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Dermatopathology, Health

I was diagnosed with pityriasis rosea

At the end of February, 2009, for approximately 3 weeks, I presented with itchy red scaly plaques on my abdomen and it was diagnosed as pityriasis rosea.  This was characterised by red oval-shaped spots and the presence of a larger very distinctive “herald lesion” that appeared about a week previous to the smaller spots.  This is an unmistakable sequence of eruptions that leave no doubt during diagnosis.

Pityriasis rosea (“rose-coloured scale”) is an acute inflammatory dermatosis with a distinctive and constant course of self-limiting oval lesions.  It presents with a primary plaque, known as the “Herald Lesion”, up to two weeks prior to the outbreak of a the secondary rash of numerous widespread plaques, which are much smaller in size.  This rash, predominantly of the trunk, usually remains for about 6 weeks.  The condition is non-contagious or is of extremely limited virulence.

This photo shows the “Herald Lesion” I presented with on my chest about one week before the eruption of the secondary rash.

The “herald” patch usually increases in size over the first 48 hours, reaching up to as large as 10cm, in some people. In my case, the herald lesion increased in size, but only up to approximately 3cm in diameter.

In the early stages of the condition, the appearance of the lesions show great similarities to ringworm, (particularly the herald lesion) as well as psoriasis and discoid eczema.  I initially held the opinion that my herald lesion looked like ringworm due to its circular reddened scaly appearance.

Pityriasis rosea has a seasonal eruption, most commonly occurring in the months of December to February and mostly in females, particularly between the ages of 10 and 35 years.

Prior to my herald lesion, I presented with a sore throat, which is also characteristic of this condition.  Other symptoms that I presented with were fever, nausea and severe fatigue, having found myself falling asleep if I was left sitting down for more than 10-15 minutes, and just the general feeling of drowsiness whilst up and about.

After the appearance of the herald lesion there is a secondary incubation period of 7-14 days before the eruption of multiple similar, but smaller, elliptical scaly lesions.  It has been discovered that these smaller lesions take their positioning on the body with their longest axis occurring along the Blaschko skin tension lines, producing the classic “fir” or “Christmas tree” appearance.  The centres of the lesions are generally more erythematous than the periphery, which are scaly.

A close up look at the scaly erythematous plaques that I presented with about a week after my herald lesion.

The secondary rash spreads from the chest to the abdomen, with each little lesion appearing seemingly simultaneously with each other.  In some cases they have also been known to spread across the thighs, arms and back.  They usually persist for 2-4 weeks and, again seemingly simultaneously, fade over a further period of 2 weeks.

The distribution of my secondary rash was predominantly spread across my abdomen, with only a few presenting on my shoulders.

I was relieved to read that it is unusual for the red plaques to form on the face or to leave scars.  Only in very rare cases are there localised, unilateral and “inverse” forms that affect the face and extremities in a severe way.  Pityriasis rosea is itchy, and luckily I only suffered from mild itchiness, but some cases have been reported to be unbearably itchy.

Initially I was routinely cleansing my skin with regular shower gel, but I soon discovered that it can aggravate pityriasis rosea even more.  I was advised that only soaps containing moisturisers (such as goat’s milk) should be used, however, any deep moisturiser can help manage the extreme dryness.  A plus point with this condition is that the itchiness tends to reside sooner than the rash.

The exact etiology of this skin disorder is unknown, but it is believed to be connected to some kind of infection, most likely viral.  It is speculated that the herald lesion is the probable site of an insect bite.  Other cases have been reported where lesions have erupted along areas of past trauma and scars, suggesting an isomorphic (Koebner’s) response.  There have also been reports of atypical pityriasis rosea in bone marrow transplant recipients and patients post interferon-alpha (IFN-α) treatment.

Histologically, pityriasis rosea shows as a non-specific subacute or chronic dermatitis, comprising of focal hyperkeratosis and angulated parakeratosis with slight acanthosis.

The only treatments available are those which relieve the irritation of the itchiness.  Soap must be avoided, the lesions must be kept moisturised and, in cases of severe symptomatic itching, topical or oral steroids may be prescribed.  Doctor-operated UV therapy, or simple exposure to sunlight can also help in some cases.  Prevention of further aggravation can include avoiding physical activity, hot baths and generally anything that can cause the body to over heat.  In most patients, the condition only lasts a few weeks.  I myself only had it for just over three.

References

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About Della Thomas

Hello, my name is Della and I'm a Specialist Scientific Lead in histological dissection working for the NHS in England.

Discussion

19 thoughts on “I was diagnosed with pityriasis rosea

  1. Thanks for the description! I had this a few years ago – it persisted for 3 months – I had the UV therapy which I’m not sure made a huge impact – and had some relief with a cream called SBS 30 which diminished the inflamed appearance at least at a cosmetic level.

    Undoubtedly a major factor for me was a great deal of family and work stress I was under at before the time of first onset – as soon as this was sorted this condition seemed to go not long afterwards and never came back. I realise it could have been a coincidence though the dermatologist seemed to think stress was relevant. Just wanted to share this in case it helps anyone else!

    ASeven

    Posted by ASeven | February 21, 2012, 2:48 am
    • Thank you so much for sharing, especially because of so much uncertainty around causal factors of this skin condition. I really have no idea what caused mine; I don’t remember feeling any more stressed than what I’d conceive as normal, but I guess I only know how my head was dealing with it, and not my body. It could very well have been due to some changes that were going on in my life at the time. I hope your itchyness didn’t last for the whole 3 months; that was driving me crazy and I was very relieved it didn’t persist for too long.

      Again, thanks so much for your comment, I hope it does help someone seeking more information about this condition.

      Posted by Della | February 21, 2012, 7:32 am
  2. Thanks for the post! Im suffering with it at present 😦 its been dragging on for at least a month and still no signs of it going away!! x

    Posted by Laura Davis | November 5, 2013, 3:23 pm
  3. Thank you for posting. I’ve been searching for clues for almost a 2 weeks now because I think I am having this kind of disorder now. At first I thought I thought was just a ringworm, but days ago smaller plaques started to grow and growing more! I am using a cream, Penavryl which recommended by a friend doctor. But it continues on appearing. Now I know why. You’ve been a big help, thanks!

    Posted by Vanessa | November 16, 2013, 11:08 am
  4. I am suffering from this now! I thought it was ringworm at first, but then started to get all the other spots on my abdomen, chest, back, butt, and neck. My doc diagnosed me with this. Mine has been so itchy, mostly on my neck and going up into my scalp. But hopefully I’m nearing the end here soon. The spots are so scab like I cant believe that they wont leave a scar, I guess I’ll just have to see. Thanks for all the info though, it was very helpful!

    Posted by Meg | January 9, 2014, 12:26 am
    • Thanks, Meg. I’m really pleased you found it useful. I haven’t a single scar, so all being well yours will clear up without a trace, too. Will keep my fingers crossed for you 🙂

      Posted by Della | January 9, 2014, 6:53 pm
      • I am dealing with this now, too! Just got over a terrible bout of bronchitis and now this 2 weeks later! Has anyone had this happen after antibiotics?

        Posted by chris | January 22, 2014, 3:42 am
      • Thanks for your comment, Chris. I’d be interested to hear if anyone else has experienced this, too.

        Posted by Della | January 23, 2014, 6:51 am
  5. I am having unbelievable results simply by showering with Nutriful creamy coconut milk nourishing shampoo! It is for very dry hair and scalp, but it has lessened the itch and my spots are very faint after just one week!!

    Posted by chris | January 25, 2014, 3:02 am
    • That’s fantastic. Well, if it works, you can’t knock it. The very name of it sounds so soothing, so no wonder it works. Thanks for sharing your tip, let’s hope it can help others too 🙂

      Posted by Della | January 26, 2014, 8:58 am
    • Chris! I also had bronchitis and was given antibiotics then diagnosed with pityriasis rosea all within the past month. There must be a link here…this is too much of a coincidence.

      Posted by Kayla | December 6, 2014, 3:18 am
  6. I am suffering from this and covered from the neck down. Had it about 2 weeks now and no sigbs of goin. Its soooonitchy its unbearable. Have felt unwell few weeks before and was initially told was allergic reaction to tablets hooe it goes soon as its painfull!

    Posted by cheryl | April 25, 2014, 9:04 pm
  7. I am suffering from this as well. I’ve had it for about 3 weeks now and it keeps spreading. I’m avoiding hot showers, exercise and all that. My itching is unbearable. I haven’t left the house other than when I absolutely have to. Worse than the itching incredible fatigue I’ve had. I’ve never felt so tired in my life. I’ve called into work 4 times in the last 2 weeks. If I stand up for more than 2-3 hours I feel like I’m going to pass out. I’m hoping it goes away sooner than later. Did anyone else have problems with severe tiredness that effected their life?

    Posted by Lindsay | July 6, 2015, 2:35 am
  8. I’ve had this for approx 2 months now and its terrible.

    I dont have much itching but i am always tired and lack of motivation. Normally I sleep for a few hours in the afternoon and also my sleep at night because I am so tired.

    I wake up and have breakfast, 30 mins later I feel tired again. My bones also ache.

    I dont know how I would explain this to any girls I date. Lol. So at least I wont be passing 1st base with this hideous rash on my chest.

    Hurry up and go away you hideous rash!! =)

    Posted by Dan | September 30, 2015, 12:09 am
    • Looks like the same thing here, at least that’s what my doctor feels.

      Based on the symptoms her diagnosis is bang on. In my case I wouldn’t say that the itching is unbearable but everyone reacts to things differently. It’s more annoying than anything.

      Nevertheless, I have been fairly fatigued..sore bones. Warm showers seems to be the answer as hot steamy showers that I’m use to seem to keep it at bay and dodging most soaps and using moisturizer aids.

      Posted by Mark | January 28, 2016, 4:06 pm
      • I am going on 6 weeks with PR. I had surgery in October and a week later spots developed in my back. Initially I was told I was allergic to a medication but 2 weeks after my dermatologist said it was PR. My back is covered and has spread to my chest arms legs etc. I have googled this so much and I do not know what else to try to make this go away faster. I am extremely tired and loss of appetite. Ugh!!!

        Posted by Dee | November 27, 2016, 5:34 pm
  9. Ive only ever had one actual full on scaly christmas tree outbreak. Now i get red spots and ringworm looking crap just below the skin its really weird. I’m not sure what brings it on but it can be scary.

    Posted by Tessa | January 15, 2017, 4:52 pm

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Della Thomas

Della Thomas

Hello, my name is Della and I'm a Specialist Scientific Lead in histological dissection working for the NHS in England.

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