Question

Pityriasis Rosea is a skin disease. I have a question about the plan of the care.

1. pharmacotherapy with complementary and OTC therapy, diagnostics (labs and testing), health education and lifestyle changes, age-appropriate preventive care, and follow-up to this visit.

• Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

Answer 1

PITYRIASIS ROSEA - also known as (Pityriasis rosea gibert)

It is a type of skin rash which begins as a large spot on the chest, abdomen and/or back, which is followed by pattern of smaller lesions.

More often, it begins with single red (herald patch) and slightly scaly area which is then followed by many rashes of similar type but smaller, oval or round lesions, mainly on chest, back, abdomen or upper limbs.

AETIOLOGY - The causes of this skin diseases is not well known but, it is thought that the condition may be triggered by reactivation of human herpes viruses (HHV-7, HHV-6)

CLINICAL FEATURES -

The condition begins with 'herald patch' in most of the cases. Lesion is characteristically oval, wrinkled with a collar of scales at the periphery or the edges.
This is followed by multiple, smaller, oval to round scally secondary eruptions. Their arrangement is characteristic as lesions run downwards and outwards from the spine along lines of cleavage.
This condition is self limiting, with the lesions resolving spontaneously within 2-10 weeks.

Other symptoms may also include - rashes, loss of colour, small bump, redness, itching, fatigue, nausea, headache, joint pain etc.

DIAGNOSIS -

The diagnosis is made mainly by looking at the patches but sometimes PR looks similar to other conditions of skin.

The diagnostic tests may include -

1) Complete blood profile

2) Erythrocye sedimentation rate

3) Globulin, Albumin, Serum protein level

4) KOH test

5) Biopsy

The trained doctors can diagnose the rashes easily but sometimes testing is necessary because some medications and some other skin infections or conditions cause rashes that look like Pityriasis rosea.

*Changes in the white blood cell count and differentials, as well as increases in the erythrocyte sedimentation rate (ESR), total serum protein level, globulin level, and albumin level, should be reported but are rare and usually minimal.

# Biopsy and KOH test are used commonly -

• Biopsy - A skin biopsy is necessary to confirm the diagnosis. During this procedure, the doctor takes a small sample of affected skin and sends it to a laboratory for further investigation.

• KOH and VDRL- When only the herald patch is present, a potassium hydrochloride (KOH) be especially useful for helping in differentiate other conditions like tinea corporis because many other skin condition rashes look alike. For differentiate from syphilis rashes, VDRL may be performed.

but diagnosis is mainly formed by tissue biopsy.

TREATMENT -

The PR is a self limiting disease, it goes away on its own but Patients with more severe disease or those who choose active treatment should weigh the potential benefits of faster resolution against the adverse effects associated with these therapies.

The treatment may include -

Supportive care, self care and medications.

The condition can improves or heals over time own it own, self care includes moisturiser that hydrates and protects skin from damage and patient should clean their surroundings and their body regularly and properly.

• Medications may include -

1) Oral antihistamine

2) Oral or topical corticosteroids

3) Anti virals

4) Phototherapy

# Oral histamines help in reducing or stoping the allergic reactions.

# Steroids stimulate hormone effects and help in reducing inflammation and tissue growth and repair.

# Antiviral medications have been used for the treatment of pityriasis rosea because of its link with HHV-6 and -7. Cidofovir (Vistide) and foscarnet may be effective against these viruses, but they have more adverse effects than acyclovir.

# Phototherapy - Studies found improvements in severity and symptoms in patients with pityriasis rosea when treated with ultraviolet B phototherapy multiple times per week for up to four weeks.

PR TREATMENT IN PREGNANCY - Pregnant women are more susceptible to pityriasis rosea because of their altered immune response. Treatment with acyclovir can be considered.