Pityriasis rosea Gibert

MUDr. et MUDr. Pavel Konrád
Dermatology Clinic, Černošice / Lasermed

The article describes a common exanthematic disease typical of adolescent age, pityriasis rosea Gibert.  The name of the disease is clarified, its etiopathogenesis and the current approach to therapy are described.

Key words – pityriasis versicolor, HHV-6, HHV-7

Genesis of the name of the disease

The disease was first described and named in 1860 by the famous French dermatologist Prof. Camille-Melchior Gibert.

The name of the disease pityriasis rosea aptly describes its clinical picture. Pityron means bran in Greek, a reference to the scales of peeling skin. The Latin word roseus means pink (note: l.rosa – rose). A loose translation into Czech is therefore pink scales.  Traditionally, the third word in the name of the disease is “Gibert” in honour of its discoverer.

History

Prof. Camille-Melchior Gibert (*September 18, 1797 in Paris – †July 30, 1866 in Paris) was a French dermatologist, born in Paris.He studied medicine in Paris, where he worked as an intern for Laurent-Théodore Biett at the Hôpital Saint-Louis in 1818-19. In 1822 he obtained his doctorate in medicine and in 1826 he was certified in dermatology. From 1836 he was a physician at the Hôpital Lourcine and from 1840 to 1863 he was attached to the Hôpital Saint-Louis. In 1847 he became a member of the Académie de médecine. He died during the Paris cholera epidemic of 1866.

Gibert(Fig.1) became famous for the first accurate description of a papulosquamous skin disease, which he named pityriasis rosea. Historically, this disease was also referred to as “Gibert’s disease”. His best written work on skin diseases was the book ‘Traité pratique des maladies spéciales de la peau’, published in 1840.

Definition

It is a common acute inflammatory dermatosis with a sowing of symmetrically, morphologically very typically arranged erythemato-squamous efflorescences, which occur mainly on the trunk.

Etiology and pathogenesis

It probably arises as an “id” type reaction to some viral infections (probably HHV-7) . The disease has a peak incidence in spring and autumn. It is most common in people between 15-40 years of age.

HHV-6 and HHV-7 belong to the family Herpesviridae. Primoinfection with HHV-6 usually takes place in childhood, and often occurs without symptoms or causes one of the most well-known manifestations of these viruses – a non-serious febrile state in infants and young children with exanthema subitum (the so-called sixth childhood disease). HHV-7 also causes very similar symptoms in adolescents. It is possible to believe that pityriasis rosea Gibert is a similar or identical type of disease, but at an older age. The higher incidence of both diseases in collectives suggests an infectious etiology, supporting the theory of a viral etiology.

After the disease, patients acquire lifelong immunity.

Clinical picture

The disease is preceded by a prodromal stage characterized by fatigue, subfebrile headache, muscle aches, and nasopharyngitis. Afterwards, the so-called primary macule (Fig.2) (also called the maternal lesion or heraldic macule) develops – an oval pityriasiform exfoliating lesion 2-5 cm in diameter, usually on the abdomen or trunk. Within 1-2 weeks, similar but smaller foci typically arranged along the lines of skin cleavage, especially on the trunk and proximally on the extremities (in embolization localization), develop. Seeding in the lines resembles “Christmas tree branches” when viewed on the patient’s back (Fig.3). In my dermatological practice I often see this typical picture and it helps to diagnose the disease confidently and quickly.

Also typical is the collar-like (so-called collerette) pityriasiform exfoliation of the lesions. The exanthema may be itchy, and I have encountered agonizing pruritus in some patients.

After healing, postinflammatory hypopigmentation or hyperpigmentation (lighter or darker patches of skin) may be seen, which disappear over the following weeks to months.

Diagnosis

It is determined by clinical findings and course.

Differential diagnosis

Includes secondary stage syphilis, drug exanthema, tinea and seborrhoeic dermatitis.

Therapy

Although the skin manifestations heal spontaneously, the healing time can be very long, even in the order of months. A persistent seeding of the entire body lasting up to half a year is not an exception, which also brings psychological alteration(Fig.4,5). Patients are often ashamed of their manifestations because the environment wrongly concludes the infectious nature of the seeding. Social isolation occurs. Also, the prolonged pruritus that occurs in some patients is bothersome and needs to be alleviated. It is advisable to soothe the manifestations and accelerate their healing with anti-inflammatory, preferably non-corticoid substances (e.g., Cutozinc Ichthamo spray) [6]. Efflorescences are prone to irritation after washing with common soaps and shampoos. [6] At the time of illness, only mild, non-irritating, sulphate-free syndettes (e.g. Cutosan^® washing gel) are recommended for hygiene, which can be used on the body and scalp. Patients are advised to wear 100% cotton, loose-fitting, breathable clothing.

Summary

Pityriasis rosea Gibert is a disease that predominantly affects young people. Despite spontaneous healing, due to the frequent prolonged duration of the disease, patients need to be treated. The aim is to alleviate the subjective discomfort, shorten the duration of the symptoms and thus prevent a negative impact on the psyche.

Literature :

1.Braun-Falco O, Plewig G, Wolf H. Dermatológia a venerológia. Osveta, s.r.o., Martin 2001,486-488 s.

2.https://www.wikiskripta.eu/w/Pityriasis_rosea

3.Baker H. Clinical dermatology, fourth edition, London: Bailliere Tindall 1989, 48-49 s.

4.Štork J, et al. Dermatovenerologie. Praha Galén, 2008,176-177 s.

5.Danda V. et al. Vybrané kapitoly z dermatovenerologie, Hradec Králové: VLVDÚ 1979, 121 s.

6.Fadrhoncová A. Farmakoterapie kožních nemocí, Praha: Grada 1999, 363-364 s.