PITYRIASIS ROSEA CLINICAL FEATUI1ES.

Pityriasis rosea is a mild inflammatory exanthem of unknown origin, characterized by salmon-colored papular and macular lesions that are at first discrete but may become confluent. The individual patches are oval or circinate and covered with finely crinkled, dry epidermis, which often desquarnates, leaving collarette scaling. The disease usually begins with a single herald or mother patch, usually larger than succeeding lesions, which may persist a week or more before others appear. By that time involution of the herald patch has begun. The efflorescence of new lesions spreads rapidly, and after three to eight weeks they usually disappear spontaneously. The incidence is highest between the ages of 15 and 40 years, and the disease is most prevalent in the spring and autumn. Women are more frequently affected. The fully developed eruption has a striking appearance because of the distribution and definite characteristics of the individual lesions. .These are arranged so that the long axis of the macules runs parallel to the lines of cleavage. The eruption is usually generalized, affecting chiefly the trunk, and sparing sun-exposed surfaces. At times it is localized to a certain area, such as the neck, thighs, groins, or axillae. In these regions confluent circinate patches with gyrate borders may be formed; these may strongly resemble tinea corporis (tinea circinata). Rarely, the eyelids, the scalp, or the penis may be involved. Sometimes involvement of the scalp is encountered. Occurrence on the oral mucous membranes has been noted. Moderate pruritus may be present, particularly during the outbreak, and there may be mild constitutional symptoms prior to the onset. Variations in the mode of onset, course, and clinical manifestations are extremely common. An unusual form, common in children under five, is that of papular pityriasis rosea, occurring in the typical sites and running a course similar to that of the common form of pityriasis rosea. Black children are particularly predisposed to this papular variant. An inverse distribution, sparing covered areas, is unusual but not rare. It is common in papular cases. Relapses and recurrences are observed infrequently. Oral lesions are relatively uncommon. They are asymptomatic erythernatous macules with raised borders and clearing centers. An aphthous ulcerlike appearance has recently been reported by Kay et al. They involute simultaneously with the skin lesions. ETIOLOGY. The etiology of pityriasis rosea remains unknown. A virus infection is most frequently suggested but remains unproven. It does not occur in epidemic forms. The formation of a herald patch, the self-limited course, the seasonal preponderance, and rare recurrence are all suggestive of a virus infection. On the other hand, cases only rarely occur either together or consecutively in the same house-hold.

A pityriasis rosealike eruption may occur as a reaction to captopril, arsenicals, gold, bismuth, clonidine, methoxypromazine, tripelennamine hydrochloride, or barbiturates.