Lecture on Gibert's rosy (pityriasis rosea)

2021-03-24 12:00 AM

There are many authors who believe that the disease is caused by one bacterium but not proven and so is fungus and spirochetes, the rest is caused by the virus, it deserves to be considered the most likely.

Define

Acute disease, autoimmune, transmissible, common in children and young people, characterized by specific skin damage, with little effect on the whole.

Epidemiological aetiology

It is a common disease in the world, has not seen a big difference in the rate between groups and over the years but is common in women (58-60% of patients). The average age of the patient is 35 and particularly in children or the elderly (possibly in infants or 90 years old).

The cause of the disease is unknown. In terms of epidemiology and clinical picture it can be said that it is an infectious disease, in the Transvaal region, there is a period of 2-3 years, there is a natural "epidemic" of the patient skyrocketing (from 2- 4 individuals were infected in a home or school) but there is no official report of the transmission of the disease. An association between cases has also been found in Australia. Since 1892 Lassar observed that the disease was related to wearing new clothes or clothes that had been taken away for a while. There is also no evidence of transmission by clothing or by insects that reside in clothing.

There are many authors who believe that the disease is caused by one bacterium but not proven and so is fungus and spirochetes, the rest is caused by virus, it deserves to be considered the most likely. An author has preliminarily determined that it is due to the Epstein-Barr virus (a DNA virus belonging to the Herpès virus family) (usually the EB virus causes mononucleosis). Some authors have been able to transmit the disease through the skin scabs and through the fluid of the blisters in the lesion.

The susceptibility of the disease was associated with other common factors such as atopic allergy, eczema, and asthma, compared with the control group.

clinical

Initially, the disease is not apparent in 50% of cases. The patient feels headache, low fever, and fatigue. Primary lesions are usually on the upper half of the body chest, back of abdomen, wings, forearms, neck. Maybe in the face, head. Lesions are well-defined round or oval clusters, with a well defined, pale red color. Lesions are 2 - 5 cm in diameter or sometimes larger. Injury lasts 5 - 15 days. May last for 2 months. Invasive (secondary) lesions begin to manifest after 2-3 days or up to 10 days. The next new lesions developed several weeks later. Classic lesions include urticaria around, mild pink, dry scaly gray covering. The lesion center is atrophy, concave, brown wrinkled skin. After a period of damage is characterized by parallel centrifuges like the ribs of the lord.

Lesions are usually in the torso, neck, also found in the arms and legs, this place is usually persistent and is present in the area, especially in children. The damage to the arms and legs is about 6 - 12%. Palm lesions may also be present, showing red, scaly skin with small blisters. Lesions in the mucosa are rare but must be considered. Red, scaly skin lesions or petechiae or blisters have also been reported. There is also vaginal damage.

Other general symptoms may be observed but mild, mild itchy papules, or maybe due to incorrect treatment. Mild malaria, fatigue, and lymph nodes in the armpit may swell.

Skin lesions usually disappear after 3 to 6 weeks, but some lesions can take up to 1-2 weeks. Lesions in the lower side, can last longer. May leave an increase or decrease in pigmentation. But usually, there is no trace.
Lesions that recur after a few months or years can be seen in 2% of patients.

Severe or solitary injury can be observed.

The disease can be in atypical form, deformed in about 20% of patients. Secondary lesions can form large clumps, it can be pervasive or even only a few lesions. At the same time, there may be an injury to the fingertip. Especially in children, the lesion can be in the form of urticaria at an early stage and has an upper scab, or the typical pediatric urticarial lesion with a haemorrhagic point, acute haemorrhagic lesions are also present in humans. big. Pus, blisters, and pus are also encountered. Lesions in the form of papules are common in Africa and Europe. Lymphoma is often found at the edge of the lesion.

Pityriasia Circinata et marginata of Vidal (Pityriasis circinata et marginata of Vidal) scabs, sometimes seen in adults. Lesions are few but widely scattered, usually localized in one area of ​​the body, especially in the armpits and groin. It lasted for several months, this form was a pervasive form.

Histopathology

Nonspecific anatomical changes, edema and mild infiltrates in the dermis, spongiosis phenomenon (Spongiosis) in the epidermis, may have subkeratosis. If there are blisters, it is under the horny layer.

Diagnose

When the lesions are typical, it is not difficult.
When atypical or deformed (urticaria, hemorrhage, lethargy ...), 
it must be distinguished from:

Drug allergic skin toxicity by inVitro tests.

Seborrheic dermatitis can be mistaken for powders. If the dermatitis is oily, the damage is usually slow and, in the scalp,, chest, back, and cheeks. Scaly and crumbled, papules. Injury will last if left untreated.

Syphilis 2: There must be lesions elsewhere, slowly progressing lymphadenopathy, with general and mucosal lesions, maculopapular lesions, syphilis serology (+).

The morphology of urticaria in children.

Dropletous psoriasis is also sometimes mistaken for lichenic rosacea (lichénoi'd). Both lesions are papules. But nacre-white psoriasis and rosy-pink psoriasis are diverse. One sometimes has bleeding and in young people.

The dry chromosome parts of the face, in streptococcal dermatitis, in children are easy to confuse with this disease.

Treatment
Symptomatic treatment is key. Strong local treatment is not required. Avoid irritation by hot showers, soaps and woollen clothing. To prevent dry skin, avoid irritation can use crem coticôid. At the lesion site can be used under the skin reddish ultraviolet dose.

Applying a 1% o Rivanol solution can give good results. There are authors who also drink Rivanol.