anyone's LO have pityriasis rosea?

groovygrl · January 2011

DD has had this pink oval patch on her one thigh about a week or so. I kept waiting for it to fade, tried moisturizing, hydrocortisone, aquaphor (thinking maybe eczema or something) but nothing changed it. At bathtime tonight, she has like 4-5 more of them on her back & legs and a sort of scattered rough area on on her lower abdomen. I"ve been reading into different pediatric rashes in the last few days but now w/ the spread I will be calling pedi on Monday but I don't think it is urgent- she is not uncomfortable, not itching any of them, no other symptoms.

She is currently on day 6 of amoxicillin but this is not really an allergic reaction type rash, esp at the weird rate of development of the rash & she has had amox several times in the past.

So the only thing I can even begin to hypothesize is pityriasis rosea...wondering if anyone has experience? Doesn't seem to be that big a deal if that is what it is.

chatty6176 · January 2011

My DS didn't have it, but I did about 6 or 7 years ago. Mine started on my upper chest area and spread. Like you said not that big of a deal....just hydro cortisone. My dr. said it could take up to 6-8 weeks to go away. It took almost that long to go away for me.

caruso_60 · January 2011

My LO has never had it, but I have. It was a few years ago and it was very frustrating because I went to urgent care and they suggested I had scabies and gave me a prescription for cream that I cover my entire body in. I was pretty sure that was not it, so I got in to see my dermatologist and she took a biopsy to be sure, but it was in fact pityriasis rosea. I don't remember if she gave me any medicine for it. I think it just had to run its course. It was very itchy, so I did use anti-itch cream. If I remember correctly I don't think it is very uncommon, but I thought it occured more often in people in their teens and 20's.

groovygrl · January 2011

Yeah- that is the thing, it is really rare in toddlers/really young kids so that's sort of my biggest hesitation about thinking that is what it is...

My other thought is ringworm but the areas don't really have the typical ringworm appearance with the 'ring' at the outer edge. I might just try some OTC antifungal tomorrow though, it won't hurt.

g8orell · January 2011

I'm a pediatric dermatology PA - it sounds like PR to me. Usually it starts with a "herald patch" as you mentioned, then an outbreak.They are pink-brown oval shaped, sometimes raised/scaly patches. Usually they are in the distribution of the trunk, most commonly on the back in a christmas-tree like pattern, but not always. We treat with 5 days of azithromycin (zithromax), calamine lotion, sometimes a topical steroid like hydrocortisone, and sunlight helps. it's nothing bad at all and can take up to 8-12 weeks to disappear. It's still somewhat unknown what causes it, but most think it's a virus or a reaction to a virus.

g8orell · January 2011

groovygrl:

Yeah- that is the thing, it is really rare in toddlers/really young kids so that's sort of my biggest hesitation about thinking that is what it is...

My other thought is ringworm but the areas don't really have the typical ringworm appearance with the 'ring' at the outer edge. I might just try some OTC antifungal tomorrow though, it won't hurt.

That's not true at all...I see it pretty frequently during the peak times of PR, usually in the fall...they think it may have to do with school starting and spreading viruses. And with ringworm, you usually don't have 4-5 patches, it's usually 1-2. And ringworm usually looks like red round patches with raised borders and clear in the center.

TSD · January 2011

*I* HAD it when I was a teenager! It went away on it's own. It itched like crazy and it was all over my back and chest. The doc at the time (this was in the 80's) said there was nothing I could do but spray on an anti-itch mist.

groovygrl · January 2011

g8orell:
I'm a pediatric dermatology PA - it sounds like PR to me. Usually it starts with a "herald patch" as you mentioned, then an outbreak.They are pink-brown oval shaped, sometimes raised/scaly patches. Usually they are in the distribution of the trunk, most commonly on the back in a christmas-tree like pattern, but not always. We treat with 5 days of azithromycin (zithromax), calamine lotion, sometimes a topical steroid like hydrocortisone, and sunlight helps. it's nothing bad at all and can take up to 8-12 weeks to disappear. It's still somewhat unknown what causes it, but most think it's a virus or a reaction to a virus.

Thanks! It really does seem exactly like it esp w/ the herald patch (I'm actually a nurse so I guess I feel like I know a little but don't want to overkill on self diagnosing & jumping to conclusions...) , I just didn't think it was very common in younger kids. No xmas tree pattern as of yet (there are 2 patches on the back of one knee, 1 on the back of the other, and 1 or 2 randomly on the back) and there is also this diffuse pink rash on half of her lower abdomen- it is rough like really dry skin, is this typical?

just out of curiosity, why the azithromycin if the cause is unknown & thought to be possibly viral? Assuming the calamine/hydrocortisone are just for symptom treatment, not to help it heal up since it has to take its course, correct?

g8orell · January 2011

groovygrl:

g8orell:
I'm a pediatric dermatology PA - it sounds like PR to me. Usually it starts with a "herald patch" as you mentioned, then an outbreak.They are pink-brown oval shaped, sometimes raised/scaly patches. Usually they are in the distribution of the trunk, most commonly on the back in a christmas-tree like pattern, but not always. We treat with 5 days of azithromycin (zithromax), calamine lotion, sometimes a topical steroid like hydrocortisone, and sunlight helps. it's nothing bad at all and can take up to 8-12 weeks to disappear. It's still somewhat unknown what causes it, but most think it's a virus or a reaction to a virus.

Thanks! It really does seem exactly like it esp w/ the herald patch (I'm actually a nurse so I guess I feel like I know a little but don't want to overkill on self diagnosing & jumping to conclusions...) , I just didn't think it was very common in younger kids. No xmas tree pattern as of yet (there are 2 patches on the back of one knee, 1 on the back of the other, and 1 or 2 randomly on the back) and there is also this diffuse pink rash on half of her lower abdomen- it is rough like really dry skin, is this typical?

just out of curiosity, why the azithromycin if the cause is unknown & thought to be possibly viral? Assuming the calamine/hydrocortisone are just for symptom treatment, not to help it heal up since it has to take its course, correct?

Your're welcome! It's hard to say if the rash on her abdomen is related...could be just dry skin. Does she have eczema? Pink, scaly rashes behind the knees (and antecubital area) is classic for eczmea, whereas PR is usually on the trunk. I know you tried hydrocortisone and aquaphor which is great, but sometimes you need a stronger, Rx steroid. Was she sick at all before the rash? A lot of times, there is a prodrome of fever and/or URI symptoms before the rash (hence the thinking of viral etiology).

Erythromycin used to be first line therapy with PR because empirical treatment with it did shorten the duration of the rash. Some believe PR is a post-strep type rash. For example, when we have patients with psoriasis who have a flare, we give azithromycin and check ASO titers because we believe a flare can be caused by streptococcus (regardless of symptoms)...and it works! So PR is somewhat grouped with psoriasis (although it is 100% NOT psoriasis, so don't worry about that)...they are both "papulosquamous" on histiology of biopsies. Anyways, treatment switched to azithromycin b/c of increased efficacy, less side effects, and only 5 days of treatment (which obviously increases compliance).

groovygrl · January 2011

g8orell:
groovygrl:

g8orell:
I'm a pediatric dermatology PA - it sounds like PR to me. Usually it starts with a "herald patch" as you mentioned, then an outbreak.They are pink-brown oval shaped, sometimes raised/scaly patches. Usually they are in the distribution of the trunk, most commonly on the back in a christmas-tree like pattern, but not always. We treat with 5 days of azithromycin (zithromax), calamine lotion, sometimes a topical steroid like hydrocortisone, and sunlight helps. it's nothing bad at all and can take up to 8-12 weeks to disappear. It's still somewhat unknown what causes it, but most think it's a virus or a reaction to a virus.
Thanks! It really does seem exactly like it esp w/ the herald patch (I'm actually a nurse so I guess I feel like I know a little but don't want to overkill on self diagnosing & jumping to conclusions...) , I just didn't think it was very common in younger kids. No xmas tree pattern as of yet (there are 2 patches on the back of one knee, 1 on the back of the other, and 1 or 2 randomly on the back) and there is also this diffuse pink rash on half of her lower abdomen- it is rough like really dry skin, is this typical?
just out of curiosity, why the azithromycin if the cause is unknown & thought to be possibly viral? Assuming the calamine/hydrocortisone are just for symptom treatment, not to help it heal up since it has to take its course, correct?
Your're welcome! It's hard to say if the rash on her abdomen is related...could be just dry skin. Does she have eczema? Pink, scaly rashes behind the knees (and antecubital area) is classic for eczmea, whereas PR is usually on the trunk. I know you tried hydrocortisone and aquaphor which is great, but sometimes you need a stronger, Rx steroid. Was she sick at all before the rash? A lot of times, there is a prodrome of fever and/or URI symptoms before the rash (hence the thinking of viral etiology).
Erythromycin used to be first line therapy with PR because empirical treatment with it did shorten the duration of the rash. Some believe PR is a post-strep type rash. For example, when we have patients with psoriasis who have a flare, we give azithromycin and check ASO titers because we believe a flare can be caused by streptococcus (regardless of symptoms)...and it works! So PR is somewhat grouped with psoriasis (although it is 100% NOT psoriasis, so don't worry about that)...they are both "papulosquamous" on histiology of biopsies. Anyways, treatment switched to azithromycin b/c of increased efficacy, less side effects, and only 5 days of treatment (which obviously increases compliance).

Interesting & yes, getting over an ear infection in the last week or so & viral what have you before that at the holidays.

I was thinking the abdomen was dry skin but it has also gotten darker/more obvious today than it has been. The back of knee thing made me think of eczema but all of these patches are pretty clearly defined ovoid type shapes (but no clearly defined borders).

Guess I'll try to get her in to pedi on Mon if I can to get it taken care of & also b/c I know if daycare sees it they will want confirmation it is not contagious...or maybe just do urgent care tomorrow to get it out of the way.... argh.

Thanks so much for your help!

g8orell · January 2011

groovygrl:
g8orell:
groovygrl:

g8orell:
I'm a pediatric dermatology PA - it sounds like PR to me. Usually it starts with a "herald patch" as you mentioned, then an outbreak.They are pink-brown oval shaped, sometimes raised/scaly patches. Usually they are in the distribution of the trunk, most commonly on the back in a christmas-tree like pattern, but not always. We treat with 5 days of azithromycin (zithromax), calamine lotion, sometimes a topical steroid like hydrocortisone, and sunlight helps. it's nothing bad at all and can take up to 8-12 weeks to disappear. It's still somewhat unknown what causes it, but most think it's a virus or a reaction to a virus.

Thanks! It really does seem exactly like it esp w/ the herald patch (I'm actually a nurse so I guess I feel like I know a little but don't want to overkill on self diagnosing & jumping to conclusions...) , I just didn't think it was very common in younger kids. No xmas tree pattern as of yet (there are 2 patches on the back of one knee, 1 on the back of the other, and 1 or 2 randomly on the back) and there is also this diffuse pink rash on half of her lower abdomen- it is rough like really dry skin, is this typical?

just out of curiosity, why the azithromycin if the cause is unknown & thought to be possibly viral? Assuming the calamine/hydrocortisone are just for symptom treatment, not to help it heal up since it has to take its course, correct?

Your're welcome! It's hard to say if the rash on her abdomen is related...could be just dry skin. Does she have eczema? Pink, scaly rashes behind the knees (and antecubital area) is classic for eczmea, whereas PR is usually on the trunk. I know you tried hydrocortisone and aquaphor which is great, but sometimes you need a stronger, Rx steroid. Was she sick at all before the rash? A lot of times, there is a prodrome of fever and/or URI symptoms before the rash (hence the thinking of viral etiology).

Erythromycin used to be first line therapy with PR because empirical treatment with it did shorten the duration of the rash. Some believe PR is a post-strep type rash. For example, when we have patients with psoriasis who have a flare, we give azithromycin and check ASO titers because we believe a flare can be caused by streptococcus (regardless of symptoms)...and it works! So PR is somewhat grouped with psoriasis (although it is 100% NOT psoriasis, so don't worry about that)...they are both "papulosquamous" on histiology of biopsies. Anyways, treatment switched to azithromycin b/c of increased efficacy, less side effects, and only 5 days of treatment (which obviously increases compliance).

Interesting & yes, getting over an ear infection in the last week or so & viral what have you before that at the holidays.

I was thinking the abdomen was dry skin but it has also gotten darker/more obvious today than it has been. The back of knee thing made me think of eczema but all of these patches are pretty clearly defined ovoid type shapes (but no clearly defined borders).

Guess I'll try to get her in to pedi on Mon if I can to get it taken care of & also b/c I know if daycare sees it they will want confirmation it is not contagious...or maybe just do urgent care tomorrow to get it out of the way.... argh.

Thanks so much for your help!

There is a type of eczema called "nummular eczema". Nummular means coin shaped, so they tend to be more round than classic eczema. Does it look like that. Based on history of what I assume is a herald patch, and an ear infection and virus before, I would say PR. But double check with your pedi. Either way, it's basically the same treatment, aside from the azithromycin, which I have some parents refuse for their children and that's fine, I don't give it to them if they don't want it.

Here's a picture of nummular eczema:

groovygrl · January 2011

Definitely not big like that & color is very even, no variegation or anything...

i forgot to mention size, the herald/thigh patch is maybe 1.5 cm x 1/2 cm and the posterior knee ones are not even 1cm x1cm big.

g8orell · January 2011

groovygrl:

Definitely not big like that & color is very even, no variegation or anything...

i forgot to mention size, the herald/thigh patch is maybe 1.5 cm x 1/2 cm and the posterior knee ones are not even 1cm x1cm big.

It probably is PR. Again, it's really the same treatment besides the azithromycin. Keep me posted! I'm interested in what your pedi will say!

gokeyoke987 · January 2011

I had it when I was pregnant...it was awful!! I had to get two shots in my bum and two light therapy treatments. The Dr. said it was one of the top 10 itchiest things you could have on your skin! Maybe I had a severe case, good luck to you!!

caramia858 · July 2011

Since you had it when you were pregnant, did everything with baby turn out ok? I was diagnosed with it at around 5 weeks and it has been making me so nervous

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