Pityriasis Rosea: BE GONE! *itch itch*
As any of my regular readers will recall, I’ve not had the best year, medically speaking. First, there was Bell’s Palsy which recovered 99% by 1 months time after a 10 day course of steroids in December. Then, in January, I had a delayed type IV-hypersensitivity reaction to a medication, where my face swelled up like it had been rubbed with poison ivy. This required more steroids. Around the same time I had my – in my opinion – totally superfluous MRI, which revealed a “incidentaloma,” a lump in my neck. This was ultrasounded which showed, as we all knew it would, that there was nothing to fret about. Anyway, the Bell’s problem is all wrapped up… but I’m still having (somewhat comedic) issues in this chain of events.
Just after I finished the second course of prednisone, I went away to the beautiful Kootenays to work for 2 months. Nestled in this snowy paradise amidst the rocky mountains, I was living in a basement apartment for the time being. After a shower one day, I noticed a scaly, itchy reddish-orange patch on my back about 7cm in diameter and a smaller one on my inner arm. They each kind of had a redder ring around the outside. I knew I had to have these looked at, but being in a new place, 10+hrs by road and ferry to my family doctor, I decided to ask my preceptor for help. A couple more spots had appeared in the time it took me to ask for an opinion. She, only out of residency 9 months prior, wasn’t quite sure. Neither was I. Together, we decided it was probably Tinea Corporis aka “ringworm.” That’s a fungal infection that can occur on the trunk or extremities. So as to not go to the trouble of putting me in the electronic medical record (EMR), she scribbled a prescription for an anti-fungal on an old Rx pad.
Dutifully, I collected the medication, applied it regularly, and waited. After a few days the scaliness was gone. I told her so, along with a “thanks! I think it’s working.” Well, I spoke too soon. Though it did make the patches less dry and itchy, new ones cropped up. Over the next week, they appeared all over my chest, my back, the inner parts of my arms and even a few on my bum and thighs. Itch! Itch! Our clinic’s cheekiest nurse walked by my office one day and noticed me scratching, remarking “boy, I love it! You’re so nonchalant!” Slightly embarrassed, I felt compelled to explain the itch.
I wondered if it could be numular eczema – coin shaped spots of eczema – but thick moisturizer was not helping. I’d never had eczema before, and no asthma or true allergies (eczema, allergies, and asthma go together in the triad of atopy). Really, I knew what it was. I just didn’t want it to be THIS THING because I knew there was no treatment. Also on the differential were syphilis and psoriasis… but no… no I did not have either of those.
This THING is Pityriasis rosea. Dang. I’ve seen 2 cases of it before. It’s an inconvenient, at worst, quite itchy rash mainly over the trunk. Medical students around the world will remember it for its pathognemonic “herald patch,” a large salmon-red patch that appears on the trunk before the other spots appear. Being mostly unaware of my body, I had failed to notice this before the other spots started appearing. A few days after the herald patch, spots start to appear over the trunk. A textbook will tell you the red, scaly macules (flat-type of rash spots) appear in a Christmas-tree distribution. Well, they didn’t, but they were mostly symmetrical. The odd couple on my forearms were the worst because they might betray my disease to my patients if I wore short sleeves. Not really a big deal – this rash is likely caused by a virus, most likely HHV-7, but science isn’t sure. The spots worsen with heat, probably because most red things (especially inflammatory thins) on the body have increased blood flow; when hot, capillaries (small blood vessels) dilate.
This virus, or whatever it is, isn’t very contagious. Usually only one person in a household “gets” it. Maybe everyone is a carrier, but only one manifests the rash. Well my household of 1 was 100% affected, and I suspect it is because I had just been relatively immunocompromised with my recent illness and prednisone courses. The only treatment is time. It usually lasts between 6-12 weeks and just goes away on its own.
At its peak, I was willing to try anything. I had read that topical corticosteroids might help a bit, so I tried, and they didn’t. Antihistamines made no difference to the itch. I learned that in the first 2 weeks, photo-therapy may be helpful. It was winter and there was none for free outside in my snowy heaven. I drove by the tanning salon but just couldn’t bring myself to enter. Tanning salons are one of the worse human inventions and I couldn’t bear to support one, never mind the Jersey-shore culture that they are associated with.
Well, it’s been 9 weeks for me and only the last-to-appear spots have yet to disappear. I am much less itchy now.
Since you’ve read this far, maybe you’ll heed my plea: the next time your doctor has trouble figuring out your spots, please try to be a patient patient. Your GP may have had their share of spots too! There are a few scary rashes, but most skin changes do not signal doom; rather, they are just a bit annoying to have – and tricky to diagnose.
These rashes all friggin’ look the same! No?
If you are lucky enough to get this or just want to learn more about it, the best article I found was from the American Academy of Family Physicians (AAFP).