skin controls. Transmission electron microscopy failed to reveal herpesviral virions in pityriasis rosea lesional skin. Nested polymerase chain reaction and in situ hybridization enabled detection of human herpesvirus-7 and human herpesvirus-6 in skin and other tissues isolated from patients with pityriasis rosea. These results suggest that pityriasis rosea is associated with systemic active infection with both human herpesvirus-7 and human herpesvirus-6.
=======================================================
12.) Detection of human herpesvirus 7 in pityriasis rosea by nested PCR.
=======================================================
Int J Dermatol 2002 Sep;41(9):563-
Karabulut AA, Kocak M, Yilmaz N, Eksioglu M.
Department of Dermatology, Ankara Education and Research Hospital, Refik Saydam Hifzisihha Institute, Ministry of Health, Turkey.
BACKGROUND: Clinical presentation, immunologic, light microscopic, and electron microscopic studies suggest a viral etiology for pityriasis rosea (PR). OBJECTIVE: To evaluate whether human herpesvirus 7 (HHV-7) is an etiologic factor for PR. PATIENTS AND METHODS: Twenty-one PR patients (12 female, nine male) aged between 12 and 52 years, whose diagnoses were confirmed clinically and histopathologically, were included in the study. The duration of the disease was questioned. Tissue samples of 5-mm punch biopsy material were collected from the patients and from six healthy volunteers (three female, three male) as the controls. Nested polymerase chain reaction (PCR) with specific primers for HHV-7 DNA sequences (OPERON technologies Inc., HV-7S/HV-8A external sences and HV-10S/HV11A internal sences) was performed on each tissue sample. Polymerase chain reaction products were analyzed by electrophoresis on 2% agarose gels. After molecular weight markers (Haphi174) had been placed and visualized on an ultraviolet transilluminator, the gels were immersed and photographs were taken. RESULTS: The mean age was 29.86 +/- 11.77 for the PR patients and 25.33 +/- 11.69 for the controls. The mean duration of the disease was 16.28 +/- 15.74 days. Human herpesvirus 7 DNA sequences were detected in six of the PR patients (28.57%). The mean duration of the disease was calculated as 11.67 +/- 9.85 for the HHV-7-positive patients (patient nos. 3, 4, 5, 7, 8, 9) and 18.13 +/- 17.05 for the HHV-7-negative patients, and there was no statistically significant differences in either of the groups (U = 29.5, W = 50.5, P = 0.2241, using the Mann-Whitney U and Wilcoxon's rank sum W-tests). Nested PCR was negative for HHV-7 in all of the specimens from the controls. There was no statistically significant difference for the presence of HHV-7 DNA sequence between the PR patients and the controls (P = 0.2843, Fisher's exact two-tail analysis test). CONCLUSION: Our results failed to support a possible role for HHV-7 in the pathogenesis of PR.
=======================================================
13.) An epidemiological study of pityriasis rosea in the Eastern Anatolia.
=======================================================
Eur J Epidemiol 1998 Jul;14(5):495-7
Harman M, Aytekin S, Akdeniz S, Inaloz HS.
Department of Dermatology & Venerology, Faculty of Medicine, University of Dicle, Diyarbakir, Turkey.
The purpose of this study was to investigate the epidemiological features of pityriasis rosea (PR) in the Eastern Anatolia, Turkey. Three hundred ninety-one patients (214 females, 177 males) with PR seen during the years 1992-1995 were analyzed for annual incidence among dermatologic outpatients, sex, age, and distribution by month and year. The average annual incidence was 0.75 per 100 dermatologic patients. PR was reported to be slightly more common in women by margin of 1.2:1.0. Eighty-seven percent of the cases were between the ages of 10 and 39 years, with a peak in the 20-29 age group. The incidence of the disease was much higher in the rainy and snowy months. No declining incidence was observed over the years. Changes in incidence from year to year, though not great, were statistically significant.
=======================================================
14.) Human herpesvirus 7 in patients with pityriasis rosea. Electron microscopy investigations and polymerase chain reaction in mononuclear cells, plasma and skin.
=======================================================
Dermatology 1997;195(4):374-8
Comment in:
Dermatology. 1998;196(2):275.
Dermatology. 1999;199(2):197-8.
Drago F, Ranieri E, Malaguti F, Battifoglio ML, Losi E, Rebora A.
Institute of Dermatology, University of Genoa, Italy.
BACKGROUND: Clinical evidence suggests a viral etiology for pityriasis rosea (PR). OBJECTIVE: To evaluate human herpesvirus (HHV)-6 and HHV-7 as candidates for the etiology of PR. METHODS: Blood and skin tissue from 12 patients with acute PR, and 12 patients with other dermatoses were studied, as well as blood samples from 25 healthy persons. Serum interferon (IFN)-alpha and IFN-gamma were analyzed by ELISA. Analysis of morphological changes in cocultured peripheral blood mononuclear cells (PBMC) and electron microscopy (EM) to identify viral particles were performed. Polymerase chain reaction (PCR) with specific primers for HHV-6 and HHV-7 DNA sequences was performed on the plasma and PBMC of patients and healthy controls and on the skin of patients with PR and other skin diseases. RESULTS: PR plasma contained detectable IFN-alpha and IFN-gamma, whereas plasma from controls did not. PBMC from PR patients showed ballooning cells and syncytia after 7 days in culture whereas PBMC from controls and recovered PR patients did not. This cytopathic effect was also documented in a PR patient who relapsed and in Sup-T1 cell cultures inoculated with the cell-free supernatant from centrifuged cultured PBMC; in this supernatant, herpesvirus, virions were detected by EM, PCR identified HHV-7 DNA in PBMC, plasma and skin from all patients with active PR and in the PBMC only of 5 patients tested 10-14 months later. Weaker signals of HHV-7 DNA were detected in PBMC of 11 controls, but not in their plasma. Skin was negative for HHV-7 in all control specimens. CONCLUSIONS: Although the detection of HHV-7 DNA in PBMC and tissues does not prove directly a causal role, HHV-7 DNA in cell-free plasma corresponds to active replication which supports a causal relationship. We propose that PR is a clinical presentation of HHV-7 reactivation.
=======================================================
15.) A pityriasis rosea-like eruption secondary to bacillus Calmette-Guerin therapy for bladder cancer.
=======================================================
Cutis 1996 Jun;57(6):447-50
Honl BA, Keeling JH, Lewis CW, Thompson IM.
Dermatology Service, Brooke Army Medical Center, Fort Sam Houston, Texas, USA.
The use of bacillus Calmette-Guerin (BCG) for the treatment of bladder cancer has been followed by reports documenting adverse reactions. Eruptions of the skin have been included (although not well described) in the list of side effects. We report a pityriasis rosea-like rash secondary to BCG therapy for bladder cancer. Although the treatment was interrupted because of this reaction, the medication was restarted later with only a mild transient recurrence of the eruption.
=======================================================
16.) UVB phototherapy for pityriasis rosea: a bilateral comparison study.
=======================================================
J Am Acad Dermatol 1995 Dec;33(6):996-9
Leenutaphong V, Jiamton S.
Department of Dermatology, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
BACKGROUND: Pityriasis rosea is a common self-limiting disease. UV light has been mentioned as helpful, but only a few studies substantiate this possibility. OBJECTIVE: Our purpose was to evaluate the clinical efficacy of UVB phototherapy in pityriasis rosea and the course of the disease after treatment. METHODS: Seventeen patients with extensive pityriasis rosea were treated with unilateral UVB phototherapy in a bilateral comparison study. One joule of UVA was used as a "placebo" on the untreated side. The treatments were given five times per week for 2 weeks. The rate of clearing was monitored by estimation of the severity score. RESULTS: Ten daily erythemogenic exposures of UVB resulted in substantially decreased severity of disease, greater than that on the untreated side in 15 of 17 patients. The overall reduction of severity score showed a significant difference after the third treatment; the UVB irradiation was superior. However, during the follow-up period the two sides were indistinguishable in regard to severity score (p = 0.6784). No significant difference in pruritus was noted between the two sides (p > 0.1638). The duration of disease did not relate to the success of UVB phototherapy. CONCLUSION: During the treatment period UVB phototherapy resulted in decreased severity of disease. However, the itching and the course of the disease were unchanged.
=======================================================
17.) Pityriasis rosea Gibert: detection of Legionella micdadei antibodies in patients.
=======================================================
Eur J Epidemiol 1995 Aug;11(4):459-62
Gjenero-Margan I, Vidovic R, Drazenovic V.
Epidemiology Service, Croatian National Institute of Public Health, Zagreb, Croatia.
Some epidemiological and clinical characteristics of Pityriasis rosea Gibert has led us to hypothesize that this disease may be the clinical manifestation of an infection caused by legionellas. We have thus tested the sera of 36 patients ill with Pityriasis rosea and 19 controls for Legionella pneumophila serogroup 1-6 and Legionella micdadei antibodies. These, who had the same age and sex distribution as study patients, were receiving treatment for other diseases in the same ward. Also tested were 200 sera from the voluntary blood donors from the same region as study patients. Legionella micdadei antibodies were detected in 12 (33.3%) Pityriasis rosea cases and in one (5.2%) control. They were significantly more common in Pityriasis rosea cases than in either controls or voluntary blood donor population. The findings to date encourage continued research into the causative relationship between the Legionella micddadei infection and the onset of Pityriasis rosea Gibert.
=======================================================
18.) Pityriasis rosea-like eruption after bone marrow transplantation.
=======================================================
J Am Acad Dermatol 1994 Aug;31(2 Pt 2):348-51
Spelman LJ, Robertson IM, Strutton GM, Weedon D.
Department of Dermatology, Royal Brisbane Hospital, Australia.
Bone marrow transplantation is associated with numerous cutaneous complications that may be related to the underlying (preexisting) disease, to pretransplant conditioning, to immunosuppression, to concomitant medication, or to graft-versus-host reaction. We describe four bone marrow transplant recipients with the clinical and histologic features of pityriasis rosea, a hitherto unreported association.
=======================================================
19.) Tongue and cheek: oral lesions in pityriasis rosea.
=======================================================
Cutis 1992 Oct;50(4):276-80
Vidimos AT, Camisa C.
Cleveland Clinic Foundation, Department of Dermatology A61, Ohio 44195-5032.
Fifty-one consecutive patients with clinical findings and history consistent with pityriasis rosea underwent a complete oral examination to search for any concomitant oral lesions. One case was omitted from the statistical analysis because the results of a rapid plasma reagin test were positive. Of the fifty remaining cases, eight patients (16 percent) were noted to have various oral lesions, all of which were asymptomatic. These findings suggest that the actual incidence of oral lesions in pityriasis rosea may be higher than previously reported. A complete oral examination in a patient presenting with a papulosquamous eruption may be helpful in ascertaining the diagnosis of pityriasis rosea.
=======================================================
20.) Pityriasis rosea and discoid eczema: dose related reactions to treatment with gold.
=======================================================
Ann Rheum Dis 1992 Jul;51(7):881-4
Wilkinson SM, Smith AG, Davis MJ, Mattey D, Dawes PT.
Department of Dermatology, North Staffordshire Health District, Stoke-on-Trent, United Kingdom.
Sixteen cases of either a pityriasiform or discoid eczematous rash occurring in patients with rheumatoid arthritis receiving treatment with gold (sodium aurothiomalate and auranofin) were studied. The results suggest that this is a dose related, not allergic, reaction to gold. The development of this rash is not an absolute indication to stop treatment with gold. Control can often be effected with potent topical steroids or a reduction in the dose or frequency of treatment with gold.
=======================================================
21.) [Pityriasis rosea-like skin eruptions caused by captopril]
=======================================================
G Ital Dermatol Venereol 1990 Oct;125(10):457-9
[Article in Italian]
Ghersetich I, Rindi L, Teofoli P, Tsampau D, Palleschi GM, Lotti T.
Istituto di Clinica Dermosifilopatica, Universita degli Studi di Firenze.
Captopril is an antihypertensive drug that works by inhibiting the angiotensin-converting enzyme and provokes increased levels of plasma quinine. In the case here reported a picture of pityriasis rosea-like reaction is described. The frequency of the observed and reported reactions by captopril suggests a particular caution in the use of this drug.
=======================================================
22.) Recurrent pityriasis rosea. New episodes every year for five years. A case report.
=======================================================
Acta Derm Venereol 1990;70(2):179-80
Halkier-Sorensen L.
Department of Dermatology and Venereology, Marselisborg Hospital, University of Aarhus, Denmark.
A case of recurrent pityriasis rosea in a 39-year-old woman is presented. She had her first attack of pityriasis rosea 5 years ago and new outbreaks followed every year, in the spring. Her husband had a severe attack of pityriasis rosea 6 years ago. All laboratory investigations were normal and no explanation for the many recurrences was found.
=======================================================
23.) Pityriasis rosea-like eruption associated with BCG vaccination.
=======================================================
Isr J Med Sci 1989 Oct;25(10):570-2
Kaplan B, Grunwald MH, Halevy S.
Department of Dermatology, Soroka Medical Center, Beer Sheva, Israel.
We report a case of a pityriasis rosea-like eruption in a 12-year-old boy several days following BCG vaccination. It is suggested that the BCG vaccination be included in the etiology of pityriasis rosea-like eruptions.
=======================================================
24.) [Vesicular pityriasis rosea]
=======================================================
Hautarzt 1988 Aug;39(8):524-6
[Article in German]
Strauss T, Kuhn A, Steigleder GK.
Universitats-Hautklinik Koln.
Pityriasis rosea is a frequently occurring skin disease of unknown aetiology. Ten clinical forms of this disease are known, with predominance of the macular type. We observed a healthy 24-year-old patient with the very rare vesicular variant of pityriasis rosea, which has to be differentiated from vesicular virus and drug-induced eruptions.
=======================================================
25.) [Benign familial chronic pemphigus and pityriasis rosea. Clinical aspects and histology of the coexistence of both dermatoses]
=======================================================
Hautarzt 1988 May;39(5):324-7
[Article in German]
Winzer M.
Klinik fur Dermatologie und Venerologie, Medizinischen Universitat zu Lubeck.
We report the course of benign familial pemphigus (Hailey-Hailey disease) in a 45-year-old woman. While this condition was in remission the patient started to suffer from pityriasis rosea. A biopsy of this coexisting dermatosis revealed the typical features of Hailey-Hailey disease (suprabasal acantholysis) and of pityriasis rosea within the same lesion.
=======================================================
26.) Human herpesvirus 6 and 7 DNA in peripheral blood leucocytes and plasma in patients with pityriasis rosea by polymerase chain reaction: a prospective case control study.
=======================================================
Acta Derm Venereol 2001 Aug-Sep;81(4):289-90
Chuh AA, Chiu SS, Peiris JS.
Department of Medicine, University of Hong Kong, China. achuh@iohk.com
An association between pityriasis rosea and human herpesvirus 7 (HHV-7) has been reported but remains controversial. The purpose of the present study was to investigate the association between HHV-6 and HHV-7 with pityriasis rosea. Fifteen patients aged 6-54 years with a diagnosis of pityriasis rosea and 15 age-matched controls were recruited. None of the patients had HHV-6 or HHV-7 DNA detected by polymerase chain reaction in the acute or convalescent plasma specimen. In the acute peripheral blood leucocytes specimen, 3 patients and one control had RHV-6 DNA detected (p=0.299; NS), while 7 patients and 5 controls had HHV-7 DNA (p=0.355; NS). Antibody to HHV-6 was detected in the acute specimen of 13 patients and 13 controls, while antibody to HHV-7 was found in all 15 of patients and controls. We thus found no evidence of recent HHV-6 or HHV-7 infection in patients with a diagnosis of pityriasis rosea.
=======================================================
27.) The human herpesviruses and pityriasis rosea: curious covert companions?
=======================================================
J Invest Dermatol 2002 Oct;119(4):779-80
Comment on:
J Invest Dermatol. 2002 Oct;119(4):793-7.
Breese Hall C.
University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A.
Publication Types:
Comment
======================================================
=======================================================
28.) Pityriasis rosea is not associated with human herpesvirus 7.
=======================================================
Kempf W, Adams V, Kleinhans M, Burg G, Panizzon RG, Campadelli-Fiume G, Nestle FO.
Department of Dermatology, University Hospital, Zurich, Switzerland.
OBJECTIVE: To examine the proposed association between pityriasis rosea and human herpesvirus 7 (HHV-7). DESIGN: A retrospective cross-sectional survey. SETTING: University medical center in Switzerland. PATIENTS: Thirteen patients with pityriasis rosea and 14 persons with normal skin (control subjects). MAIN OUTCOME MEASURES: Detection of HHV-7-specific DNA sequences and antigen (85-kd phosphoprotein [pp85]) by nested polymerase chain reaction and immunohistochemical analysis, respectively. RESULTS: Human herpesvirus 7 DNA sequences and expression of the HHV-7-specific immunodominant pp85 antigen were found in 1 (8%) of 13 lesional skin biopsy specimens of pityriasis rosea. The prevalence of HHV-7 DNA sequences and antigens is even slightly lower in lesional skin of patients with pityriasis rosea than in clinically and morphologically normal skin of 14 control persons, in 2 of whom (14%) HHV-7 DNA sequences and antigens could be detected. CONCLUSION: The low detection rate of HHV-7 DNA sequences and antigens argues strongly against a causative role for HHV-7 in the pathogenesis of pityriasis rosea.
=======================================================
29.) Association of pityriasis rosea with human herpesvirus-6 and human herpesvirus-7 in Taipei.
=======================================================
J Formos Med Assoc 2001 Jul;100(7):478-83
Wong WR, Tsai CY, Shih SR, Chan HL.
Department of Dermatology, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipei, Taiwan.
BACKGROUND AND PURPOSE: Pityriasis rosea (PR) is a common papulosquamous skin disease with unknown etiology. The possible relationship of PR with human herpesvirus infection (HHV) has been extensively studied. This study used the polymerase chain reaction (PCR) to investigate the presence of human herpesvirus 6 and 7 (HHV-6 and HHV-7) in 41 PR patients from two hospitals in Northern Taiwan. The epidemiologic features of PR in patients were also studied. METHODS: A total of 41 PR patients (11 males, 30 females) were enrolled in this study from April 1999 to March 2000. PCR of skin biopsy specimens from 24 PR patients was used to identify the existence of HHV-6 and HHV-7. Viral culture from PR biopsy specimens was also performed. Blood from these patients was sampled for Venereal Disease Research Laboratory tests. Skin biopsies from 20 age- and sex-matched controls with other skin diseases were also subjected to PCR study. RESULTS: The ages of the 41 PR patients ranged from 8 to 62 years. An increased incidence (17/41) of PR episodes was observed during the spring. Both HHV-6 and HHV-7 DNA was below the limit of detection in all biopsy specimens from patients and healthy controls. Viral culture for HHV was negative in all patients. CONCLUSION: The epidemiologic features of PR in this series are comparable to other studies except for an exaggerated female predominance (male:female ratio 1:2.7). Our data indicate a lack of association between HHV-6 and HHV-7 infection and PR.
=======================================================
30.) Epidemiological study of human herpesvirus-6 and human herpesvirus-7 in pityriasis rosea.
=======================================================
Br J Dermatol 2000 Oct;143(4):795-8
Comment in:
Br J Dermatol. 2001 May;144(5):1090.
Kosuge H, Tanaka-Taya K, Miyoshi H, Amo K, Harada R, Ebihara T, Kawahara Y, Yamanishi K, Nishikawa T.
Department of Dermatology, Tokyo Electric Power Hospital, 9-2 Shinanomachi, Shinjuku-ku, Tokyo 160-0016, Japan. haruhiko.kosuge@psl.ap-hop-paris.fr
BACKGROUND: Pityriasis rosea (PR) is a common papulosquamous skin disorder that is suspected to have an infectious aetiology. OBJECTIVES: We aimed to study the role of human herpesvirus (HHV)-7 and HHV-6 in the pathogenesis of PR. METHODS: We performed seroepidemiological studies (indirect immunofluorescence test) and polymerase chain reaction (PCR) analysis for HHV-6 and HHV-7 in patients with PR. Seventy-two serum samples and 37 samples of peripheral blood mononuclear cells (PBMC) from 44 patients with PR were obtained. Twenty-five patients with other skin disorders such as drug eruption, urticaria or herpes zoster were studied as controls in the PCR analysis. RESULTS: HHV-7 DNA was detected in 13 of 30 (43%) samples of PBMC of the patients with PR and 14 of 25 (56%) samples of PBMC of controls. HHV-6 DNA was detected in six of 29 (21%) patients with PR and nine of 23 (39%) controls. Thus there was no difference in the prevalence of HHV-6 or HHV-7 in PBMC between patients with PR and those with other skin disorders. In the seroepidemiological study, two cases of at least a fourfold rise in titre and five cases of a fourfold decrease in titre to HHV-7 antibody, and two cases of a fourfold rise in titre and two cases of a fourfold decrease in titre to HHV-6 antibody, were observed in 24 patients with PR. This seroepidemiological study revealed antibody responses consistent with active infection in several PR patients, but the greater proportion of the patients had no definite increase in the antibody titres. CONCLUSIONS: We conclude that HHV-7 and HHV-6 may play a part in some patients with PR, but that other causative agents may exist. Further analyses are needed to determine the causative agents of PR.
=======================================================
31.) Lack of evidence of active human herpesvirus 7 (HHV-7) infection in three cases of pityriasis rosea in children.
=======================================================
Pediatr Dermatol 2001 Sep-Oct;18(5):381-3
Chuh AA, Peiris JS.
Department of Medicine, University of Hong Kong, Hong Kong. achuh@iohk.com
Three cases of pityriasis rosea in Chinese children are presented. Using polymerase chain reaction for detection of human herpesvirus 7 (HHV-7) DNA in plasma and peripheral blood lymphocytes, we find no evidence of active HHV-7 infection.
=======================================================
32.) Pityriasis rosea associated with herpesvirus 7 DNA.
=======================================================
J Eur Acad Dermatol Venereol 2000 Jul;14(4):313-4
Offidani A, Pritelli E, Simonetti O, Cellini A, Giornetta L, Bossi G.
Publication Types:
Letter
=======================================================
=======================================================
33.)Pityriasis rosea: one virus, two viruses, more viruses?
=======================================================
Br J Dermatol 2001 May;144(5):1090
Comment on:
Br J Dermatol. 1999 Jan;140(1):169-70.
Br J Dermatol. 2000 Oct;143(4):795-8.
Drago F, Rebora A.
Publication Types:
Comment
Letter
=======================================================
=======================================================
34.) Reactivation of human herpesvirus 6 in pityriasis rosea.
=======================================================
J Dermatol 1999 Jan;140(1):169-70
Comment in:
Br J Dermatol. 2001 May;144(5):1090.
Yasukawa M, Sada E, MacHino H, Fujita S.
Publication Types:
Letter
=======================================================
=======================================================
35.) Absence of picornavirus genome in pityriasis rosea.
=======================================================
Arch Dermatol Res 1996 Dec;289(1):60-1
Aractingi S, Morinet F, Mokni M, Tieng V, Flageul B, Fermand JP, Dubertret L.
Unite de Dermatologie, Hopital Tenon, Paris, France.
=======================================================
=======================================================
36.) Human herpesvirus 7 in pityriasis rosea.
=======================================================
Lancet 1997 May 10;349(9062):1367-8
Drago F, Ranieri E, Malaguti F, Losi E, Rebora A.
Publication Types:
Letter
=======================================================
=======================================================
37.) Detection of human herpesvirus 7 in patients with pityriasis rosea and healthy individuals.
=======================================================
Dermatology 1999;199(2):197-8
Comment on:
Dermatology. 1997;195(4):374-8.
Yoshida M.
Publication Types:
Comment
Letter
=======================================================
=======================================================
38.) The association of pityriasis rosea with cytomegalovirus, Epstein-Barr virus and parvovirus B19 infections - A prospective case control study by polymerase chain reaction and serology.
=======================================================
Eur J Dermatol 2003 Jan-Feb;13(1):25-8
Chuh AA.
Department of Medicine, The University of Hong Kong and Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
A viral aetiology is suspected for pityriasis rosea (PR). The objective was to investigate the association of PR with cytomegalovirus (CMV), Epstein Barr virus (EBV) and parvovirus B19 infections. Patients with PR were recruited in a primary care setting over 18 months. Blood was collected at initial presentation and four weeks later. Controls were the next age-and-sex-matched patients requiring blood collection for non-dermatological disease. Polymerase chain reaction was performed for EBV and parvovirus B19 DNA. Serology was done for CMV, EBV and parvovirus B19. 12 patients with PR and 12 control subjects were recruited. No patient had viral DNA or significant antibody rise against any of the viruses investigated. The seroprevalence of all three viruses and Ab titres in the patients with PR were insignificantly different from those of control subjects. Two patients had IgM detectable against CMV and EBV respectively. Based on other investigation results, we believe that both IgM results were caused by cross reactivity. PR is not associated with CMV, EBV or parvovirus B19 infections.
=======================================================
39.) Pityriasis rosea associated with imatinib (STI571, Gleevec).
=======================================================
Dermatology 2002;205(2):172-3
Konstantopoulos K, Papadogianni A, Dimopoulou M, Kourelis C, Meletis J.
First Department of Medicine, University of Athens School of Medicine at Laikon Hospital, Athens, Greece. kkonstan@med.uoa.gr
A tyrosine kinase inhibitor (STI571, Gleevec) has recently been applied in the treatment of chronic myeloid leukemia. We present the first reported case of pityriasis rosea occurring as a reaction to Gleevec in a woman with blast crisis of this disorder. It is suggested that although coincidental, this exanthem may be due to this agent. Copyright 2002 S. Karger AG, Basel
=======================================================
40.) Erythromycin in pityriasis rosea: A double-blind, placebo-controlled clinical trial.
=======================================================
J Am Acad Dermatol 2000 Feb;42(2 Pt 1):241-4
Sharma PK, Yadav TP, Gautam RK, Taneja N, Satyanarayana L.
Department of Dermatology, Dr Ram Manohar Lohia Hospital, New Delhi, India.
BACKGROUND: The study stemmed from an incidental observation of improvement in 2 patients with pityriasis rosea while receiving erythromycin. OBJECTIVE: The purpose of the study was to evaluate the efficacy of erythromycin in patients with pityriasis rosea. METHODS: A double-blind, placebo-controlled clinical study was performed in an outpatient setting in a major hospital. Ninety patients over a period of 2 years were alternatively assigned to treatment group or placebo group. Patients in the treatment group received erythromycin in divided doses for 14 days. The response was categorized as complete response, partial response, or no response. All patients were followed up for 6 weeks. RESULTS: Both groups were comparable with regard to age at presentation, sex, and average duration of disease at the time of reporting to the clinic. Upper respiratory tract infection before the appearance of skin lesions was reported in 68.8% of all patients. Complete response was observed in 33 patients (73.33%) in the treatment group and none in the placebo group (P <.0001). CONCLUSION: Oral erythromycin was effective in treating patients with pityriasis rosea.
=======================================================
41.) A Remarkable Result of a Double-Masked, Placebo-Controlled Trial of Erythromycin in the Treatment of Pityriasis Rosea.
=======================================================
Arch Dermatol 2000 Jun;136(6):775-776
Bigby M.
Editor.
PMID: 10871946 [PubMed - as supplied by publisher]
=======================================================
=======================================================
42.) Case Clustering in Pityriasis Rosea
A Multicenter Epidemiologic Study in Primary Care Settings in Hong Kong
=======================================================
Arch Dermatol. 2003;139:489-493.
Antonio A. T. Chuh, MRCP(UK), MRCP(Irel), MRCPCH, DipDerm; Albert Lee, MPH, FRACGP, FHKCFP, FHKAM(Family Medicine); Nicolas Molinari, PhD
Objectives To investigate the epidemiology of pityriasis rosea in primary care settings in Hong Kong and to analyze for temporal clustering.
Design Retrospective epidemiologic study.
Setting Six primary care teaching practices affiliated with a university.
Patients Forty-one patients with pityriasis rosea, 564 patients with atopic dermatitis (negative control condition), and 35 patients with scabies (positive control condition).
Methods We retrieved all records of patients with pityriasis rosea, atopic dermatitis, or scabies diagnosed in 3 years. We analyzed temporal clustering by a method based on a regression model.
Results The monthly incidence of pityriasis rosea is negatively but insignificantly correlated with mean air temperature (s = -0.41, P = .19) and mean total rainfall (s = -0.34, P = .27). Three statistically significant clusters with 7, 6, and 7 cases were identified (P = .03), occurring in the second coldest month in the year (February), the second hottest month (July), and a temperate month (April), respectively. For atopic dermatitis (negative control condition), the nonclustering regression model was selected by Akaike information criteria. For scabies (positive control condition), 1 cluster of 20 cases was detected (P = .03).
Conclusions Significant temporal clustering independent of seasonal variation occurred in our series of patients with pityriasis rosea. This may be indicative of an infectious cause.
From the Department of Medicine, University of Hong Kong (Dr Chuh); Department of Community and Family Medicine, Chinese University of Hong Kong (Dr Lee); and Department of Biostatistics, Institut Universitaire de Recherche Clinique, University of Montpellier I, Montpellier, France (Dr Molinari). The authors have no relevant financial interest in this article.
=======================================================
43.) Pityriasis rosea--a virus-induced skin disease? An update.
=======================================================
Arch Virol 2000;145(8):1509-20
Kempf W, Burg G.
Department of Dermatology, University Hospital, Zurich, Switzerland.
Pityriasis rosea (PR) is an acute, inflammatory skin disease of unknown cause. Clinical and experimental findings indicate an infectious etiology of PR. Various infectious agents including viruses have been proposed as causative agents and their presence in PR samples has been extensively investigated. Recently, human herpesvirus 7 was linked to PR, but contradictory findings have been reported by various investigators. Here, we describe the features of PR that suggest an infectious cause and review the data from viral studies in PR reported in the literature. In addition, we present a pathogenetic model of PR which may be helpful in planning and evaluating studies for the search of a putative PR-associated virus. Based on the current state of knowledge, none of the known viruses could, so far, be conclusively associated with PR.
======================================================
HERPES VIRUS 6, 7 AND 8 … MORE
======================================================
======================================================
44.) Association between human herpesvirus type 6 and type 7, and cytomegalovirus disease in heart transplant recipients.
======================================================
Transplant Proc 2002 Feb;34(1):75-6
de Ona M, Melon S, Rodriguez JL, Sanmartin JC, Bernardo MJ.
Unidades de Trasplante Cardiaco y de Virologia, Servicios de Cardiologia y Microbiologia I, Hospital Central de Asturias, Spain.
======================================================
45.) Invasion by human herpesvirus 6 and human herpesvirus 7 of the central nervous system in patients with neurological signs and symptoms.
======================================================
Arch Dis Child 2000 Aug;83(2):170-1
Yoshikawa T, Ihira M, Suzuki K, Suga S, Matsubara T, Furukawa S, Asano Y.
Department of Pediatrics, Fujita Health University School of Medicine, Aichi, Japan. tetsushi@med.nagoya-u.ac.jp
METHODS: A total of 43 children with neurological signs and symptoms were enrolled in the study. All children were suspected of having meningitis, and lumbar punctures were performed. Human herpesvirus 6 (HHV-6) and HHV-7 DNA was detected in cerebrospinal fluid (CSF) and peripheral blood mononuclear cells (PBMC) by nested polymerase chain reaction. RESULTS: Most patients had detectable serum antibody to both HHV6 and 7. HHV6 DNA was detected in PBMC of 15 patients and in CSF cell pellet of seven. Corresponding figures for HHV7 were 28 and 6.2/7, and 5/6 with CSF viral DNA also had it in PBMC, respectively. No viral DNA was detected in CSF supernatants. The seven HHV6 CSF viruses were all variant B. CONCLUSION: These data suggest that HHV-7 may invade the CNS.
======================================================
46.) Association of human herpesvirus 6 and human herpesvirus 7 with demyelinating diseases of the nervous system.
======================================================
J Neurovirol 2001 Dec;7(6):564-9
Tomsone V, Logina I, Millers A, Chapenko S, Kozireva S, Murovska M.
August Kirchenshtein Institute of Microbiology and Virology, University of Latvia, Ratsupites st. 1, Riga LV-1067, Latvia. vtomsone@hotmail.com
Peripheral blood mononuclear cells and plasma of 113 patients with neurological disorders and 150 blood donors were analyzed for HHV-6 and HHV-7 sequences by PCR. The prevalence of HHV-6 was significantly higher in patients with multiple sclerosis (P < 0.01) than in cases of nondemyelinating diseases of the central and demyelinating diseases of the peripheral nervous systems and blood donors. HHV-6 viremia was found only in patients with multiple sclerosis, predominantly in the active phase of the disease. A significantly higher frequency of HHV-7 reactivation in patients with demyelinating diseases of the peripheral nervous system suggests also its association with demyelinating processes.
======================================================
47.) [Detection of human herpesvirus type 6, human herpesvirus type 7, cytomegalovirus and human papillomavirus in cutaneous AIDS-associated Kaposi's sarcoma]
======================================================
Verh Dtsch Ges Pathol 1994;78:260-4
[Article in German]
Kempf W, Adams V, Hassam S, Schmid M, Moos R, Briner J, Pfaltz M.
Departement Pathologie, Universitat Zurich.
In order to evaluate a possible role of viral infections in the pathogenesis of AIDS-associated Kaposi's sarcoma (KS), we investigated 26 cutaneous AIDS-associated KS by polymerase chain reaction (PCR), in situ hybridization, and immunohistochemistry. By PCR we detected human papilloma viruses (HPV), cytomegalovirus (CMV), human herpesvirus 6 (HHV-6), and for the first time human herpesvirus 7 (HHV-7) in the KS. The prevalence of HPV, HHV-6, and HHV-7 was similar to or lower in KS than in normal skin tissues of AIDS patients without KS, but higher than in normal skin of HIV-seronegative patients. All HHV-6 found in KS were identified as HHV-6 variant B. In addition to the known HPV types 16 and 18 described in KS, we also found HPV types 6 and 33 in KS specimen. By immunohistochemistry HHV-6 could be localized in macrophages in KS, in the adjacent stroma as well as in normal skin of control cases. In situ hybridization for CMV and HPV gave negative results in KS and controls.
======================================================
48.) Influenza encephalopathy associated with infection with human herpesvirus 6 and/or human herpesvirus 7.
======================================================
Clin Infect Dis 2002 Feb 15;34(4):461-6
Sugaya N, Yoshikawa T, Miura M, Ishizuka T, Kawakami C, Asano Y.
Department of Pediatrics, Nippon Kokan Hospital, Kawasaki, Kanagawa 210-0852, Japan. sugaya-n@za2.so-net.ne.jp
Influenza-associated encephalopathy is often reported in young Japanese children, but its pathogenesis is unknown. Although influenza virus can be demonstrated by throat culture for patients with encephalopathy, cultures of samples of cerebrospinal fluids (CSF) do not yield the virus. Eight patients with encephalopathy or complicated febrile convulsions had influenza virus infection diagnosed by means of culture, polymerase chain reaction (PCR), or rapid diagnosis using throat swabs. In all 8 cases, the results of PCR testing of CSF specimens for influenza virus were negative. On the other hand, human herpesvirus 6 (HHV-6) DNA was demonstrated in CSF specimens obtained from 2 of 8 patients. In 3 of 8 patients, the presence of human herpesvirus 7 (HHV-7) DNA was demonstrated in CSF specimens. Some cases of influenza-associated encephalopathy reported in Japan may be attributable to a dual infection with influenza virus and HHV-6, -7, or both. Another possibility is that latent HHV-6 or HHV-7 in the brain is reactivated by influenza, causing encephalopathy or febrile convulsions.
======================================================
49.) Human herpesvirus 6 and human herpesvirus 7 infections in renal transplant recipients and healthy adults in Turkey.
======================================================
Arch Virol 1994;136(1-2):183-90
Yalcin S, Karpuzoglu T, Suleymanlar G, Mutlu G, Mukai T, Yamamoto T, Isegawa Y, Yamanishi K.
Department of Virology, Osaka University, Japan.
We explored the prevalence of human herpesvirus 6 (HHV-6) and human herpesvirus 7 (HHV-7) infections in 16 renal transplant recipients and 16 healthy controls by virus isolation, serology, polymerase chain reaction (PCR) followed by dot blot hybridization. HHV-6 variant A was isolated from one renal transplant recipient. Seven patients (44%) and six controls (38%) had HHV-6 variant B DNA in their peripheral blood mononuclear cells. The prevalence of HHV-7 DNA was found to be the same in patients and controls (19%).
======================================================
50.) Detection of human herpesvirus-6 DNA in peripheral blood and saliva.
======================================================
J Med Virol 1990 Sep;32(1):73-6
Jarrett RF, Clark DA, Josephs SF, Onions DE.
Department of Veterinary Pathology, Veterinary School, Glasgow, United Kingdom.
Saliva and peripheral blood samples from 20 healthy adults were examined for the presence of human herpesvirus-6 (HHV-6) DNA sequences using the polymerase chain reaction. Eighteen out of 20 whole saliva samples contained detectable HHV-6 genomes. The majority of peripheral blood samples were also positive; however, the results suggest that only a rare cell in the peripheral blood is infected. Serological studies did not reveal any correlation between HHV-6 antibody titre and the ability to detect HHV-6 DNA. The data indicate that HHV-6 genomes persist in the peripheral blood and oropharynx or salivary glands of most healthy individuals following primary infection.
======================================================
51.) Human herpesvirus-6 and human herpesvirus-7 in the bone marrow from healthy subjects.
======================================================
Transplantation 2000 Apr 27;69(8):1722-3
Gautheret-Dejean A, Dejean O, Vastel L, Kerboull M, Aubin JT, Franti M, Agut H.
Laboratoire de Virologie GH Pitie-Salpetriere, Paris, France.
BACKGROUND: Human herpesviruses (HHVs) 6 and 7 are recently discovered betaherpesviruses. Although HHV-6 has been associated with disordered hematopoiesis in bone marrow transplant recipients, little information is available on the presence of both viruses in the bone marrow from healthy subjects. METHODS: We detected HHV-6 and HHV-7 DNA by means of polymerase chain reaction in bone marrow and peripheral blood samples from 18 healthy subjects who underwent total hip arthroplasty. RESULTS: Genomic HHV-6 and HHV-7 DNA were detected in 11% and 67% of the blood samples, respectively, and in 28% and 50% of the bone marrow samples, respectively. CONCLUSIONS: Both viruses may be present in the bone marrow without hematopoiesis disorder and can be transmitted through bone marrow infusion. Therefore, the causative role of these two viruses in some bone marrow diseases cannot be inferred simply from the detection of their genome in bone marrow by means of polymerase chain reaction.
======================================================
52.) Lymphomatoid papulosis and human herpesviruses--A PCR-based evaluation for the presence of human herpesvirus 6, 7 and 8 related herpesviruses.
======================================================
J Cutan Pathol 2001 Jan;28(1):29-33
Kempf W, Kadin ME, Kutzner H, Lord CL, Burg G, Letvin NL, Koralnik IJ.
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. wkempf@hotmail.com
BACKGROUND: Lymphomatoid papulosis (LyP) is a chronic, recurrent lymphoproliferative disorder of the skin that belongs to the group of primary cutaneous CD30-positive T-cell lymphomas. Ultrastructural and clinical features of LyP suggest that it has a viral etiology. Human herpesviruses have been proposed as causative cofactors for LyP because of their oncogenic potential and their association with other lymphomas. METHODS: LyP skin lesions and a LyP-derived cell line were examined for the presence of the recently discovered oncogenic human herpesvirus 8 (HHV-8) and the two T-lymphotropic human herpesviruses 6 and 7 (HHV-6 and HHV-7) by nested polymerase chain reaction (PCR) using virus-specific oligonucleotide primers. Furthermore, a recently described method involving degenerate PCR primers was applied to detect highly conserved DNA sequences shared by a variety of herpesviruses, especially oncogenic gamma-herpesviruses, in an attempt to identify a yet undiscovered herpesvirus associated with LyP. RESULTS: HHV-6 and 8 could not be found in 26 archival and 11 snap-frozen LyP lesions and a LyP tumor cell line. HHV-7 DNA sequences were detected in 14% (5 of 37) of LyP samples. HHV-6 was found in 23% (3 of 13) and HHV-7 in 8% (1 of 13) of normal skin samples from healthy individuals, respectively. Using degenerate PCR primers to amplify the highly conserved polymerase region of herpesviruses, no DNA sequences related to human herpesviruses could be detected. CONCLUSIONS: LyP is not associated with HHV-6, HHV-7 and HHV-8. In addition, the studies using degenerate PCR primers do not indicate the presence of a previously undescribed human herpesvirus in LyP.
======================================================
53.) Presence of human herpesvirus 6 variants A and B in saliva and peripheral blood mononuclear cells of healthy adults.
======================================================
J Clin Microbiol 1996 Dec;34(12):3223-5
Aberle SW, Mandl CW, Kunz C, Popow-Kraupp T.
Institute of Virology, University of Vienna, Austria.
Saliva and peripheral blood mononuclear cells (PBMCs) from 44 healthy young adults were tested for human herpesvirus 6 variants A and B (HHV-6A and -6B) DNA by a sensitive nested PCR. HHV-6B infection was ascertained in 98% of the subjects, and 95% were found to excrete variant B in their saliva. HHV-6A was found in the PBMCs of 16%, but was not detected in saliva samples.
======================================================
54.) Detection of human herpesvirus 6 DNAs in samples from several body sites of patients with exanthem subitum and their mothers by polymerase chain reaction assay.
======================================================
J Med Virol 1995 May;46(1):52-5 Related Articles, Links
Suga S, Yazaki T, Kajita Y, Ozaki T, Asano Y.
Department of Pediatrics, Fujita Health University School of Medicine, Aichi, Japan.
Polymerase chain reaction amplification was used to detect human herpesvirus 6 (HHV-6) DNAs in peripheral blood mononuclear cells (MNCs), plasma, saliva, stool, and urine from three patients with exanthem subitum and in peripheral blood MNCs, plasma, and saliva from their mothers. HHV-6 DNAs were detected in MNCs during and after the disease and were found in plasma only in the acute phase. The virus DNAs were also detected in saliva after recovery from the illness and were found persistently or intermittently in stool but not in urine samples after the onset of the disease. In contrast, one of the three mothers excreted HHV-6 DNAs persistently in saliva. None of the mothers had the virus DNAs in peripheral blood MNCs and plasma nor a significant increase in antibody titers to HHV-6 after possible exposure from their children. These findings suggest systemic replication of HHV-6 during the acute phase in patients with exanthem subitum and persistent infection of the virus in several organs after recovery from the disease.
======================================================
55.) Human herpesvirus-6 and human herpesvirus-7 infections in bone marrow transplant recipients.
======================================================
J Med Virol 1997 Nov;53(3):295-305
Chan PK, Peiris JS, Yuen KY, Liang RH, Lau YL, Chen FE, Lo SK, Cheung CY, Chan TK, Ng MH.
Department of Microbiology, University of Hong Kong, Queen Mary Hospital, Hong Kong.
Human cytomegalovirus (HCMV), human herpesvirus-6 (HHV-6), and human herpesvirus-7 (HHV-7) DNA in peripheral blood leukocytes (PBL) of 61 bone marrow transplant recipients was monitored weekly during the first 12 weeks post-transplantation by a nested polymerase chain reaction (PCR). Thirty-seven (61%), 17 (28%), and 32 (53%) of patients had one or more PBL specimens positive for HCMV, HHV-6 or HHV-7 DNA, respectively. HHV-7 DNA in PBL during the early post-transplant period was associated with a longer time to neutrophil engraftment (mean 28.8 days vs 19.8 days; P = 0.01). In two patients who failed to engraft, HHV-6 DNA and HHV-7 DNA was detected in plasma and PBL, respectively, early in their post-transplant period. Patients with HCMV disease were more likely to have concurrent HHV-7 DNA in PBL prior to onset of disease than were patients with asymptomatic HCMV infection, suggesting that HHV-7 may be a cofactor in the progression from HCMV infection to HCMV disease. In the 17 patients (179 specimens) in whom viral DNA in plasma was studied (in addition to PBL), a positive result was found only in 3. In each, viral DNA in plasma appeared to correlate with clinically significant disease. HHV-7 DNA in plasma was associated with encephalitis in an allograft recipient.
======================================================
56.) High prevalence of HHV-6 DNA in peripheral blood mononuclear cells of healthy individuals detected by nested-PCR.
======================================================
J Med Virol 1994 Jun;43(2):115-8
Cuende JI, Ruiz J, Civeira MP, Prieto J.
Department of Internal Medicine, University Clinic, University of Navarra, Pamplona, Spain.
The aim of the study was the evaluation of human herpesvirus-6 (HHV-6) infection rate and semiquantification of viremia in healthy people. Healthy blood donors were studied. Human herpesvirus-6 IgG and IgM antibody titers were measured by indirect immunofluorescence assay. Human herpesvirus-6 DNA amplification (nested-PCR) was performed in peripheral blood mononuclear cells (PBMC) and in serum. Seventeen of 50 (34 percent) individuals were positive for IgG anti-HHV-6 and the titers ranged from 1:40 to 1:160. None of 30 individuals was positive for IgM anti-HHV-6, suggesting no recent infection nor reactivation. Human herpesvirus-6 DNA was detected by nested-PCR amplification in peripheral blood mononuclear cells but not in sera. When 1 microgram DNA was amplified, HHV-6 DNA was detected in 8 of 20 individual (40%), but in 18 of 20 (90%) when 5 micrograms DNA were amplified. It is concluded that HHV-6 is present in a high proportion of the healthy population but in minimal amounts, and although it can be detected in 1.4 x 10(5) PBMC, 7 x 10(5) cells are necessary to detect most cases. No reactivation was observed in healthy people.
======================================================
57.) Clinical features and viral excretion in an infant with primary human herpesvirus 7 infection.
======================================================
Pediatrics 1995 Feb;95(2):187-90
Asano Y, Suga S, Yoshikawa T, Yazaki T, Uchikawa T.
Department of Pediatrics, Fujita Health University School of Medicine, Aichi, Japan.
OBJECTIVE. To find clinical features of a virologically-confirmed patient with primary human herpesvirus 7 (HHV-7) infection and a relationship of the excretion of viruses between HHV-7 and human herpes-virus 6 (HHV-6). PATIENT AND METHODS. A 13-month-old boy who had a known prior history of exanthem subitum at 6 months of age developed fever for 3 days and a skin rash appeared as the fever was resolving. The course was accompanying with nonspecific signs and symptoms such as anorexia, irritability, mild diarrhea, palpebral edema, mild inflammation of pharynx, and mild occipital and cervical lymphadenopathy. Heparinized blood samples were used for isolation of HHV-6 and HHV-7 and detection of both virus DNA sequences by a nested polymerase chain reaction (PCR) amplification. Samples from other body sites were also tested for their DNA sequences using the PCR. Both virus antibody activity was measured by an indirect immunofluorescent assay or a neutralization test. RESULTS. Cultured mononuclear cells from the patient at the acute stage of the disease produced morphologic changes, which reacted only with the monoclonal antibody to HHV-7 but not with the antibody to HHV-6. Both viruses were not isolated from blood obtained at the convalescent stage. An antibody response of the patient indicated a seroconversion to HHV-7 but not to other microbial agents including HHV-6 and Mycoplasma pneumoniae. Both virus DNA sequences were detected in peripheral blood mononuclear cells at acute and convalescent stages. HHV-7 DNA was excreted into saliva and transiently into stool at an early convalescent stage followed by HHV-6 excretion into saliva. No HHV-7 and HHV-6 was excreted into urine. CONCLUSIONS. Clinical features of a virologically confirmed patient with primary HHV-7 infection were comparable with those of primary HHV-6 infection and HHV-7 infection may reactivate HHV-6.
=====================================================================
58.) Gestational Pityriasis Rosea: Suggestions for Approaching Affected Pregnant Women.
=====================================================================
Acta Dermatovenerol Croat. 2016 Dec;24(4):312-313.
Author information
1Efstathia Pasmatzi, MD, Department of Dermatology, School of Medicine, University of Patras, 26504 Rio-Patras, Greece; pasmatzi@med.upatras.gr.
Abstract
Dear Editor, Pityriasis rosea is a common, acute, and self-limiting dermatosis, which is associated with the endogenous systemic reactivation of human herpesvirus (HHV)-6 and/or HHV-7 (1). It predominantly affects individuals of both sexes in their second or third decade of life and is clinically characterized by the occurrence of an initial erythematosquamous plaque followed by the appearance of disseminated similar but smaller lesions one or two weeks later. Several patients develop systemic symptoms such as nausea, anorexia, malaise, headache, fever, arthralgia, and lymphadenopathy that may precede or accompany the eruption; the latter follows the cleavage lines of the trunk creating the configuration of a Christmas tree and spontaneously resolves within 4 to 8 weeks. Mainly based on the nature of the underlying viral reactivation, pityriasis rosea is classified into five different forms (2): 1) Classic and 2) Relapsing (characterized by sporadic and relapsing HHV-6/7 systemic reactivation, respectively), 3) Persistent (persistence of HHV-6/7 viremia), 4) Pediatric (longer activity of HHV-6/7 infection; recent primary infection) and 5) Gestational (HHV-6/7 reactivation and possible intrauterine transmission). Clearly, the inevitable impairment of immune response in pregnancy favors viral reactivation and possibly also the intrauterine transmission of HHV-6/7. Indeed, it is well known and documented that pityriasis rosea more frequently occurs in pregnant women (18%) as compared to the general population (6%) (3). However, the literature concerning the possible effect of pityriasis rosea on the outcome of pregnancy is surprisingly sparse. Only an Italian group, Drago et al (4,5), has systematically investigated the impact of this disorder on pregnant women. They found that 22 out of 61 women (36%) who developed pityriasis rosea during pregnancy had unfavorable outcomes, whereas 8 others miscarried (13%). None of the latter had any risk factors, other than pityriasis rosea, for intrauterine fetal death. All miscarrying women reportedly revealed an aggressive course of widespread eruption and severe constitutional symptoms; all of them had HHV-6 DNA in the plasma, placenta, skin lesions, and fetal tissues, whereas HHV-7 DNA was detected in the plasma and skin lesions in 3 out of 8 (37.5%) miscarrying women. HHV-6 DNA was found only in the plasma of 2 out of 31 women (6.45%) with normal pregnancy, whereas HHV-7 DNA was detected in the plasma of 3 (9.45%) and in the skin lesions of 2 women (6.45%) with normal pregnancy. The total abortion rate in women who developed pityriasis rosea during their pregnancy (13%) does not differ from that observed in the general population. Nevertheless, it is markedly higher in cases affected during the first 15 gestational weeks (57%) (4,5). Surprisingly, this devastating impact of pityriasis rosea on the outcome of pregnancy is almost completely unknown not only to the public but also to many members of the medical community. It is also largely unknown that, particularly during the first 15 gestational weeks, all pregnant women should avoid any contact with patients known to have pityriasis rosea. Since we have received a considerable number of requests for consultation with pregnant women with pityriasis rosea over the last few years, our group has compiled suggestions approaching the affected patients: 1. If an eruption suggestive for pityriasis rosea occurs in a pregnant woman, the following factors should be excluded: a. Exposure to drugs prior to the development of the rash (biologic agents, captopril, clonidine, hydrochlorothiazide, atenolol, lamotrigine, nortriptyline, barbiturates, metronidazole, terbinafine, omeprazole, non-steroidal anti-inflammatory drugs, and isotretinoin), which are capable of inducing a pityriasis rosea-like eruption (6) and b. Disorders included in the differential diagnosis (syphilis and infections due to parvovirus, herpes virus, cytomegalovirus, and Epstein-Barr virus). 2. The clinical diagnosis of pityriasis rosea should be made according to the morphological criteria (peripheral collarette scaling with central clearance on at least two lesions) put forth by Chuh (7). 3. Since specific anti-HHV-6 and -7 IgM antibodies are detected only in a low percentage of infected pregnant women (8), HHV-6 and -7 DNA should be assessed in plasma by nested PCR. Especially during the first 15 gestational weeks, pregnant women with positive PCR results deserve, apart from close monitoring, appropriate information about the existing risks in order to be able to make informed decisions. 4. Reliable and definite data from adequate and controlled human studies on the safety of acyclovir or valacyclovir in pregnant women and their efficacy in pityriasis rosea are lacking. Thus, the decision on whether these antiviral compounds will be administered should be tailored to each individual pregnant woman, subsequent to a meticulous assessment of the potential risks and their balancing against the potential benefits.
=====================================================================
Follow @dermagicexpress
===================
Hello friends of the net, DERMAGIC again with you with the topic:
PITYRIASIS ROSEA, AN UPDATE. The Pityriasis Rosea is one of those
ancestral illnesses, described for the firsttime by GIBERT, in
1860.
Other Authors have described it with other names, among them: Erythema
Annulatum (Rayer), Herpes tonsurans maculous et squamous (Strand),
Lichen annulatus serpiginous (Wilson), pityriasis circine (Horand),
Piyiriasis dissemine (Hardy), Pityriasis circinee et marginee
((Vidal), Pityriasis Rubra aigu disseminee(Bazin), Pseudoexantheme
erytematodescuamatif (Besnier), Roseola Annulata (Wilan), Roseola
furfuracea herpetiformis (Beherend) and Roseola squamosa (Nicolas and
Chapard).
Today, more than 140 years have passed since the time that I
immortalized GIBERT, and the probable causal agents of the disease are
discussed, including bacteria and viruses of the herpes family, the
latter being the HERPES 6 and 7 viruses, the most associated With the
disease.
It is noteworthy that there are studies that demonstrate the
effectiveness of ERITROMICINE in the treatment of the disease, I have
particularly obtained good results in many cases with the antibiotic
CEPHALOSPORIN and in other cases the antiviral VALACICLOVIR has also
been successful.
The PITYRIASIS ROSEA has a behavior highly SEASONAL, in a time of the
year they are presented most of the cases (autumn and winter) , it is
more frequents in woman, and although CLASSICALLY it doesn't produce
lesions on the face, palms and plants, I have seen such manifestations
and are described in the literature.
The classic HERALDIC MACULE or PATCH represents the beginning of the
disease and then the metameric outbreak is presented in "Christmas tree"
pattern classic of the disease, usually oval plaques, but variants,
VESICULAR, PAPULAR AND PURPURIC of the same affection have been
described.
An interesting fact is that in most of the cases it doesn't REPEAT THE ILLNESS, although in some cases some years after a second manifestation SIMILAR to the first time can be presented. But in general she leaves DEFINITIVE IMMUNITY. Also PITYRIASIS ROSEA drug-induced rashes have also been reported.
IIf we take as valid the RECENT statement that PITYRIASIS ROSEA is
associated with HERPES VIRUS 6 and 7, and that these can be found in the
saliva of healthy people, we could LAUNCH THE THEORY that THE SEASONAL
CHANGE (autumn, winter) ACTIVATES the virulence Of these viruses,
provoking disease. And then when changing the climate again (summer),
THE VIRUSES LOSE ACTIVITY and decreases the percentage of cases.
WHY DO NOT ALL MANIFEST DISEASE, ?? Like all classical eruptive, would
be explained by the degree of immunological protection that PEOPLE have
AGAINST THESE HERPES VIRUSES. PEOPLE ALSO EXIST TO WHICH NEVER SUFFERED
THEM SOME OF THE CLASSIC ERUPTIVES !! with or without immunization !!!
The classic PITYRIASIS ROSEA behaves almost equally in all patients,
with an eruptive RASH after an incubation time marked by HERALD path,
cases of mucosal (mouth) lesions have been described, more than 98% of
the cases leave definitive immunity and now has been proven his
INFECTIOUS ETIOLOGY (mainly VIRAL)
Based on these FACTS, particularly I would PROPOSE to reclassify it and
to place it in the ERUPTIVE DISEASES GROUP as the SIXTH disease after
the MEASLES, RUBELLA, CHICKEN POX, SUBITUM EXANTHEMA (infantile Roseola)
and the ERYTHEMA INFECTIOSUM (fifth desease).
Let's remember that ERYTHEMA INFECTIOSUM has been associated to the
VIRUS parvovirus B19, and the SUBITUM EXANTHEM to the VIRUS HERPES 6. It
seems LOGICAL to place the PITYRIASIS ROSEA within this ERUPTIVE group,
I mean the classic disease, NOT TO THE ONE INDUCED for medications or
other agents, THAT they are REALLY similar eczemas (LIKE) to the
Pitiyriasis.Rosea.
The PITYRIASIS ROSEA can last up to 90 days in some cases after the
Heraldic path appears, with or without treatment, and in some cases
disappears alone. But it is advisable to go to the dermatologist for
proper treatment.
In the references the facts.
Greetings !!!
Dr José Lapenta
Dr. Jose M Lapenta
===========================================================
REFERENCIAS BIBLIOGRAFICAS/ BIBLIOGRAPHICAL REFERENCES
===========================================================
1.) Papular pityriasis rosea.
2.) Human herpes virus-like particles in pityriasis rosea lesions: an electron microscopy study.
3.) Human herpesviruses 6 and 7.
4.) Human herpesvirus 7 in dermatology: what role does it play?
5.) [Myerson nevus as a primary patch of Gibert pityriasis rosea. A case report]
6.) Rash orientation in pityriasis rosea: a qualitative study.
7.) Skin diseases associated with human herpesvirus 6, 7, and 8 infection.
8.) Collarette scaling in pityriasis rosea demonstrated by digital epiluminescence dermatoscopy.
9.) [Etiopathogenic importance of human herpes viruses type 6, 7 and 8 in manifestations of certain skin diseases]
10.) Prospective case-control study of chlamydia, legionella and mycoplasma infections in patients with pityriasis rosea.
11.) Pityriasis rosea is associated with systemic active infection with both human herpesvirus-7 and human herpesvirus-6.
12.) Detection of human herpesvirus 7 in pityriasis rosea by nested PCR.
13.) An epidemiological study of pityriasis rosea in the Eastern Anatolia.
14.) Human herpesvirus 7 in patients with pityriasis rosea. Electron microscopy investigations and polymerase chain reaction in mononuclear cells, plasma and skin.
15.) A pityriasis rosea-like eruption secondary to bacillus Calmette-Guerin therapy for bladder cancer.
16.) UVB phototherapy for pityriasis rosea: a bilateral comparison study.
17.) Pityriasis rosea Gibert: detection of Legionella micdadei antibodies in patients.
18.) Pityriasis rosea-like eruption after bone marrow transplantation.
19.) Tongue and cheek: oral lesions in pityriasis rosea.
20.) Pityriasis rosea and discoid eczema: dose related reactions to treatment with gold.
21.) [Pityriasis rosea-like skin eruptions caused by captopril]
22.) Recurrent pityriasis rosea. New episodes every year for five years. A case report.
23.) Pityriasis rosea-like eruption associated with BCG vaccination.
24.) [Vesicular pityriasis rosea]
25.) [Benign familial chronic pemphigus and pityriasis rosea. Clinical aspects and histology of the coexistence of both dermatoses]
26.) Human herpesvirus 6 and 7 DNA in peripheral blood leucocytes and plasma in patients with pityriasis rosea by polymerase chain reaction: a prospective case control study.
27.) The human herpesviruses and pityriasis rosea: curious covert companions?
28.) Pityriasis rosea is not associated with human herpesvirus 7.
29.) Association of pityriasis rosea with human herpesvirus-6 and human herpesvirus-7 in Taipei.
30.) Epidemiological study of human herpesvirus-6 and human herpesvirus-7 in pityriasis rosea.
31.) Lack of evidence of active human herpesvirus 7 (HHV-7) infection in three cases of pityriasis rosea in children.
32.) Pityriasis rosea associated with herpesvirus 7 DNA.
33.)Pityriasis rosea: one virus, two viruses, more viruses?
34.) Reactivation of human herpesvirus 6 in pityriasis rosea.
35.) Absence of picornavirus genome in pityriasis rosea.
36.) Human herpesvirus 7 in pityriasis rosea.
37.) Detection of human herpesvirus 7 in patients with pityriasis rosea and healthy individuals.
38.) The association of pityriasis rosea with cytomegalovirus, Epstein-Barr virus and parvovirus B19 infections - A prospective case control study by polymerase chain reaction and serology.
39.) Pityriasis rosea associated with imatinib (STI571, Gleevec).
40.) Erythromycin in pityriasis rosea: A double-blind, placebo-controlled clinical trial.
41.) A Remarkable Result of a Double-Masked, Placebo-Controlled Trial of Erythromycin in the Treatment of Pityriasis Rosea.
42.) Case Clustering in Pityriasis Rosea
A Multicenter Epidemiologic Study in Primary Care Settings in Hong Kong
43.) Pityriasis rosea--a virus-induced skin disease? An update.
======================================================
HERPES VIRUS 6, 7 AND 8 … MORE
======================================================
======================================================
44.) Association between human herpesvirus type 6 and type 7, and cytomegalovirus disease in heart transplant recipients.
45.) Invasion by human herpesvirus 6 and human herpesvirus 7 of the central nervous system in patients with neurological signs and symptoms.
46.) Association of human herpesvirus 6 and human herpesvirus 7 with demyelinating diseases of the nervous system.
47.) [Detection of human herpesvirus type 6, human herpesvirus type 7, cytomegalovirus and human papillomavirus in cutaneous AIDS-associated Kaposi's sarcoma]
48.) Influenza encephalopathy associated with infection with human herpesvirus 6 and/or human herpesvirus 7.
49.) Human herpesvirus 6 and human herpesvirus 7 infections in renal transplant recipients and healthy adults in Turkey.
50.) Detection of human herpesvirus-6 DNA in peripheral blood and saliva.
51.) Human herpesvirus-6 and human herpesvirus-7 in the bone marrow from healthy subjects.
52.) Lymphomatoid papulosis and human herpesviruses--A PCR-based evaluation for the presence of human herpesvirus 6, 7 and 8 related herpesviruses.
53.) Presence of human herpesvirus 6 variants A and B in saliva and peripheral blood mononuclear cells of healthy adults.
54.) Detection of human herpesvirus 6 DNAs in samples from several body sites of patients with exanthem subitum and their mothers by polymerase chain reaction assay.
55.) Human herpesvirus-6 and human herpesvirus-7 infections in bone marrow transplant recipients.
56.) High prevalence of HHV-6 DNA in peripheral blood mononuclear cells of healthy individuals detected by nested-PCR.
57.) Clinical features and viral excretion in an infant with primary human herpesvirus 7 infection.
58.) Gestational Pityriasis Rosea: Suggestions for Approaching Affected Pregnant Women.
=======================================================
=======================================================
1.) Papular pityriasis rosea.
=======================================================
Cutis 2002 Jul;70(1):51-5; quiz 48
Bernardin RM, Ritter SE, Murchland MR.
David Grant Medical Center, Travis Air Force Base, Fairfield, California, USA.
Pityriasis rosea (PR) is a seasonal papulosquamous disorder that can be easily confused with a wide variety of similar appearing cutaneous disorders. This is particularly evident in its atypical papular form. We present a case report of atypical papular PR, along with a discussion of clinical presentation, histologic criteria, proposed etiology, and treatment options. Papular PR is atypical, presenting in a minority of patients, and may pose a diagnostic challenge. Being familiar with these atypical characteristics will facilitate accurate and timely diagnosis.
=======================================================
2.) Human herpes virus-like particles in pityriasis rosea lesions: an electron microscopy study.
=======================================================
J Cutan Pathol 2002 Jul;29(6):359-61
Drago F, Malaguti F, Ranieri E, Losi E, Rebora A.
Section of Dermatology, Department of Health Sciences, DiSEM, University of Genoa, Viale Benedetto XV 7, 16132 Genoa, Italy. rebdermo@unige.it
BACKGROUND: In a previous study we detected virions with electron microscopy features of human herpes viruses in the supernatant of cocultured mononuclear cells from patients with acute pityriasis rosea. Because of their morphology and of polymerase chain reaction studies, we ascribed them to human herpes virus 7. OBJECTIVE: To find such virions in the lesional skin of pityriasis rosea patients. METHODS: Skin specimens from lesions of 21 patients with acute pityriasis rosea were examined by elecron microscopy. RESULTS: In 15 (71%) patients, human herpes virus particles in various stages of morphogenesis were detected. Mature enveloped virions appeared as typical human herpes virus virions, measuring about 160-200 nm in diameter and containing an electrodense cylindrical core, a capsid, an envelope with typical spikes and a very distinct tegument layer between the capsid and the envelope. They were very similar to those we reported in the supernatant of co-cultured circulating mononuclear cells from patients with pityriasis rosea. CONCLUSION: Our results confirm our previous findings and provides further evidence of a viral etiology for pityriasis rosea.
=======================================================
3.) Human herpesviruses 6 and 7.
=======================================================
Dermatol Clin 2002 Apr;20(2):301-6
De Araujo T, Berman B, Weinstein A.
Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, FL 33136, USA.
Human herpesviruses 6 and 7 are newly discovered viruses that belong to the genus Roseolavirus within the subfamily Betaherpesvirinae. These ubiquitous viruses may cause primary or chronic persistent infection or remain in a state of latency for many years, until a decrease in the immunologic state of the host leads to reactivation of infection. Several diseases have been linked with HHV-6 and HHV-7. In the dermatologic arena, a definite association has been proven only for HHV-6 and exanthema subitum (roseola infantum), whereas the role of HHV-7 in the pathogenesis of pityriasis rosea remains a matter of debate.
=======================================================
4.) Human herpesvirus 7 in dermatology: what role does it play?
=======================================================
Am J Clin Dermatol 2002;3(5):309-15
Kempf W.
Department of Dermatology, University Hospital, Zurich, Switzerland. kempf@derm.unizh.ch
Human herpesvirus 7 (HHV-7) was discovered in 1989 as a new member of the beta-herpesvirus subfamily. Primary infection occurs early in life and manifests as exanthema subitum, or other febrile illnesses mimicking measles and rubella. Thus, HHV-7 has to be considered as a causative agent in a variety of macular-papular rashes in children. In addition, HHV-7 was found in some cases of other inflammatory skin disorders, such as psoriasis. There are controversial data on the detection of HHV-7 in pityriasis rosea, but so far there is not enough evidence for a pathogenetic association of HHV-7 with this exanthematic skin disease. Although HHV-7 can be found in some cases of Hodgkin's disease, there are no data supporting a direct causative role in this lymphoma type nor in other nodal or primary cutaneous lymphomas. In various epidemiologic forms of Kaposi's sarcoma, infection of monocytic cells with HHV-7 was demonstrated, which may indirectly influence tumor biology. In the context of immunosuppression, HHV-7 has recently been identified as an emerging pathogen in transplant recipients and may exacerbate graft rejection in renal transplant recipients. The ability of HHV-7 to induce cytokine production in infected cells could make HHV-7 an important pathogenetic co-factor in inflammatory and neoplastic disorders. Moreover, the restricted cellular tropism of HHV-7 may render this virus an interesting vector for gene therapy. Thirteen years after the discovery of HHV-7, there has been considerable progress in characterizing its genetic structure, virus-induced effects on infected host cells and in the development of diagnostic tools. Nevertheless, the role of HHV-7 in various skin diseases and the clinical manifestations of reactivation of HHV-7 infection have still to be defined.
=======================================================
5.) [Myerson nevus as a primary patch of Gibert pityriasis rosea. A case report]
=======================================================
Hautarzt 2002 May;53(5):338-41
[Article in German]
Hofer T.
Dermatologie FMH, Winkelriedstrasse 10, CH-5430 Wettingen. thomas.hofer@active.ch
There are only few articles in literature which discuss the association between Meyerson's naevi and Pityriasis rosea. And when so, the discussion is done in a controversial way. Here an 18 year old man is presented who visits the outpatient clinic. He has a ten day history of a solitary Meyerson's naevus on his back. Over the next three weeks this naevus will develop to the typical herold patch followed by the classical exantheme of Pityriasis rosea. CONCLUSION: Halo dermatitis associated with Pityriasis rosea don't represent Meyerson's naevi. But they reflect the rare "nevocentric" property of a not so rare dermatose.
=======================================================
6.) Rash orientation in pityriasis rosea: a qualitative study.
=======================================================
Eur J Dermatol 2002 May-Jun;12(3):253-6
Chuh AA.
University of Hong Kong, Shop B5, Ning Yeung Terrace, 78 Bonham Road, Ground Floor, Hong Kong. achuh@iohk.com
Rash orientation in pityriasis rosea (PR) has been described as Christmas-tree pattern, inverted Christmas-tree pattern, fir tree pattern, parallel to the ribs or along skin cleavage lines. We retrieved clinical photographs of 11 patients diagnosed as having PR over a two-year period for qualitative study of rash orientation. We found that Langer's cleavage lines are the most appropriate description. All three components of these lines on the trunk, i.e. V-shaped pattern on upper chest and upper back, circumferential pattern around the shoulders and hips, and transverse pattern on the lower anterior trunk and lower back, are demonstrated by most patients. We believe with the present state of knowledge, the mechanism for PR following Langer's lines is best considered unknown. We advocate abandoning other descriptions which might cause confusion to students and trainee physicians.
=======================================================
7.) Skin diseases associated with human herpesvirus 6, 7, and 8 infection.
=======================================================
J Investig Dermatol Symp Proc 2001 Dec;6(3):197-202
Blauvelt A.
Dermatology Branch, National Cancer Institute, Bethesda, Maryland 20892-1908, USA. blauvelt@mail.nih.gov
Relatively recently, the discovery and analysis of three new human herpesviruses, human herpesvirus (HHV)-6, HHV-7, and Kaposi's sarcoma-associated herpesvirus (KSHV), also known as HHV-8, has contributed greatly to our understanding of the pathogenesis of several common dermatoses. HHV-6 and HHV-7 are closely related beta-herpesviruses that have been linked with roseola (mostly HHV-6), severe drug eruptions (HHV-6), and pityriasis rosea (mostly HHV-7). KSHV is a gamma-herpesvirus that is now believed to be the long sought after etiologic agent of Kaposi's sarcoma. The evidence for these skin disease associations and key findings from recent basic science investigations on viral pathogenesis are discussed in this review. In addition, possible therapeutic implications of these research studies are explored.
=======================================================
8.) Collarette scaling in pityriasis rosea demonstrated by digital epiluminescence dermatoscopy.
=======================================================
Australas J Dermatol 2001 Nov;42(4):288-90
Chuh AA.
Department of Medicine, University of Hong Kong, Hong Kong, ROC. achuh@iohk.com
Collarette scaling is a characteristic sign in pityriasis rosea. The use of digital epiluminescence dermatoscopy is proposed to assist in the recognition of this sign as this technique can magnify the lesions, eliminate other epidermal changes, and demonstrate the morphology and direction of scaling.
=======================================================
9.) [Etiopathogenic importance of human herpes viruses type 6, 7 and 8 in manifestations of certain skin diseases]
=======================================================
Med Pregl 2001 Sep-Oct;54(9-10):459-63
[Article in Serbo-Croatian (Roman)]
Poljacki M, Rajic N, Matic M.
Klinika za kozno-venericne bolesti, 21000 Novi Sad, Hajduk Veljkova 1-3. cojans@eunet.yu
INTRODUCTION: In the past few years new human herpes viruses (HHV): HHV-6, -7 and -8 have been discovered. According to the most recent literature, they might have an important role in etiopathogenesis of some dermatological diseases. HUMAN HERPESVIRUS 6: HHV-6 was isolated in 1984 from peripheral blood lymphocytes of AIDS patients and patients with different lymphoproliferative diseases. Up to now, two variants of this virus have been identified, A and B, which differ in genetic, biological and immunological characteristics. The etiological importance of variant A, has not yet been clarified, while variant B is considered to be the major cause of many diseases, such as exanthema subitum in infants. In many cases primary infection is associated with elevated temperature, without rash. HUMAN HERPESVIRUS 7: HHV-7 was isolated in 1990 from activated peripheral blood CD4+ T cells of healthy persons. The virus is ubiquitous and more than 80% of babies and infants are affected. Presence of DNA sequences of this virus in mononuclear cells of peripheral blood, skin and plasma of pityriasis rosea patients, points to possible connection between this illness and HHV-7 infection. HUMAN HERPESVIRUS 8: HHV-8 was first identified in tissue samples of patients with Kaposi's sarcoma associated with AIDS in 1994. DNA virus sequences were also isolated in HIV negative persons with Kaposis's sarcoma. Presence of virus can be established in mononuclear cells of peripheral blood, endothelial cells that cover vascular spaces and spindle cells within skin changes. Modes of transmission are still not clarified. However, HHV-8 was identified in some other dermatological diseases as well.
=======================================================
10.) Prospective case-control study of chlamydia, legionella and mycoplasma infections in patients with pityriasis rosea.
=======================================================
Eur J Dermatol 2002 Mar-Apr;12(2):170-3
Chuh AA, Chan HH.
The Bonham Surgery, Shop B5, Ning Yeung Terrace, 78 Bonham Road, Ground Floor, Hong Kong, China. achuh@iohk.com
A double-blind placebo-controlled trial reported the benefit of erythromycin in treating pityriasis rosea (PR), a postulated mechanism being the eradication of bacteria susceptible to erythromycin. The aim of this study was to investigate the association between PR and Chlamydia pneumoniae, C. trachomatis, Legionella longbeachae, L. micdadei, L. pneumophila, and Mycoplasma pneumoniae infections. We recruited 13 patients aged seven to 46 years (mean: 26.8 years) diagnosed to have PR in a primary care setting in 18 months. Lesional histopathology was arranged for atypical cases. Clotted blood was collected at initial presentation and four weeks later. Controls were 13 paired age-and-sex-matched patients requiring blood collection for non-dermatological diseases. Serology tests were performed in parallel but were read "blinded" on the acute and convalescent specimens of patients and the control subjects. The serology profiles were not diagnostic of active infection by any of the bacteria studied for all 13 patients. Two patients had four-fold increase in IgG titres against C. pneumoniae, with IgM being negative. Two patients had IgM detectable against L. pneumophila serotype 6 and M. pneumoniae respectively, with no significant rise of the specific IgG. These patients had no symptom or sign of chest infection. The seroprevalence and IgG titres of the study patients for the bacteria investigated were insignificantly different from those of control subjects. We conclude that the bacteria investigated in this study do not play a significant role in the pathogenesis of PR. We believe that anti-inflammatory and immunomodulatary effects might contribute towards the action of erythromycin, if any, in PR.
=======================================================
11.) Pityriasis rosea is associated with systemic active infection with both human herpesvirus-7 and human herpesvirus-6.
=======================================================
J Invest Dermatol 2002 Oct;119(4):793-7
Comment in:
J Invest Dermatol. 2002 Oct;119(4):779-80.
Watanabe T, Kawamura T, Jacob SE, Aquilino EA, Orenstein JM, Black JB, Blauvelt A.
Dermatology Branch and Division of Cancer Treatment and Diagnosis, Center for Cancer Research, National Cancer Institute, Howard Hughes Medical Institute, NIH Medical Research Scholar Program, Bethesda, Maryland, USA.
Pityriasis rosea is a common skin disease that has been suspected to have a viral etiology. We performed nested polymerase chain reaction to detect human herpesvirus-7, human herpesvirus-6, and cytomegalovirus DNA in lesional skin, nonlesional skin, peripheral blood mononuclear cells, serum, and saliva samples isolated from 14 pityriasis rosea patients. Viral mRNA expression and virion visualization within lesional skin were studied by in situ hybridization and transmission electron microscopy, respectively. By nested polymerase chain reaction, human herpesvirus-7 DNA was present in lesional skin (93%), nonlesional skin (86%), saliva (100%), peripheral blood mononuclear cells (83%), and serum (100%) samples, whereas human herpesvirus-6 DNA was detected in lesional skin (86%), nonlesional skin (79%), saliva (80%), peripheral blood mononuclear cells (83%), and serum (88%) samples. By contrast, cytomegalovirus DNA was not detected in these tissues. Control samples from 12 healthy volunteers and 10 psoriasis patients demonstrated rare positivity for either human herpesvirus-7 or human herpesvirus-6 DNA in skin or serum. By in situ hybridization, infiltrating mononuclear cells expressing human herpesvirus-7 and human herpesvirus-6 mRNA were identified in perivascular and periappendageal areas in 100% and 75% pityriasis rosea skin lesions, respectively, compared to herpesviral mRNA positivity in only 13% normal skin and psoriasis skin controls. Transmission electron microscopy failed to reveal herpesviral virions in pityriasis rosea lesional skin. Nested polymerase chain reaction and in situ hybridization enabled detection of human herpesvirus-7 and human herpesvirus-6 in skin and other tissues isolated from patients with pityriasis rosea. These results suggest that pityriasis rosea is associated with systemic active infection with both human herpesvirus-7 and human herpesvirus-6.
=======================================================
12.) Detection of human herpesvirus 7 in pityriasis rosea by nested PCR.
=======================================================
Int J Dermatol 2002 Sep;41(9):563-
Karabulut AA, Kocak M, Yilmaz N, Eksioglu M.
Department of Dermatology, Ankara Education and Research Hospital, Refik Saydam Hifzisihha Institute, Ministry of Health, Turkey.
BACKGROUND: Clinical presentation, immunologic, light microscopic, and electron microscopic studies suggest a viral etiology for pityriasis rosea (PR). OBJECTIVE: To evaluate whether human herpesvirus 7 (HHV-7) is an etiologic factor for PR. PATIENTS AND METHODS: Twenty-one PR patients (12 female, nine male) aged between 12 and 52 years, whose diagnoses were confirmed clinically and histopathologically, were included in the study. The duration of the disease was questioned. Tissue samples of 5-mm punch biopsy material were collected from the patients and from six healthy volunteers (three female, three male) as the controls. Nested polymerase chain reaction (PCR) with specific primers for HHV-7 DNA sequences (OPERON technologies Inc., HV-7S/HV-8A external sences and HV-10S/HV11A internal sences) was performed on each tissue sample. Polymerase chain reaction products were analyzed by electrophoresis on 2% agarose gels. After molecular weight markers (Haphi174) had been placed and visualized on an ultraviolet transilluminator, the gels were immersed and photographs were taken. RESULTS: The mean age was 29.86 +/- 11.77 for the PR patients and 25.33 +/- 11.69 for the controls. The mean duration of the disease was 16.28 +/- 15.74 days. Human herpesvirus 7 DNA sequences were detected in six of the PR patients (28.57%). The mean duration of the disease was calculated as 11.67 +/- 9.85 for the HHV-7-positive patients (patient nos. 3, 4, 5, 7, 8, 9) and 18.13 +/- 17.05 for the HHV-7-negative patients, and there was no statistically significant differences in either of the groups (U = 29.5, W = 50.5, P = 0.2241, using the Mann-Whitney U and Wilcoxon's rank sum W-tests). Nested PCR was negative for HHV-7 in all of the specimens from the controls. There was no statistically significant difference for the presence of HHV-7 DNA sequence between the PR patients and the controls (P = 0.2843, Fisher's exact two-tail analysis test). CONCLUSION: Our results failed to support a possible role for HHV-7 in the pathogenesis of PR.
=======================================================
13.) An epidemiological study of pityriasis rosea in the Eastern Anatolia.
=======================================================
Eur J Epidemiol 1998 Jul;14(5):495-7
Harman M, Aytekin S, Akdeniz S, Inaloz HS.
Department of Dermatology & Venerology, Faculty of Medicine, University of Dicle, Diyarbakir, Turkey.
The purpose of this study was to investigate the epidemiological features of pityriasis rosea (PR) in the Eastern Anatolia, Turkey. Three hundred ninety-one patients (214 females, 177 males) with PR seen during the years 1992-1995 were analyzed for annual incidence among dermatologic outpatients, sex, age, and distribution by month and year. The average annual incidence was 0.75 per 100 dermatologic patients. PR was reported to be slightly more common in women by margin of 1.2:1.0. Eighty-seven percent of the cases were between the ages of 10 and 39 years, with a peak in the 20-29 age group. The incidence of the disease was much higher in the rainy and snowy months. No declining incidence was observed over the years. Changes in incidence from year to year, though not great, were statistically significant.
=======================================================
14.) Human herpesvirus 7 in patients with pityriasis rosea. Electron microscopy investigations and polymerase chain reaction in mononuclear cells, plasma and skin.
=======================================================
Dermatology 1997;195(4):374-8
Comment in:
Dermatology. 1998;196(2):275.
Dermatology. 1999;199(2):197-8.
Drago F, Ranieri E, Malaguti F, Battifoglio ML, Losi E, Rebora A.
Institute of Dermatology, University of Genoa, Italy.
BACKGROUND: Clinical evidence suggests a viral etiology for pityriasis rosea (PR). OBJECTIVE: To evaluate human herpesvirus (HHV)-6 and HHV-7 as candidates for the etiology of PR. METHODS: Blood and skin tissue from 12 patients with acute PR, and 12 patients with other dermatoses were studied, as well as blood samples from 25 healthy persons. Serum interferon (IFN)-alpha and IFN-gamma were analyzed by ELISA. Analysis of morphological changes in cocultured peripheral blood mononuclear cells (PBMC) and electron microscopy (EM) to identify viral particles were performed. Polymerase chain reaction (PCR) with specific primers for HHV-6 and HHV-7 DNA sequences was performed on the plasma and PBMC of patients and healthy controls and on the skin of patients with PR and other skin diseases. RESULTS: PR plasma contained detectable IFN-alpha and IFN-gamma, whereas plasma from controls did not. PBMC from PR patients showed ballooning cells and syncytia after 7 days in culture whereas PBMC from controls and recovered PR patients did not. This cytopathic effect was also documented in a PR patient who relapsed and in Sup-T1 cell cultures inoculated with the cell-free supernatant from centrifuged cultured PBMC; in this supernatant, herpesvirus, virions were detected by EM, PCR identified HHV-7 DNA in PBMC, plasma and skin from all patients with active PR and in the PBMC only of 5 patients tested 10-14 months later. Weaker signals of HHV-7 DNA were detected in PBMC of 11 controls, but not in their plasma. Skin was negative for HHV-7 in all control specimens. CONCLUSIONS: Although the detection of HHV-7 DNA in PBMC and tissues does not prove directly a causal role, HHV-7 DNA in cell-free plasma corresponds to active replication which supports a causal relationship. We propose that PR is a clinical presentation of HHV-7 reactivation.
=======================================================
15.) A pityriasis rosea-like eruption secondary to bacillus Calmette-Guerin therapy for bladder cancer.
=======================================================
Cutis 1996 Jun;57(6):447-50
Honl BA, Keeling JH, Lewis CW, Thompson IM.
Dermatology Service, Brooke Army Medical Center, Fort Sam Houston, Texas, USA.
The use of bacillus Calmette-Guerin (BCG) for the treatment of bladder cancer has been followed by reports documenting adverse reactions. Eruptions of the skin have been included (although not well described) in the list of side effects. We report a pityriasis rosea-like rash secondary to BCG therapy for bladder cancer. Although the treatment was interrupted because of this reaction, the medication was restarted later with only a mild transient recurrence of the eruption.
=======================================================
16.) UVB phototherapy for pityriasis rosea: a bilateral comparison study.
=======================================================
J Am Acad Dermatol 1995 Dec;33(6):996-9
Leenutaphong V, Jiamton S.
Department of Dermatology, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
BACKGROUND: Pityriasis rosea is a common self-limiting disease. UV light has been mentioned as helpful, but only a few studies substantiate this possibility. OBJECTIVE: Our purpose was to evaluate the clinical efficacy of UVB phototherapy in pityriasis rosea and the course of the disease after treatment. METHODS: Seventeen patients with extensive pityriasis rosea were treated with unilateral UVB phototherapy in a bilateral comparison study. One joule of UVA was used as a "placebo" on the untreated side. The treatments were given five times per week for 2 weeks. The rate of clearing was monitored by estimation of the severity score. RESULTS: Ten daily erythemogenic exposures of UVB resulted in substantially decreased severity of disease, greater than that on the untreated side in 15 of 17 patients. The overall reduction of severity score showed a significant difference after the third treatment; the UVB irradiation was superior. However, during the follow-up period the two sides were indistinguishable in regard to severity score (p = 0.6784). No significant difference in pruritus was noted between the two sides (p > 0.1638). The duration of disease did not relate to the success of UVB phototherapy. CONCLUSION: During the treatment period UVB phototherapy resulted in decreased severity of disease. However, the itching and the course of the disease were unchanged.
=======================================================
17.) Pityriasis rosea Gibert: detection of Legionella micdadei antibodies in patients.
=======================================================
Eur J Epidemiol 1995 Aug;11(4):459-62
Gjenero-Margan I, Vidovic R, Drazenovic V.
Epidemiology Service, Croatian National Institute of Public Health, Zagreb, Croatia.
Some epidemiological and clinical characteristics of Pityriasis rosea Gibert has led us to hypothesize that this disease may be the clinical manifestation of an infection caused by legionellas. We have thus tested the sera of 36 patients ill with Pityriasis rosea and 19 controls for Legionella pneumophila serogroup 1-6 and Legionella micdadei antibodies. These, who had the same age and sex distribution as study patients, were receiving treatment for other diseases in the same ward. Also tested were 200 sera from the voluntary blood donors from the same region as study patients. Legionella micdadei antibodies were detected in 12 (33.3%) Pityriasis rosea cases and in one (5.2%) control. They were significantly more common in Pityriasis rosea cases than in either controls or voluntary blood donor population. The findings to date encourage continued research into the causative relationship between the Legionella micddadei infection and the onset of Pityriasis rosea Gibert.
=======================================================
18.) Pityriasis rosea-like eruption after bone marrow transplantation.
=======================================================
J Am Acad Dermatol 1994 Aug;31(2 Pt 2):348-51
Spelman LJ, Robertson IM, Strutton GM, Weedon D.
Department of Dermatology, Royal Brisbane Hospital, Australia.
Bone marrow transplantation is associated with numerous cutaneous complications that may be related to the underlying (preexisting) disease, to pretransplant conditioning, to immunosuppression, to concomitant medication, or to graft-versus-host reaction. We describe four bone marrow transplant recipients with the clinical and histologic features of pityriasis rosea, a hitherto unreported association.
=======================================================
19.) Tongue and cheek: oral lesions in pityriasis rosea.
=======================================================
Cutis 1992 Oct;50(4):276-80
Vidimos AT, Camisa C.
Cleveland Clinic Foundation, Department of Dermatology A61, Ohio 44195-5032.
Fifty-one consecutive patients with clinical findings and history consistent with pityriasis rosea underwent a complete oral examination to search for any concomitant oral lesions. One case was omitted from the statistical analysis because the results of a rapid plasma reagin test were positive. Of the fifty remaining cases, eight patients (16 percent) were noted to have various oral lesions, all of which were asymptomatic. These findings suggest that the actual incidence of oral lesions in pityriasis rosea may be higher than previously reported. A complete oral examination in a patient presenting with a papulosquamous eruption may be helpful in ascertaining the diagnosis of pityriasis rosea.
=======================================================
20.) Pityriasis rosea and discoid eczema: dose related reactions to treatment with gold.
=======================================================
Ann Rheum Dis 1992 Jul;51(7):881-4
Wilkinson SM, Smith AG, Davis MJ, Mattey D, Dawes PT.
Department of Dermatology, North Staffordshire Health District, Stoke-on-Trent, United Kingdom.
Sixteen cases of either a pityriasiform or discoid eczematous rash occurring in patients with rheumatoid arthritis receiving treatment with gold (sodium aurothiomalate and auranofin) were studied. The results suggest that this is a dose related, not allergic, reaction to gold. The development of this rash is not an absolute indication to stop treatment with gold. Control can often be effected with potent topical steroids or a reduction in the dose or frequency of treatment with gold.
=======================================================
21.) [Pityriasis rosea-like skin eruptions caused by captopril]
=======================================================
G Ital Dermatol Venereol 1990 Oct;125(10):457-9
[Article in Italian]
Ghersetich I, Rindi L, Teofoli P, Tsampau D, Palleschi GM, Lotti T.
Istituto di Clinica Dermosifilopatica, Universita degli Studi di Firenze.
Captopril is an antihypertensive drug that works by inhibiting the angiotensin-converting enzyme and provokes increased levels of plasma quinine. In the case here reported a picture of pityriasis rosea-like reaction is described. The frequency of the observed and reported reactions by captopril suggests a particular caution in the use of this drug.
=======================================================
22.) Recurrent pityriasis rosea. New episodes every year for five years. A case report.
=======================================================
Acta Derm Venereol 1990;70(2):179-80
Halkier-Sorensen L.
Department of Dermatology and Venereology, Marselisborg Hospital, University of Aarhus, Denmark.
A case of recurrent pityriasis rosea in a 39-year-old woman is presented. She had her first attack of pityriasis rosea 5 years ago and new outbreaks followed every year, in the spring. Her husband had a severe attack of pityriasis rosea 6 years ago. All laboratory investigations were normal and no explanation for the many recurrences was found.
=======================================================
23.) Pityriasis rosea-like eruption associated with BCG vaccination.
=======================================================
Isr J Med Sci 1989 Oct;25(10):570-2
Kaplan B, Grunwald MH, Halevy S.
Department of Dermatology, Soroka Medical Center, Beer Sheva, Israel.
We report a case of a pityriasis rosea-like eruption in a 12-year-old boy several days following BCG vaccination. It is suggested that the BCG vaccination be included in the etiology of pityriasis rosea-like eruptions.
=======================================================
24.) [Vesicular pityriasis rosea]
=======================================================
Hautarzt 1988 Aug;39(8):524-6
[Article in German]
Strauss T, Kuhn A, Steigleder GK.
Universitats-Hautklinik Koln.
Pityriasis rosea is a frequently occurring skin disease of unknown aetiology. Ten clinical forms of this disease are known, with predominance of the macular type. We observed a healthy 24-year-old patient with the very rare vesicular variant of pityriasis rosea, which has to be differentiated from vesicular virus and drug-induced eruptions.
=======================================================
25.) [Benign familial chronic pemphigus and pityriasis rosea. Clinical aspects and histology of the coexistence of both dermatoses]
=======================================================
Hautarzt 1988 May;39(5):324-7
[Article in German]
Winzer M.
Klinik fur Dermatologie und Venerologie, Medizinischen Universitat zu Lubeck.
We report the course of benign familial pemphigus (Hailey-Hailey disease) in a 45-year-old woman. While this condition was in remission the patient started to suffer from pityriasis rosea. A biopsy of this coexisting dermatosis revealed the typical features of Hailey-Hailey disease (suprabasal acantholysis) and of pityriasis rosea within the same lesion.
=======================================================
26.) Human herpesvirus 6 and 7 DNA in peripheral blood leucocytes and plasma in patients with pityriasis rosea by polymerase chain reaction: a prospective case control study.
=======================================================
Acta Derm Venereol 2001 Aug-Sep;81(4):289-90
Chuh AA, Chiu SS, Peiris JS.
Department of Medicine, University of Hong Kong, China. achuh@iohk.com
An association between pityriasis rosea and human herpesvirus 7 (HHV-7) has been reported but remains controversial. The purpose of the present study was to investigate the association between HHV-6 and HHV-7 with pityriasis rosea. Fifteen patients aged 6-54 years with a diagnosis of pityriasis rosea and 15 age-matched controls were recruited. None of the patients had HHV-6 or HHV-7 DNA detected by polymerase chain reaction in the acute or convalescent plasma specimen. In the acute peripheral blood leucocytes specimen, 3 patients and one control had RHV-6 DNA detected (p=0.299; NS), while 7 patients and 5 controls had HHV-7 DNA (p=0.355; NS). Antibody to HHV-6 was detected in the acute specimen of 13 patients and 13 controls, while antibody to HHV-7 was found in all 15 of patients and controls. We thus found no evidence of recent HHV-6 or HHV-7 infection in patients with a diagnosis of pityriasis rosea.
=======================================================
27.) The human herpesviruses and pityriasis rosea: curious covert companions?
=======================================================
J Invest Dermatol 2002 Oct;119(4):779-80
Comment on:
J Invest Dermatol. 2002 Oct;119(4):793-7.
Breese Hall C.
University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A.
Publication Types:
Comment
======================================================
=======================================================
28.) Pityriasis rosea is not associated with human herpesvirus 7.
=======================================================
Kempf W, Adams V, Kleinhans M, Burg G, Panizzon RG, Campadelli-Fiume G, Nestle FO.
Department of Dermatology, University Hospital, Zurich, Switzerland.
OBJECTIVE: To examine the proposed association between pityriasis rosea and human herpesvirus 7 (HHV-7). DESIGN: A retrospective cross-sectional survey. SETTING: University medical center in Switzerland. PATIENTS: Thirteen patients with pityriasis rosea and 14 persons with normal skin (control subjects). MAIN OUTCOME MEASURES: Detection of HHV-7-specific DNA sequences and antigen (85-kd phosphoprotein [pp85]) by nested polymerase chain reaction and immunohistochemical analysis, respectively. RESULTS: Human herpesvirus 7 DNA sequences and expression of the HHV-7-specific immunodominant pp85 antigen were found in 1 (8%) of 13 lesional skin biopsy specimens of pityriasis rosea. The prevalence of HHV-7 DNA sequences and antigens is even slightly lower in lesional skin of patients with pityriasis rosea than in clinically and morphologically normal skin of 14 control persons, in 2 of whom (14%) HHV-7 DNA sequences and antigens could be detected. CONCLUSION: The low detection rate of HHV-7 DNA sequences and antigens argues strongly against a causative role for HHV-7 in the pathogenesis of pityriasis rosea.
=======================================================
29.) Association of pityriasis rosea with human herpesvirus-6 and human herpesvirus-7 in Taipei.
=======================================================
J Formos Med Assoc 2001 Jul;100(7):478-83
Wong WR, Tsai CY, Shih SR, Chan HL.
Department of Dermatology, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipei, Taiwan.
BACKGROUND AND PURPOSE: Pityriasis rosea (PR) is a common papulosquamous skin disease with unknown etiology. The possible relationship of PR with human herpesvirus infection (HHV) has been extensively studied. This study used the polymerase chain reaction (PCR) to investigate the presence of human herpesvirus 6 and 7 (HHV-6 and HHV-7) in 41 PR patients from two hospitals in Northern Taiwan. The epidemiologic features of PR in patients were also studied. METHODS: A total of 41 PR patients (11 males, 30 females) were enrolled in this study from April 1999 to March 2000. PCR of skin biopsy specimens from 24 PR patients was used to identify the existence of HHV-6 and HHV-7. Viral culture from PR biopsy specimens was also performed. Blood from these patients was sampled for Venereal Disease Research Laboratory tests. Skin biopsies from 20 age- and sex-matched controls with other skin diseases were also subjected to PCR study. RESULTS: The ages of the 41 PR patients ranged from 8 to 62 years. An increased incidence (17/41) of PR episodes was observed during the spring. Both HHV-6 and HHV-7 DNA was below the limit of detection in all biopsy specimens from patients and healthy controls. Viral culture for HHV was negative in all patients. CONCLUSION: The epidemiologic features of PR in this series are comparable to other studies except for an exaggerated female predominance (male:female ratio 1:2.7). Our data indicate a lack of association between HHV-6 and HHV-7 infection and PR.
=======================================================
30.) Epidemiological study of human herpesvirus-6 and human herpesvirus-7 in pityriasis rosea.
=======================================================
Br J Dermatol 2000 Oct;143(4):795-8
Comment in:
Br J Dermatol. 2001 May;144(5):1090.
Kosuge H, Tanaka-Taya K, Miyoshi H, Amo K, Harada R, Ebihara T, Kawahara Y, Yamanishi K, Nishikawa T.
Department of Dermatology, Tokyo Electric Power Hospital, 9-2 Shinanomachi, Shinjuku-ku, Tokyo 160-0016, Japan. haruhiko.kosuge@psl.ap-hop-paris.fr
BACKGROUND: Pityriasis rosea (PR) is a common papulosquamous skin disorder that is suspected to have an infectious aetiology. OBJECTIVES: We aimed to study the role of human herpesvirus (HHV)-7 and HHV-6 in the pathogenesis of PR. METHODS: We performed seroepidemiological studies (indirect immunofluorescence test) and polymerase chain reaction (PCR) analysis for HHV-6 and HHV-7 in patients with PR. Seventy-two serum samples and 37 samples of peripheral blood mononuclear cells (PBMC) from 44 patients with PR were obtained. Twenty-five patients with other skin disorders such as drug eruption, urticaria or herpes zoster were studied as controls in the PCR analysis. RESULTS: HHV-7 DNA was detected in 13 of 30 (43%) samples of PBMC of the patients with PR and 14 of 25 (56%) samples of PBMC of controls. HHV-6 DNA was detected in six of 29 (21%) patients with PR and nine of 23 (39%) controls. Thus there was no difference in the prevalence of HHV-6 or HHV-7 in PBMC between patients with PR and those with other skin disorders. In the seroepidemiological study, two cases of at least a fourfold rise in titre and five cases of a fourfold decrease in titre to HHV-7 antibody, and two cases of a fourfold rise in titre and two cases of a fourfold decrease in titre to HHV-6 antibody, were observed in 24 patients with PR. This seroepidemiological study revealed antibody responses consistent with active infection in several PR patients, but the greater proportion of the patients had no definite increase in the antibody titres. CONCLUSIONS: We conclude that HHV-7 and HHV-6 may play a part in some patients with PR, but that other causative agents may exist. Further analyses are needed to determine the causative agents of PR.
=======================================================
31.) Lack of evidence of active human herpesvirus 7 (HHV-7) infection in three cases of pityriasis rosea in children.
=======================================================
Pediatr Dermatol 2001 Sep-Oct;18(5):381-3
Chuh AA, Peiris JS.
Department of Medicine, University of Hong Kong, Hong Kong. achuh@iohk.com
Three cases of pityriasis rosea in Chinese children are presented. Using polymerase chain reaction for detection of human herpesvirus 7 (HHV-7) DNA in plasma and peripheral blood lymphocytes, we find no evidence of active HHV-7 infection.
=======================================================
32.) Pityriasis rosea associated with herpesvirus 7 DNA.
=======================================================
J Eur Acad Dermatol Venereol 2000 Jul;14(4):313-4
Offidani A, Pritelli E, Simonetti O, Cellini A, Giornetta L, Bossi G.
Publication Types:
Letter
=======================================================
=======================================================
33.)Pityriasis rosea: one virus, two viruses, more viruses?
=======================================================
Br J Dermatol 2001 May;144(5):1090
Comment on:
Br J Dermatol. 1999 Jan;140(1):169-70.
Br J Dermatol. 2000 Oct;143(4):795-8.
Drago F, Rebora A.
Publication Types:
Comment
Letter
=======================================================
=======================================================
34.) Reactivation of human herpesvirus 6 in pityriasis rosea.
=======================================================
J Dermatol 1999 Jan;140(1):169-70
Comment in:
Br J Dermatol. 2001 May;144(5):1090.
Yasukawa M, Sada E, MacHino H, Fujita S.
Publication Types:
Letter
=======================================================
=======================================================
35.) Absence of picornavirus genome in pityriasis rosea.
=======================================================
Arch Dermatol Res 1996 Dec;289(1):60-1
Aractingi S, Morinet F, Mokni M, Tieng V, Flageul B, Fermand JP, Dubertret L.
Unite de Dermatologie, Hopital Tenon, Paris, France.
=======================================================
=======================================================
36.) Human herpesvirus 7 in pityriasis rosea.
=======================================================
Lancet 1997 May 10;349(9062):1367-8
Drago F, Ranieri E, Malaguti F, Losi E, Rebora A.
Publication Types:
Letter
=======================================================
=======================================================
37.) Detection of human herpesvirus 7 in patients with pityriasis rosea and healthy individuals.
=======================================================
Dermatology 1999;199(2):197-8
Comment on:
Dermatology. 1997;195(4):374-8.
Yoshida M.
Publication Types:
Comment
Letter
=======================================================
=======================================================
38.) The association of pityriasis rosea with cytomegalovirus, Epstein-Barr virus and parvovirus B19 infections - A prospective case control study by polymerase chain reaction and serology.
=======================================================
Eur J Dermatol 2003 Jan-Feb;13(1):25-8
Chuh AA.
Department of Medicine, The University of Hong Kong and Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
A viral aetiology is suspected for pityriasis rosea (PR). The objective was to investigate the association of PR with cytomegalovirus (CMV), Epstein Barr virus (EBV) and parvovirus B19 infections. Patients with PR were recruited in a primary care setting over 18 months. Blood was collected at initial presentation and four weeks later. Controls were the next age-and-sex-matched patients requiring blood collection for non-dermatological disease. Polymerase chain reaction was performed for EBV and parvovirus B19 DNA. Serology was done for CMV, EBV and parvovirus B19. 12 patients with PR and 12 control subjects were recruited. No patient had viral DNA or significant antibody rise against any of the viruses investigated. The seroprevalence of all three viruses and Ab titres in the patients with PR were insignificantly different from those of control subjects. Two patients had IgM detectable against CMV and EBV respectively. Based on other investigation results, we believe that both IgM results were caused by cross reactivity. PR is not associated with CMV, EBV or parvovirus B19 infections.
=======================================================
39.) Pityriasis rosea associated with imatinib (STI571, Gleevec).
=======================================================
Dermatology 2002;205(2):172-3
Konstantopoulos K, Papadogianni A, Dimopoulou M, Kourelis C, Meletis J.
First Department of Medicine, University of Athens School of Medicine at Laikon Hospital, Athens, Greece. kkonstan@med.uoa.gr
A tyrosine kinase inhibitor (STI571, Gleevec) has recently been applied in the treatment of chronic myeloid leukemia. We present the first reported case of pityriasis rosea occurring as a reaction to Gleevec in a woman with blast crisis of this disorder. It is suggested that although coincidental, this exanthem may be due to this agent. Copyright 2002 S. Karger AG, Basel
=======================================================
40.) Erythromycin in pityriasis rosea: A double-blind, placebo-controlled clinical trial.
=======================================================
J Am Acad Dermatol 2000 Feb;42(2 Pt 1):241-4
Sharma PK, Yadav TP, Gautam RK, Taneja N, Satyanarayana L.
Department of Dermatology, Dr Ram Manohar Lohia Hospital, New Delhi, India.
BACKGROUND: The study stemmed from an incidental observation of improvement in 2 patients with pityriasis rosea while receiving erythromycin. OBJECTIVE: The purpose of the study was to evaluate the efficacy of erythromycin in patients with pityriasis rosea. METHODS: A double-blind, placebo-controlled clinical study was performed in an outpatient setting in a major hospital. Ninety patients over a period of 2 years were alternatively assigned to treatment group or placebo group. Patients in the treatment group received erythromycin in divided doses for 14 days. The response was categorized as complete response, partial response, or no response. All patients were followed up for 6 weeks. RESULTS: Both groups were comparable with regard to age at presentation, sex, and average duration of disease at the time of reporting to the clinic. Upper respiratory tract infection before the appearance of skin lesions was reported in 68.8% of all patients. Complete response was observed in 33 patients (73.33%) in the treatment group and none in the placebo group (P <.0001). CONCLUSION: Oral erythromycin was effective in treating patients with pityriasis rosea.
=======================================================
41.) A Remarkable Result of a Double-Masked, Placebo-Controlled Trial of Erythromycin in the Treatment of Pityriasis Rosea.
=======================================================
Arch Dermatol 2000 Jun;136(6):775-776
Bigby M.
Editor.
PMID: 10871946 [PubMed - as supplied by publisher]
=======================================================
=======================================================
42.) Case Clustering in Pityriasis Rosea
A Multicenter Epidemiologic Study in Primary Care Settings in Hong Kong
=======================================================
Arch Dermatol. 2003;139:489-493.
Antonio A. T. Chuh, MRCP(UK), MRCP(Irel), MRCPCH, DipDerm; Albert Lee, MPH, FRACGP, FHKCFP, FHKAM(Family Medicine); Nicolas Molinari, PhD
Objectives To investigate the epidemiology of pityriasis rosea in primary care settings in Hong Kong and to analyze for temporal clustering.
Design Retrospective epidemiologic study.
Setting Six primary care teaching practices affiliated with a university.
Patients Forty-one patients with pityriasis rosea, 564 patients with atopic dermatitis (negative control condition), and 35 patients with scabies (positive control condition).
Methods We retrieved all records of patients with pityriasis rosea, atopic dermatitis, or scabies diagnosed in 3 years. We analyzed temporal clustering by a method based on a regression model.
Results The monthly incidence of pityriasis rosea is negatively but insignificantly correlated with mean air temperature (s = -0.41, P = .19) and mean total rainfall (s = -0.34, P = .27). Three statistically significant clusters with 7, 6, and 7 cases were identified (P = .03), occurring in the second coldest month in the year (February), the second hottest month (July), and a temperate month (April), respectively. For atopic dermatitis (negative control condition), the nonclustering regression model was selected by Akaike information criteria. For scabies (positive control condition), 1 cluster of 20 cases was detected (P = .03).
Conclusions Significant temporal clustering independent of seasonal variation occurred in our series of patients with pityriasis rosea. This may be indicative of an infectious cause.
From the Department of Medicine, University of Hong Kong (Dr Chuh); Department of Community and Family Medicine, Chinese University of Hong Kong (Dr Lee); and Department of Biostatistics, Institut Universitaire de Recherche Clinique, University of Montpellier I, Montpellier, France (Dr Molinari). The authors have no relevant financial interest in this article.
=======================================================
43.) Pityriasis rosea--a virus-induced skin disease? An update.
=======================================================
Arch Virol 2000;145(8):1509-20
Kempf W, Burg G.
Department of Dermatology, University Hospital, Zurich, Switzerland.
Pityriasis rosea (PR) is an acute, inflammatory skin disease of unknown cause. Clinical and experimental findings indicate an infectious etiology of PR. Various infectious agents including viruses have been proposed as causative agents and their presence in PR samples has been extensively investigated. Recently, human herpesvirus 7 was linked to PR, but contradictory findings have been reported by various investigators. Here, we describe the features of PR that suggest an infectious cause and review the data from viral studies in PR reported in the literature. In addition, we present a pathogenetic model of PR which may be helpful in planning and evaluating studies for the search of a putative PR-associated virus. Based on the current state of knowledge, none of the known viruses could, so far, be conclusively associated with PR.
======================================================
HERPES VIRUS 6, 7 AND 8 … MORE
======================================================
======================================================
44.) Association between human herpesvirus type 6 and type 7, and cytomegalovirus disease in heart transplant recipients.
======================================================
Transplant Proc 2002 Feb;34(1):75-6
de Ona M, Melon S, Rodriguez JL, Sanmartin JC, Bernardo MJ.
Unidades de Trasplante Cardiaco y de Virologia, Servicios de Cardiologia y Microbiologia I, Hospital Central de Asturias, Spain.
======================================================
45.) Invasion by human herpesvirus 6 and human herpesvirus 7 of the central nervous system in patients with neurological signs and symptoms.
======================================================
Arch Dis Child 2000 Aug;83(2):170-1
Yoshikawa T, Ihira M, Suzuki K, Suga S, Matsubara T, Furukawa S, Asano Y.
Department of Pediatrics, Fujita Health University School of Medicine, Aichi, Japan. tetsushi@med.nagoya-u.ac.jp
METHODS: A total of 43 children with neurological signs and symptoms were enrolled in the study. All children were suspected of having meningitis, and lumbar punctures were performed. Human herpesvirus 6 (HHV-6) and HHV-7 DNA was detected in cerebrospinal fluid (CSF) and peripheral blood mononuclear cells (PBMC) by nested polymerase chain reaction. RESULTS: Most patients had detectable serum antibody to both HHV6 and 7. HHV6 DNA was detected in PBMC of 15 patients and in CSF cell pellet of seven. Corresponding figures for HHV7 were 28 and 6.2/7, and 5/6 with CSF viral DNA also had it in PBMC, respectively. No viral DNA was detected in CSF supernatants. The seven HHV6 CSF viruses were all variant B. CONCLUSION: These data suggest that HHV-7 may invade the CNS.
======================================================
46.) Association of human herpesvirus 6 and human herpesvirus 7 with demyelinating diseases of the nervous system.
======================================================
J Neurovirol 2001 Dec;7(6):564-9
Tomsone V, Logina I, Millers A, Chapenko S, Kozireva S, Murovska M.
August Kirchenshtein Institute of Microbiology and Virology, University of Latvia, Ratsupites st. 1, Riga LV-1067, Latvia. vtomsone@hotmail.com
Peripheral blood mononuclear cells and plasma of 113 patients with neurological disorders and 150 blood donors were analyzed for HHV-6 and HHV-7 sequences by PCR. The prevalence of HHV-6 was significantly higher in patients with multiple sclerosis (P < 0.01) than in cases of nondemyelinating diseases of the central and demyelinating diseases of the peripheral nervous systems and blood donors. HHV-6 viremia was found only in patients with multiple sclerosis, predominantly in the active phase of the disease. A significantly higher frequency of HHV-7 reactivation in patients with demyelinating diseases of the peripheral nervous system suggests also its association with demyelinating processes.
======================================================
47.) [Detection of human herpesvirus type 6, human herpesvirus type 7, cytomegalovirus and human papillomavirus in cutaneous AIDS-associated Kaposi's sarcoma]
======================================================
Verh Dtsch Ges Pathol 1994;78:260-4
[Article in German]
Kempf W, Adams V, Hassam S, Schmid M, Moos R, Briner J, Pfaltz M.
Departement Pathologie, Universitat Zurich.
In order to evaluate a possible role of viral infections in the pathogenesis of AIDS-associated Kaposi's sarcoma (KS), we investigated 26 cutaneous AIDS-associated KS by polymerase chain reaction (PCR), in situ hybridization, and immunohistochemistry. By PCR we detected human papilloma viruses (HPV), cytomegalovirus (CMV), human herpesvirus 6 (HHV-6), and for the first time human herpesvirus 7 (HHV-7) in the KS. The prevalence of HPV, HHV-6, and HHV-7 was similar to or lower in KS than in normal skin tissues of AIDS patients without KS, but higher than in normal skin of HIV-seronegative patients. All HHV-6 found in KS were identified as HHV-6 variant B. In addition to the known HPV types 16 and 18 described in KS, we also found HPV types 6 and 33 in KS specimen. By immunohistochemistry HHV-6 could be localized in macrophages in KS, in the adjacent stroma as well as in normal skin of control cases. In situ hybridization for CMV and HPV gave negative results in KS and controls.
======================================================
48.) Influenza encephalopathy associated with infection with human herpesvirus 6 and/or human herpesvirus 7.
======================================================
Clin Infect Dis 2002 Feb 15;34(4):461-6
Sugaya N, Yoshikawa T, Miura M, Ishizuka T, Kawakami C, Asano Y.
Department of Pediatrics, Nippon Kokan Hospital, Kawasaki, Kanagawa 210-0852, Japan. sugaya-n@za2.so-net.ne.jp
Influenza-associated encephalopathy is often reported in young Japanese children, but its pathogenesis is unknown. Although influenza virus can be demonstrated by throat culture for patients with encephalopathy, cultures of samples of cerebrospinal fluids (CSF) do not yield the virus. Eight patients with encephalopathy or complicated febrile convulsions had influenza virus infection diagnosed by means of culture, polymerase chain reaction (PCR), or rapid diagnosis using throat swabs. In all 8 cases, the results of PCR testing of CSF specimens for influenza virus were negative. On the other hand, human herpesvirus 6 (HHV-6) DNA was demonstrated in CSF specimens obtained from 2 of 8 patients. In 3 of 8 patients, the presence of human herpesvirus 7 (HHV-7) DNA was demonstrated in CSF specimens. Some cases of influenza-associated encephalopathy reported in Japan may be attributable to a dual infection with influenza virus and HHV-6, -7, or both. Another possibility is that latent HHV-6 or HHV-7 in the brain is reactivated by influenza, causing encephalopathy or febrile convulsions.
======================================================
49.) Human herpesvirus 6 and human herpesvirus 7 infections in renal transplant recipients and healthy adults in Turkey.
======================================================
Arch Virol 1994;136(1-2):183-90
Yalcin S, Karpuzoglu T, Suleymanlar G, Mutlu G, Mukai T, Yamamoto T, Isegawa Y, Yamanishi K.
Department of Virology, Osaka University, Japan.
We explored the prevalence of human herpesvirus 6 (HHV-6) and human herpesvirus 7 (HHV-7) infections in 16 renal transplant recipients and 16 healthy controls by virus isolation, serology, polymerase chain reaction (PCR) followed by dot blot hybridization. HHV-6 variant A was isolated from one renal transplant recipient. Seven patients (44%) and six controls (38%) had HHV-6 variant B DNA in their peripheral blood mononuclear cells. The prevalence of HHV-7 DNA was found to be the same in patients and controls (19%).
======================================================
50.) Detection of human herpesvirus-6 DNA in peripheral blood and saliva.
======================================================
J Med Virol 1990 Sep;32(1):73-6
Jarrett RF, Clark DA, Josephs SF, Onions DE.
Department of Veterinary Pathology, Veterinary School, Glasgow, United Kingdom.
Saliva and peripheral blood samples from 20 healthy adults were examined for the presence of human herpesvirus-6 (HHV-6) DNA sequences using the polymerase chain reaction. Eighteen out of 20 whole saliva samples contained detectable HHV-6 genomes. The majority of peripheral blood samples were also positive; however, the results suggest that only a rare cell in the peripheral blood is infected. Serological studies did not reveal any correlation between HHV-6 antibody titre and the ability to detect HHV-6 DNA. The data indicate that HHV-6 genomes persist in the peripheral blood and oropharynx or salivary glands of most healthy individuals following primary infection.
======================================================
51.) Human herpesvirus-6 and human herpesvirus-7 in the bone marrow from healthy subjects.
======================================================
Transplantation 2000 Apr 27;69(8):1722-3
Gautheret-Dejean A, Dejean O, Vastel L, Kerboull M, Aubin JT, Franti M, Agut H.
Laboratoire de Virologie GH Pitie-Salpetriere, Paris, France.
BACKGROUND: Human herpesviruses (HHVs) 6 and 7 are recently discovered betaherpesviruses. Although HHV-6 has been associated with disordered hematopoiesis in bone marrow transplant recipients, little information is available on the presence of both viruses in the bone marrow from healthy subjects. METHODS: We detected HHV-6 and HHV-7 DNA by means of polymerase chain reaction in bone marrow and peripheral blood samples from 18 healthy subjects who underwent total hip arthroplasty. RESULTS: Genomic HHV-6 and HHV-7 DNA were detected in 11% and 67% of the blood samples, respectively, and in 28% and 50% of the bone marrow samples, respectively. CONCLUSIONS: Both viruses may be present in the bone marrow without hematopoiesis disorder and can be transmitted through bone marrow infusion. Therefore, the causative role of these two viruses in some bone marrow diseases cannot be inferred simply from the detection of their genome in bone marrow by means of polymerase chain reaction.
======================================================
52.) Lymphomatoid papulosis and human herpesviruses--A PCR-based evaluation for the presence of human herpesvirus 6, 7 and 8 related herpesviruses.
======================================================
J Cutan Pathol 2001 Jan;28(1):29-33
Kempf W, Kadin ME, Kutzner H, Lord CL, Burg G, Letvin NL, Koralnik IJ.
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. wkempf@hotmail.com
BACKGROUND: Lymphomatoid papulosis (LyP) is a chronic, recurrent lymphoproliferative disorder of the skin that belongs to the group of primary cutaneous CD30-positive T-cell lymphomas. Ultrastructural and clinical features of LyP suggest that it has a viral etiology. Human herpesviruses have been proposed as causative cofactors for LyP because of their oncogenic potential and their association with other lymphomas. METHODS: LyP skin lesions and a LyP-derived cell line were examined for the presence of the recently discovered oncogenic human herpesvirus 8 (HHV-8) and the two T-lymphotropic human herpesviruses 6 and 7 (HHV-6 and HHV-7) by nested polymerase chain reaction (PCR) using virus-specific oligonucleotide primers. Furthermore, a recently described method involving degenerate PCR primers was applied to detect highly conserved DNA sequences shared by a variety of herpesviruses, especially oncogenic gamma-herpesviruses, in an attempt to identify a yet undiscovered herpesvirus associated with LyP. RESULTS: HHV-6 and 8 could not be found in 26 archival and 11 snap-frozen LyP lesions and a LyP tumor cell line. HHV-7 DNA sequences were detected in 14% (5 of 37) of LyP samples. HHV-6 was found in 23% (3 of 13) and HHV-7 in 8% (1 of 13) of normal skin samples from healthy individuals, respectively. Using degenerate PCR primers to amplify the highly conserved polymerase region of herpesviruses, no DNA sequences related to human herpesviruses could be detected. CONCLUSIONS: LyP is not associated with HHV-6, HHV-7 and HHV-8. In addition, the studies using degenerate PCR primers do not indicate the presence of a previously undescribed human herpesvirus in LyP.
======================================================
53.) Presence of human herpesvirus 6 variants A and B in saliva and peripheral blood mononuclear cells of healthy adults.
======================================================
J Clin Microbiol 1996 Dec;34(12):3223-5
Aberle SW, Mandl CW, Kunz C, Popow-Kraupp T.
Institute of Virology, University of Vienna, Austria.
Saliva and peripheral blood mononuclear cells (PBMCs) from 44 healthy young adults were tested for human herpesvirus 6 variants A and B (HHV-6A and -6B) DNA by a sensitive nested PCR. HHV-6B infection was ascertained in 98% of the subjects, and 95% were found to excrete variant B in their saliva. HHV-6A was found in the PBMCs of 16%, but was not detected in saliva samples.
======================================================
54.) Detection of human herpesvirus 6 DNAs in samples from several body sites of patients with exanthem subitum and their mothers by polymerase chain reaction assay.
======================================================
J Med Virol 1995 May;46(1):52-5 Related Articles, Links
Suga S, Yazaki T, Kajita Y, Ozaki T, Asano Y.
Department of Pediatrics, Fujita Health University School of Medicine, Aichi, Japan.
Polymerase chain reaction amplification was used to detect human herpesvirus 6 (HHV-6) DNAs in peripheral blood mononuclear cells (MNCs), plasma, saliva, stool, and urine from three patients with exanthem subitum and in peripheral blood MNCs, plasma, and saliva from their mothers. HHV-6 DNAs were detected in MNCs during and after the disease and were found in plasma only in the acute phase. The virus DNAs were also detected in saliva after recovery from the illness and were found persistently or intermittently in stool but not in urine samples after the onset of the disease. In contrast, one of the three mothers excreted HHV-6 DNAs persistently in saliva. None of the mothers had the virus DNAs in peripheral blood MNCs and plasma nor a significant increase in antibody titers to HHV-6 after possible exposure from their children. These findings suggest systemic replication of HHV-6 during the acute phase in patients with exanthem subitum and persistent infection of the virus in several organs after recovery from the disease.
======================================================
55.) Human herpesvirus-6 and human herpesvirus-7 infections in bone marrow transplant recipients.
======================================================
J Med Virol 1997 Nov;53(3):295-305
Chan PK, Peiris JS, Yuen KY, Liang RH, Lau YL, Chen FE, Lo SK, Cheung CY, Chan TK, Ng MH.
Department of Microbiology, University of Hong Kong, Queen Mary Hospital, Hong Kong.
Human cytomegalovirus (HCMV), human herpesvirus-6 (HHV-6), and human herpesvirus-7 (HHV-7) DNA in peripheral blood leukocytes (PBL) of 61 bone marrow transplant recipients was monitored weekly during the first 12 weeks post-transplantation by a nested polymerase chain reaction (PCR). Thirty-seven (61%), 17 (28%), and 32 (53%) of patients had one or more PBL specimens positive for HCMV, HHV-6 or HHV-7 DNA, respectively. HHV-7 DNA in PBL during the early post-transplant period was associated with a longer time to neutrophil engraftment (mean 28.8 days vs 19.8 days; P = 0.01). In two patients who failed to engraft, HHV-6 DNA and HHV-7 DNA was detected in plasma and PBL, respectively, early in their post-transplant period. Patients with HCMV disease were more likely to have concurrent HHV-7 DNA in PBL prior to onset of disease than were patients with asymptomatic HCMV infection, suggesting that HHV-7 may be a cofactor in the progression from HCMV infection to HCMV disease. In the 17 patients (179 specimens) in whom viral DNA in plasma was studied (in addition to PBL), a positive result was found only in 3. In each, viral DNA in plasma appeared to correlate with clinically significant disease. HHV-7 DNA in plasma was associated with encephalitis in an allograft recipient.
======================================================
56.) High prevalence of HHV-6 DNA in peripheral blood mononuclear cells of healthy individuals detected by nested-PCR.
======================================================
J Med Virol 1994 Jun;43(2):115-8
Cuende JI, Ruiz J, Civeira MP, Prieto J.
Department of Internal Medicine, University Clinic, University of Navarra, Pamplona, Spain.
The aim of the study was the evaluation of human herpesvirus-6 (HHV-6) infection rate and semiquantification of viremia in healthy people. Healthy blood donors were studied. Human herpesvirus-6 IgG and IgM antibody titers were measured by indirect immunofluorescence assay. Human herpesvirus-6 DNA amplification (nested-PCR) was performed in peripheral blood mononuclear cells (PBMC) and in serum. Seventeen of 50 (34 percent) individuals were positive for IgG anti-HHV-6 and the titers ranged from 1:40 to 1:160. None of 30 individuals was positive for IgM anti-HHV-6, suggesting no recent infection nor reactivation. Human herpesvirus-6 DNA was detected by nested-PCR amplification in peripheral blood mononuclear cells but not in sera. When 1 microgram DNA was amplified, HHV-6 DNA was detected in 8 of 20 individual (40%), but in 18 of 20 (90%) when 5 micrograms DNA were amplified. It is concluded that HHV-6 is present in a high proportion of the healthy population but in minimal amounts, and although it can be detected in 1.4 x 10(5) PBMC, 7 x 10(5) cells are necessary to detect most cases. No reactivation was observed in healthy people.
======================================================
57.) Clinical features and viral excretion in an infant with primary human herpesvirus 7 infection.
======================================================
Pediatrics 1995 Feb;95(2):187-90
Asano Y, Suga S, Yoshikawa T, Yazaki T, Uchikawa T.
Department of Pediatrics, Fujita Health University School of Medicine, Aichi, Japan.
OBJECTIVE. To find clinical features of a virologically-confirmed patient with primary human herpesvirus 7 (HHV-7) infection and a relationship of the excretion of viruses between HHV-7 and human herpes-virus 6 (HHV-6). PATIENT AND METHODS. A 13-month-old boy who had a known prior history of exanthem subitum at 6 months of age developed fever for 3 days and a skin rash appeared as the fever was resolving. The course was accompanying with nonspecific signs and symptoms such as anorexia, irritability, mild diarrhea, palpebral edema, mild inflammation of pharynx, and mild occipital and cervical lymphadenopathy. Heparinized blood samples were used for isolation of HHV-6 and HHV-7 and detection of both virus DNA sequences by a nested polymerase chain reaction (PCR) amplification. Samples from other body sites were also tested for their DNA sequences using the PCR. Both virus antibody activity was measured by an indirect immunofluorescent assay or a neutralization test. RESULTS. Cultured mononuclear cells from the patient at the acute stage of the disease produced morphologic changes, which reacted only with the monoclonal antibody to HHV-7 but not with the antibody to HHV-6. Both viruses were not isolated from blood obtained at the convalescent stage. An antibody response of the patient indicated a seroconversion to HHV-7 but not to other microbial agents including HHV-6 and Mycoplasma pneumoniae. Both virus DNA sequences were detected in peripheral blood mononuclear cells at acute and convalescent stages. HHV-7 DNA was excreted into saliva and transiently into stool at an early convalescent stage followed by HHV-6 excretion into saliva. No HHV-7 and HHV-6 was excreted into urine. CONCLUSIONS. Clinical features of a virologically confirmed patient with primary HHV-7 infection were comparable with those of primary HHV-6 infection and HHV-7 infection may reactivate HHV-6.
=====================================================================
58.) Gestational Pityriasis Rosea: Suggestions for Approaching Affected Pregnant Women.
=====================================================================
Acta Dermatovenerol Croat. 2016 Dec;24(4):312-313.
Author information
1Efstathia Pasmatzi, MD, Department of Dermatology, School of Medicine, University of Patras, 26504 Rio-Patras, Greece; pasmatzi@med.upatras.gr.
Abstract
Dear Editor, Pityriasis rosea is a common, acute, and self-limiting dermatosis, which is associated with the endogenous systemic reactivation of human herpesvirus (HHV)-6 and/or HHV-7 (1). It predominantly affects individuals of both sexes in their second or third decade of life and is clinically characterized by the occurrence of an initial erythematosquamous plaque followed by the appearance of disseminated similar but smaller lesions one or two weeks later. Several patients develop systemic symptoms such as nausea, anorexia, malaise, headache, fever, arthralgia, and lymphadenopathy that may precede or accompany the eruption; the latter follows the cleavage lines of the trunk creating the configuration of a Christmas tree and spontaneously resolves within 4 to 8 weeks. Mainly based on the nature of the underlying viral reactivation, pityriasis rosea is classified into five different forms (2): 1) Classic and 2) Relapsing (characterized by sporadic and relapsing HHV-6/7 systemic reactivation, respectively), 3) Persistent (persistence of HHV-6/7 viremia), 4) Pediatric (longer activity of HHV-6/7 infection; recent primary infection) and 5) Gestational (HHV-6/7 reactivation and possible intrauterine transmission). Clearly, the inevitable impairment of immune response in pregnancy favors viral reactivation and possibly also the intrauterine transmission of HHV-6/7. Indeed, it is well known and documented that pityriasis rosea more frequently occurs in pregnant women (18%) as compared to the general population (6%) (3). However, the literature concerning the possible effect of pityriasis rosea on the outcome of pregnancy is surprisingly sparse. Only an Italian group, Drago et al (4,5), has systematically investigated the impact of this disorder on pregnant women. They found that 22 out of 61 women (36%) who developed pityriasis rosea during pregnancy had unfavorable outcomes, whereas 8 others miscarried (13%). None of the latter had any risk factors, other than pityriasis rosea, for intrauterine fetal death. All miscarrying women reportedly revealed an aggressive course of widespread eruption and severe constitutional symptoms; all of them had HHV-6 DNA in the plasma, placenta, skin lesions, and fetal tissues, whereas HHV-7 DNA was detected in the plasma and skin lesions in 3 out of 8 (37.5%) miscarrying women. HHV-6 DNA was found only in the plasma of 2 out of 31 women (6.45%) with normal pregnancy, whereas HHV-7 DNA was detected in the plasma of 3 (9.45%) and in the skin lesions of 2 women (6.45%) with normal pregnancy. The total abortion rate in women who developed pityriasis rosea during their pregnancy (13%) does not differ from that observed in the general population. Nevertheless, it is markedly higher in cases affected during the first 15 gestational weeks (57%) (4,5). Surprisingly, this devastating impact of pityriasis rosea on the outcome of pregnancy is almost completely unknown not only to the public but also to many members of the medical community. It is also largely unknown that, particularly during the first 15 gestational weeks, all pregnant women should avoid any contact with patients known to have pityriasis rosea. Since we have received a considerable number of requests for consultation with pregnant women with pityriasis rosea over the last few years, our group has compiled suggestions approaching the affected patients: 1. If an eruption suggestive for pityriasis rosea occurs in a pregnant woman, the following factors should be excluded: a. Exposure to drugs prior to the development of the rash (biologic agents, captopril, clonidine, hydrochlorothiazide, atenolol, lamotrigine, nortriptyline, barbiturates, metronidazole, terbinafine, omeprazole, non-steroidal anti-inflammatory drugs, and isotretinoin), which are capable of inducing a pityriasis rosea-like eruption (6) and b. Disorders included in the differential diagnosis (syphilis and infections due to parvovirus, herpes virus, cytomegalovirus, and Epstein-Barr virus). 2. The clinical diagnosis of pityriasis rosea should be made according to the morphological criteria (peripheral collarette scaling with central clearance on at least two lesions) put forth by Chuh (7). 3. Since specific anti-HHV-6 and -7 IgM antibodies are detected only in a low percentage of infected pregnant women (8), HHV-6 and -7 DNA should be assessed in plasma by nested PCR. Especially during the first 15 gestational weeks, pregnant women with positive PCR results deserve, apart from close monitoring, appropriate information about the existing risks in order to be able to make informed decisions. 4. Reliable and definite data from adequate and controlled human studies on the safety of acyclovir or valacyclovir in pregnant women and their efficacy in pityriasis rosea are lacking. Thus, the decision on whether these antiviral compounds will be administered should be tailored to each individual pregnant woman, subsequent to a meticulous assessment of the potential risks and their balancing against the potential benefits.
=====================================================================
Producido Por Dr. Jose Lapenta R. Dermatologo
Maracay Estado Aragua Venezuela 2.017-2.023
Telf: 04142976087- 04127766810
04166401045
Follow @dermagicexpress
No hay comentarios:
Publicar un comentario
Tu comentario será objeto de revisión y luego aprobado.
Your comment will be revised and then approved.