背景:玫瑰糠疹是一种常见的急性,主要影响儿童和年轻人的自限性丘疹鳞状皮肤病。该疾病及其临床变异可能构成诊断挑战,尤其是在没有先驱补丁的情况下。
目的:本文旨在使儿科医生熟悉临床表现,评估,诊断,和玫瑰糠疹的管理。
方法:于2020年3月在Pubmed临床查询中使用关键术语“玫瑰糠疹”进行了搜索。搜索策略包括所有临床试验(包括开放试验,非随机对照试验,和随机对照试验),观察性研究,以及过去10年发表的评论(包括叙述性评论和荟萃分析)。本评论仅包括在英语文献中发表的论文。从上述搜索中检索到的信息用于本文的汇编。
结果:玫瑰糠疹主要发生在10至35岁的个体中,在青春期达到高峰。人类疱疹病毒(HHV)-7和HHV-6被认为是某些玫瑰糠疹患者的病原体。由头痛组成的轻度前驱症状,发烧,萎靡不振,疲劳,厌食症,喉咙痛,大约5%的患者存在淋巴结肿大和关节痛。最常见的提示标志,在大约80%的患者中发现,是一个“先驱”或“母亲”补丁,比后来爆发的病变更大,更明显。广义的,双边,对称喷发在大约4到14天内发展,并在接下来的12到21天内继续在作物中爆发。典型病变为0.5至1厘米,卵形或椭圆形,暗淡的粉红色或鲑鱼色的斑疹,外围有精致的鳞片。长轴倾向于沿着分裂的皮肤线(朗格线)取向。背部的病变可能具有特征性的“圣诞树”,而上胸部的病变可能具有V形图案。有许多条件可以模仿玫瑰糠疹。在没有先驱补丁及其变体的情况下,玫瑰糠疹可能会带来诊断挑战。典型的课程是6到8周。在绝大多数情况下,安慰和对症治疗就足够了。对于患有严重或复发性玫瑰糠疹的个体和患有该疾病的孕妇,可以考虑积极干预。治疗方案包括阿昔洛韦,大环内酯类(特别是,红霉素),和紫外线光疗。如果需要积极干预,有证据支持口服阿昔洛韦缩短病程.
结论:玫瑰糠疹是一种常见的,急性,主要影响儿童和年轻人的自限性发斑性皮肤病。这种情况的特征是一个\'先驱斑块\'之后,椭圆形的红斑鳞状病变出现在躯干和近端的兰格的分裂线,给它一个“圣诞树”的外观。以其经典形式出现的疾病可以很容易地诊断。该疾病的临床变异可能对普通儿科医生构成诊断挑战。对疾病的了解对于迅速诊断和避免不必要的检查至关重要。
BACKGROUND: Pityriasis rosea is a common acute, self-limited papulosquamous dermatosis that primarily affects children and young adults. The condition and its clinical variants may pose a diagnostic challenge, especially in the absence of the herald patch.
OBJECTIVE: This article aimed to familiarize pediatricians with clinical manifestations, evaluation, diagnosis, and management of pityriasis rosea.
METHODS: A search was conducted in March 2020 in Pubmed Clinical Queries using the key term \' pityriasis rosea\'. The search strategy included all clinical trials (including open trials, non-randomized controlled trials, and randomized controlled trials), observational studies, and reviews (including narrative reviews and meta-analyses) published within the past 10 years. Only papers published in the English literature were included in this
review. The information retrieved from the above search was used in the compilation of the present article.
RESULTS: Pityriasis rosea occurs mainly in individuals between 10 and 35 years of age with a peak during adolescence. Human herpesvirus (HHV)-7 and HHV-6 have been implicated as the causative agents in some patients with pityriasis rosea. A mild prodrome consisting of headaches, fever, malaise, fatigue, anorexia, sore throat, enlarged lymph nodes and arthralgia is present in about 5% of patients. The most common presenting sign, found in approximately 80% of patients, is a \'herald\' or \"mother\" patch which is larger and more noticeable than the lesions of the later eruption. A generalized, bilateral, symmetrical eruption develops in approximately 4 to 14 days and continues to erupt in crops over the next 12 to 21 days. Typical lesions are 0.5 to 1 cm, oval or elliptical, dull pink or salmon-colored macules with a delicate collarette of scales at the periphery. The long axes tend to be oriented along the skin lines of cleavage (Langer lines). Lesions on the back may have a characteristic \"Christmas tree\" whereas lesions on the upper chest may have a V-shaped pattern. There are many conditions that may mimic pityriasis rosea. Pityriasis rosea in the absence of the herald patch and its variants may pose a diagnostic challenge. The typical course is 6 to 8 weeks. In the vast majority of cases, reassurance and symptomatic treatment should suffice. Active intervention may be considered for individuals with severe or recurrent pityriasis rosea and pregnant women with the disease. Treatment options include acyclovir, macrolides (in particular, erythromycin), and ultraviolet phototherapy. If active intervention is needed, there is evidence supporting the use of oral acyclovir to shorten the duration of illness.
CONCLUSIONS: Pityriasis rosea is a common, acute, self-limiting exanthematous skin disease that primarily affects children and young adults. The condition is characterized by a \'herald patch\' after which oval erythematous squamous lesions appear along Langer\'s lines of cleavage on the trunk and proximal extremities, giving it a \"Christmas tree\" appearance. The disease presenting in its classical form can easily be diagnosed. Clinical variants of the disease may pose a diagnostic challenge for the general pediatrician. Knowledge of the disease is essential to allow a prompt diagnosis and to avoid unnecessary investigations.