ATYPICAL PITYRIASIS ROSEA IN A 2YEAROLD (original) (raw)
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Atypical cases of pityriasis rosea (PR) are fairly common and less readily recognized than typical eruptions. We present four patients for whom we believe atypical PR is the most likely diagnosis. A 33-year-old man had purpuric lesions bilaterally on the legs with classical rash on the trunk. A 28-year-old woman had intensely pruritic and urticarial lesions. A 10-year-old girl had hundreds of small papular lesions 1-3 mm in size. A pregnant woman aged 26 had oral haemorrhagic ulcers with classical PR eruption on her trunk. The oral ulcers erupted and remitted at the same time as the generalized eruption. We reviewed the literature and proposed a classification based on rash morphology, rash size, rash distribution, number of lesions, site of lesions, severity of symptoms and course of the eruption. We believe that it is difficult to make a clear division to define typical and atypical PR, and that it is important not to ascribe any unusual or atypical skin eruption with PR unless other dermatoses have been excluded.
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Journal of the Royal College of Physicians of Edinburgh
Background Diagnostic criteria are frequently used in dermatology. There are many skin diseases with well-established diagnostic criteria, particularly those with an autoimmune pathogenesis and with systemic involvement. Utilising diagnostic criteria might enhance the validity, inter-rater reliability, and intra-rater reliability of diagnoses. Investigators have pointed out the need for diagnostic criteria in autoimmune vesiculobullous diseases such as bullous pemphigoid, for which atypical variants could well be more common than classical bullous eruptions. The paraviral exanthems, a relatively new concept, 1 are a group of diseases with numerous atypical variants. We have previously proposed and validated, in different ethnic groups, sets of diagnostic criteria for pityriasis rosea (PR) 2,3 (Figures 1a and 1b) and Gianotti-Crosti Syndrome (GCS) 4,5 (Figures 2a and 2b), which are the two most common paraviral exanthems (see Tables 1 and 2, respectively). The pros and cons of the diagnostic criteria have been assessed in detail 6 and are summarised in Table 3. In brief, most clinical studies, including clinical trials on these exanthems, adopted different inclusion criteria, and the results cannot be readily meta-analysed. This is The diagnostic criteria of pityriasis rosea and Gianotti-Crosti syndrome-a protocol to establish diagnostic criteria of skin diseases
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