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Francesco Drago - One of the best experts on this subject based on the ideXlab platform.

  • human herpesvirus 6 7 and epstein barr virus reactivation in Pityriasis Rosea during covid 19
    Journal of Medical Virology, 2021
    Co-Authors: Francesco Drago, Giulia Ciccarese, A Rebora, Aurora Parodi
    Abstract:

    Cutaneous manifestations during Coronavirus Disease 2019 (COVID-19) include Pityriasis Rosea (PR) and PR-like eruptions(1-3) We describe a patient with PR demonstrating that concurrent viral reactivations may occur during COVID-19 This article is protected by copyright All rights reserved

  • Pityriasis Rosea during pregnancy major and minor alarming signs
    Dermatology, 2018
    Co-Authors: Francesco Drago, Giulia Ciccarese, A Rebora, Astrid Herzum, Aurora Parodi
    Abstract:

    Background Pityriasis Rosea (PR) is a self-limiting exanthematous disease associated with human herpesvirus (HHV)-6 and/or HHV-7 reactivation. In pregnant women, PR may be associated with pregnancy complications. Objective To determine relevant risk factors in the development of negative pregnancy outcome in PR. Methods Between 2005 and 2017 at the Department of Dermatology, University of Genoa, we recruited 76 women who developed PR during pregnancy. In 60 patients without known risk factors for intrauterine fetal death (30 with pregnancy complications and 30 without) we analyzed the pregnancy week of PR onset, presence of enanthem and of constitutional symptoms, PR body surface area involvement, age, and in 50 patients (20 with pregnancy complications and 30 without), the viral load of HHV-6 and HHV-7 (copies/mL). Results In logistic regression analysis, early onset of PR (p = 0.0017) and enanthem (p = 0.0392) proved to be significantly associated with pregnancy complications. HHV-6 viral load (copies/mL) (p Conclusion The onset of PR before week 15 and enanthem may be considered major risk factors that should alarm the dermatologist. Constitutional symptoms and involvement of > 50% of the body area may be considered minor risk factors.

  • oropharyngeal lesions in Pityriasis Rosea
    Journal of The American Academy of Dermatology, 2017
    Co-Authors: Giulia Ciccarese, A Rebora, Aurora Parodi, Francesco Broccolo, Francesco Drago
    Abstract:

    Background Pityriasis Rosea (PR) is an exanthematous disease associated with the endogenous systemic reactivation of human herpesvirus-6 (HHV-6) and human herpesvirus-7 (HHV-7). Oropharyngeal lesions may be associated with the exanthema, but anecdotal evidence suggests that few dermatologists are aware of their occurrence. Objective Classifying oropharyngeal lesions in PR, establishing their prevalence, and assessing their possible association with different PR forms. Methods The records of all PR cases diagnosed in the Dermatology Clinic of Genoa University between 2003 and 2016 were retrospectively reviewed to examine sex and age of the patients, PR type, presence of enanthema, systemic symptoms, specific anti–HHV-6 and or HHV-7 serology, and HHV-6 and/or HHV-7 DNA loads. Results The oropharyngeal mucosa was carefully examined in 527 patients with PR. Painless oropharyngeal lesions were observed in 149 patients with PR (28%) and classified as erythematomacular, macular and papular, erythematovesicular, and petechial lesions. The petechial and macular and papular patterns were those most frequently observed. There was no statistically significant difference in the levels of HHV-6 and HHV-7 viremia in the plasma of patients with enanthema and those without. Limitations Because this was a retrospective study, biopsies on mucosal lesions were not performed. Conclusion Our findings showed that enanthemas are frequently associated with forms of PR different from the classic form.

  • Pityriasis Rosea a comprehensive classification
    Dermatology, 2016
    Co-Authors: Francesco Drago, Giulia Ciccarese, A Rebora, Francesco Broccolo, Aurora Parodi
    Abstract:

    Pityriasis Rosea (PR) is an acute, self-limiting exanthematous disease associated with the endogenous systemic reactivation of human herpesvirus (HHV)-6 and/or HHV-7. The disease typically begins with a single, erythematous plaque followed by a secondary eruption with lesions on the cleavage lines of the trunk (configuration of a 'Christmas tree'). The duration may vary from 2 weeks to a few months. Besides the typical presentation of PR, atypical forms have been described. The previous classifications of PR are mainly based on its atypical morphological features rather than on the pathogenetic mechanisms that underlie the different presentations of the disease. Notably, most of the morphologically atypical forms follow a course amenable to the classic form. The classification that we propose, taking into account the pathogenesis, clinical features, and course of the disease, is easy and intuitive and may be helpful in identifying the atypical forms of PR in order to avoid misdiagnosis and establish the best treatment options. Finally, this classification provides indications for managing potentially harmful forms of PR (such as PR in pregnancy) and PR-like eruptions.

  • the role of cytokines chemokines and growth factors in the pathogenesis of Pityriasis Rosea
    Mediators of Inflammation, 2015
    Co-Authors: Francesco Drago, Giulia Ciccarese, Francesco Broccolo, Paola Contini, Hajdhica Thanasi, Massimo Ghio, Aurora Parodi
    Abstract:

    Introduction. Pityriasis Rosea (PR) is an exanthematous disease related to human herpesvirus- (HHV-) 6/7 reactivation. The network of mediators involved in recruiting the infiltrating inflammatory cells has never been studied. Object. To investigate the levels of serum cytokines, growth factors, and chemokines in PR and healthy controls in order to elucidate the PR pathogenesis. Materials and Methods. Interleukin- (IL-) 1, IL-6, IL-17, interferon- (IFN-) γ, tumor necrosis factor- (TNF-) α, vascular endothelial growth factor (VEGF), granulocyte colony stimulating factor (G-CSF), and chemokines, CXCL8 (IL-8) and CXCL10 (IP-10), were measured simultaneously by a multiplex assay in early acute PR patients' sera and healthy controls. Subsequently, sera from PR patients were analysed at 3 different times (0, 15, and 30 days). Results and discussion. Serum levels of IL-17, IFN-γ, VEGF, and IP-10 resulted to be upregulated in PR patients compared to controls. IL-17 has a key role in host defense against pathogens stimulating the release of proinflammatory cytokines/chemokines. IFN-γ has a direct antiviral activity promoting NK cells and virus specific T cells cytotoxicity. VEGF stimulates vasculogenesis and angiogenesis. IP-10 can induce chemotaxis, apoptosis, cell growth, and angiogenesis. Conclusions. Our findings suggest that these inflammatory mediators may modulate PR pathogenesis in synergistic manner.

Antonio A. T. Chuh - One of the best experts on this subject based on the ideXlab platform.

  • Nomenclature of drug-induced Pityriasis Rosea-like rashes
    2016
    Co-Authors: Antonio A. T. Chuh
    Abstract:

    Dear editor I read with admiration an article published in your prestigious journal on the rare adverse effects of clozapine (CLZ).1 I write to address a specific issue in this article. In the second paragraph of the section “Dermatological adverse effects”, it was stated that a 54-year-old patient with schizophrenia treated for 28 days with CLZ developed a generalized rash compatible with Pityriasis Rosea (skin rash that usually begins as one large circular or oval spot on your chest, abdomen, or back). I wish to point out certain problems for coining Pityriasis Rosea (PR) as the diag-nostic label in the patient concerned. First, PR is a paraviral exanthem that might be associated with primary infections or endogenous reactivations of human herpesvirus-7,-6,2,3 or other viruses.4,5 The underlying immunopathogenesis of PR is likely to be entirely different from that in PR-like drug eruptions.6 Second, rashes with morphological and distributional resemblances to PR that ma

  • the diagnostic criteria of Pityriasis Rosea and gianotti crosti syndrome a protocol to establish diagnostic criteria of skin diseases
    Journal of the Royal College of Physicians of Edinburgh, 2015
    Co-Authors: Antonio A. T. Chuh, Gabriel F Sciallis, Vijay Zawar, Albert Lee
    Abstract:

    We established and validated diagnostic criteria for Pityriasis Rosea and Gianotti-Crosti syndrome. In this paper, we compare and contrast both diagnostic criteria to formulate a protocol in establishing diagnostic criteria for other dermatological diseases. The diagnostic criteria are similar in employing clear dividing lines and conjunctions ('and/or') to assure high reliability. Both sets of criteria should be applicable for all ethnic groups. Spontaneous remission is not included, so diagnosis is not delayed while waiting for disease remission. Laboratory investigations are not enlisted, so that the criteria can be used in medical care systems in different parts of the world. The diagnostic criteria are different in that pathognomonic clinical manifestations exist for Pityriasis Rosea, such as the herald patch and the orientation of lesions along the lines of skin cleavages. These features, however, score low for sensitivity. These specific manifestations are not seen in Gianotti-Crosti syndrome. Such differences led to different categorisation of clinical features. Atypical variants are more common for Pityriasis Rosea. The diagnostic criteria for Pityriasis Rosea therefore do not include a list of differential diagnoses, while diagnostic criteria for Gianotti-Crosti syndrome do. Using this comparison, we constructed a protocol to establish diagnostic criteria for other skin diseases. We advocate the need to justify the establishment of diagnostic criteria, that multiple diagnostic criteria for the same disease should be avoided, that diagnostic criteria should be compatible with the disease classification if applicable, and that the scope should be well-delineated with regard to clinical variants. We outline the need for validation studies to assess the criteria-related validity, test-retest intra-clinician reliability, and inter-clinician reliability. We emphasise that the establishment of diagnostic criteria should not be a generic process. We also highlight limitations of diagnostic criteria, and emphasise that no diagnostic criteria can replace the bedside experience of clinicians.

  • follicular Pityriasis Rosea a case report and a new classification of clinical variants of the disease
    Journal of Dermatological Case Reports, 2012
    Co-Authors: Vijay Zawar, Antonio A. T. Chuh
    Abstract:

    Background: Atypical forms of Pityriasis Rosea are often noticed in Indian children. Main observations: We describe a 9-year-old male child with predominant follicular eruptions on trunk consistent with a clinical diagnosis of Pityriasis Rosea. Conclusion: Follicular Pityriasis Rosea is an extremely rare presentation of the disease. We propose a new classification of clinical variants of Pityriasis Rosea. ( J Dermatol Case Rep. 2012; 6(2): 36-39)

  • temporal case clustering in Pityriasis Rosea a regression analysis on 1379 patients in minnesota kuwait and diyarbakir turkey
    Archives of Dermatology, 2005
    Co-Authors: Antonio A. T. Chuh, Gabriel F Sciallis, Nicolas Molinari, Mehmet Harman, Sedat Akdeniz, Arti Nanda
    Abstract:

    Objective To detect temporal case clustering in patients with Pityriasis Rosea in different geographic locations. Design Regression analysis of dates on which 1379 patients were diagnosed as having Pityriasis Rosea in 3 different geographic locations. The control data consisted of dates of diagnosis of patients with psoriasis in the same settings. Setting Dermatology clinics in Kuwait, Minnesota, and Diyarbakir, Turkey. Patients Patients with Pityriasis Rosea and psoriasis seeking care in the clinics. Results Three significant positive clusters ( P  = .005, P  =.001, and P  =.01, respectively) and 1 significant negative cluster ( P Conclusion Temporal case clustering exists in Pityriasis Rosea.

  • is human herpesvirus 7 the causative agent of Pityriasis Rosea a critical review
    International Journal of Dermatology, 2004
    Co-Authors: Antonio A. T. Chuh, Henry H Chan, Vijay Zawar
    Abstract:

    Background  Conflicting results on the association of Pityriasis Rosea and human herpesvirus 7 infection have been reported by different investigators. Aim  To review the level of evidence for such an association. Methods  Medline was searched with unlimited data entry and 13 reports were retrieved. The data were analyzed for a causative association according to the criteria of Fredericks and Relman, which take into consideration latent infection and the reactivation of viruses characteristic of herpesviruses, and the roles of sequence-based detection methods. Results  None of the criteria was substantiated by the findings of most investigators. Factors leading to the discrepancies of the results were discussed. Conclusion  There is currently insufficient evidence that human herpesvirus 7 infection is causally related to Pityriasis Rosea.

A Rebora - One of the best experts on this subject based on the ideXlab platform.

  • human herpesvirus 6 7 and epstein barr virus reactivation in Pityriasis Rosea during covid 19
    Journal of Medical Virology, 2021
    Co-Authors: Francesco Drago, Giulia Ciccarese, A Rebora, Aurora Parodi
    Abstract:

    Cutaneous manifestations during Coronavirus Disease 2019 (COVID-19) include Pityriasis Rosea (PR) and PR-like eruptions(1-3) We describe a patient with PR demonstrating that concurrent viral reactivations may occur during COVID-19 This article is protected by copyright All rights reserved

  • Pityriasis Rosea during pregnancy major and minor alarming signs
    Dermatology, 2018
    Co-Authors: Francesco Drago, Giulia Ciccarese, A Rebora, Astrid Herzum, Aurora Parodi
    Abstract:

    Background Pityriasis Rosea (PR) is a self-limiting exanthematous disease associated with human herpesvirus (HHV)-6 and/or HHV-7 reactivation. In pregnant women, PR may be associated with pregnancy complications. Objective To determine relevant risk factors in the development of negative pregnancy outcome in PR. Methods Between 2005 and 2017 at the Department of Dermatology, University of Genoa, we recruited 76 women who developed PR during pregnancy. In 60 patients without known risk factors for intrauterine fetal death (30 with pregnancy complications and 30 without) we analyzed the pregnancy week of PR onset, presence of enanthem and of constitutional symptoms, PR body surface area involvement, age, and in 50 patients (20 with pregnancy complications and 30 without), the viral load of HHV-6 and HHV-7 (copies/mL). Results In logistic regression analysis, early onset of PR (p = 0.0017) and enanthem (p = 0.0392) proved to be significantly associated with pregnancy complications. HHV-6 viral load (copies/mL) (p Conclusion The onset of PR before week 15 and enanthem may be considered major risk factors that should alarm the dermatologist. Constitutional symptoms and involvement of > 50% of the body area may be considered minor risk factors.

  • oropharyngeal lesions in Pityriasis Rosea
    Journal of The American Academy of Dermatology, 2017
    Co-Authors: Giulia Ciccarese, A Rebora, Aurora Parodi, Francesco Broccolo, Francesco Drago
    Abstract:

    Background Pityriasis Rosea (PR) is an exanthematous disease associated with the endogenous systemic reactivation of human herpesvirus-6 (HHV-6) and human herpesvirus-7 (HHV-7). Oropharyngeal lesions may be associated with the exanthema, but anecdotal evidence suggests that few dermatologists are aware of their occurrence. Objective Classifying oropharyngeal lesions in PR, establishing their prevalence, and assessing their possible association with different PR forms. Methods The records of all PR cases diagnosed in the Dermatology Clinic of Genoa University between 2003 and 2016 were retrospectively reviewed to examine sex and age of the patients, PR type, presence of enanthema, systemic symptoms, specific anti–HHV-6 and or HHV-7 serology, and HHV-6 and/or HHV-7 DNA loads. Results The oropharyngeal mucosa was carefully examined in 527 patients with PR. Painless oropharyngeal lesions were observed in 149 patients with PR (28%) and classified as erythematomacular, macular and papular, erythematovesicular, and petechial lesions. The petechial and macular and papular patterns were those most frequently observed. There was no statistically significant difference in the levels of HHV-6 and HHV-7 viremia in the plasma of patients with enanthema and those without. Limitations Because this was a retrospective study, biopsies on mucosal lesions were not performed. Conclusion Our findings showed that enanthemas are frequently associated with forms of PR different from the classic form.

  • Pityriasis Rosea a comprehensive classification
    Dermatology, 2016
    Co-Authors: Francesco Drago, Giulia Ciccarese, A Rebora, Francesco Broccolo, Aurora Parodi
    Abstract:

    Pityriasis Rosea (PR) is an acute, self-limiting exanthematous disease associated with the endogenous systemic reactivation of human herpesvirus (HHV)-6 and/or HHV-7. The disease typically begins with a single, erythematous plaque followed by a secondary eruption with lesions on the cleavage lines of the trunk (configuration of a 'Christmas tree'). The duration may vary from 2 weeks to a few months. Besides the typical presentation of PR, atypical forms have been described. The previous classifications of PR are mainly based on its atypical morphological features rather than on the pathogenetic mechanisms that underlie the different presentations of the disease. Notably, most of the morphologically atypical forms follow a course amenable to the classic form. The classification that we propose, taking into account the pathogenesis, clinical features, and course of the disease, is easy and intuitive and may be helpful in identifying the atypical forms of PR in order to avoid misdiagnosis and establish the best treatment options. Finally, this classification provides indications for managing potentially harmful forms of PR (such as PR in pregnancy) and PR-like eruptions.

  • persistent Pityriasis Rosea an unusual form of Pityriasis Rosea with persistent active hhv 6 and hhv 7 infection
    Dermatology, 2015
    Co-Authors: Francesco Drago, Giulia Ciccarese, A Rebora, Francesco Broccolo, Aurora Parodi
    Abstract:

    Pityriasis Rosea (PR) is an acute, self-limiting exanthematous disease, associated with the reactivation of the human herpesvirus 6 (HHV-6) and/or human herpesvirus 7 (HHV-7) that usually lasts 6-8 weeks. We studied, from a clinical and virological point of view, 12 patients in whom the features of PR lasted longer than 12 weeks, defining this form of the disease as persistent PR (PPR). As in typical PR, in most of the PPR patients the disease begins with a herald patch, but compared to typical PR, systemic symptoms and oral lesions are more common. Moreover, in PPR we found a persistent reactivation of HHV-6 and/or HHV-7 with higher viral loads than in typical PR, accounting for the unusual persistence of the illness, the more frequent and severer systemic symptoms and the oral lesions. In conclusion, we describe an unusual persistent form of PR, whose prevalence has probably been underestimated so far and which should be added to the other variants of PR.

Aurora Parodi - One of the best experts on this subject based on the ideXlab platform.

  • human herpesvirus 6 7 and epstein barr virus reactivation in Pityriasis Rosea during covid 19
    Journal of Medical Virology, 2021
    Co-Authors: Francesco Drago, Giulia Ciccarese, A Rebora, Aurora Parodi
    Abstract:

    Cutaneous manifestations during Coronavirus Disease 2019 (COVID-19) include Pityriasis Rosea (PR) and PR-like eruptions(1-3) We describe a patient with PR demonstrating that concurrent viral reactivations may occur during COVID-19 This article is protected by copyright All rights reserved

  • Pityriasis Rosea during pregnancy major and minor alarming signs
    Dermatology, 2018
    Co-Authors: Francesco Drago, Giulia Ciccarese, A Rebora, Astrid Herzum, Aurora Parodi
    Abstract:

    Background Pityriasis Rosea (PR) is a self-limiting exanthematous disease associated with human herpesvirus (HHV)-6 and/or HHV-7 reactivation. In pregnant women, PR may be associated with pregnancy complications. Objective To determine relevant risk factors in the development of negative pregnancy outcome in PR. Methods Between 2005 and 2017 at the Department of Dermatology, University of Genoa, we recruited 76 women who developed PR during pregnancy. In 60 patients without known risk factors for intrauterine fetal death (30 with pregnancy complications and 30 without) we analyzed the pregnancy week of PR onset, presence of enanthem and of constitutional symptoms, PR body surface area involvement, age, and in 50 patients (20 with pregnancy complications and 30 without), the viral load of HHV-6 and HHV-7 (copies/mL). Results In logistic regression analysis, early onset of PR (p = 0.0017) and enanthem (p = 0.0392) proved to be significantly associated with pregnancy complications. HHV-6 viral load (copies/mL) (p Conclusion The onset of PR before week 15 and enanthem may be considered major risk factors that should alarm the dermatologist. Constitutional symptoms and involvement of > 50% of the body area may be considered minor risk factors.

  • oropharyngeal lesions in Pityriasis Rosea
    Journal of The American Academy of Dermatology, 2017
    Co-Authors: Giulia Ciccarese, A Rebora, Aurora Parodi, Francesco Broccolo, Francesco Drago
    Abstract:

    Background Pityriasis Rosea (PR) is an exanthematous disease associated with the endogenous systemic reactivation of human herpesvirus-6 (HHV-6) and human herpesvirus-7 (HHV-7). Oropharyngeal lesions may be associated with the exanthema, but anecdotal evidence suggests that few dermatologists are aware of their occurrence. Objective Classifying oropharyngeal lesions in PR, establishing their prevalence, and assessing their possible association with different PR forms. Methods The records of all PR cases diagnosed in the Dermatology Clinic of Genoa University between 2003 and 2016 were retrospectively reviewed to examine sex and age of the patients, PR type, presence of enanthema, systemic symptoms, specific anti–HHV-6 and or HHV-7 serology, and HHV-6 and/or HHV-7 DNA loads. Results The oropharyngeal mucosa was carefully examined in 527 patients with PR. Painless oropharyngeal lesions were observed in 149 patients with PR (28%) and classified as erythematomacular, macular and papular, erythematovesicular, and petechial lesions. The petechial and macular and papular patterns were those most frequently observed. There was no statistically significant difference in the levels of HHV-6 and HHV-7 viremia in the plasma of patients with enanthema and those without. Limitations Because this was a retrospective study, biopsies on mucosal lesions were not performed. Conclusion Our findings showed that enanthemas are frequently associated with forms of PR different from the classic form.

  • Research Article The Role of Cytokines, Chemokines, and Growth Factors in the Pathogenesis of Pityriasis Rosea
    2016
    Co-Authors: Paola Contini, Hajdhica Thanasi, Aurora Parodi
    Abstract:

    Copyright © 2015 Francesco Drago et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Pityriasis Rosea (PR) is an exanthematous disease related to human herpesvirus- (HHV-) 6/7 reactivation.Thenetwork of mediators involved in recruiting the infiltrating inflammatory cells has never been studied. Object. To investigate the levels of serum cytokines, growth factors, and chemokines in PR and healthy controls in order to elucidate the PR pathogenesis.Materials and Methods. Interleukin- (IL-) 1, IL-6, IL-17, interferon- (IFN-

  • Pityriasis Rosea a comprehensive classification
    Dermatology, 2016
    Co-Authors: Francesco Drago, Giulia Ciccarese, A Rebora, Francesco Broccolo, Aurora Parodi
    Abstract:

    Pityriasis Rosea (PR) is an acute, self-limiting exanthematous disease associated with the endogenous systemic reactivation of human herpesvirus (HHV)-6 and/or HHV-7. The disease typically begins with a single, erythematous plaque followed by a secondary eruption with lesions on the cleavage lines of the trunk (configuration of a 'Christmas tree'). The duration may vary from 2 weeks to a few months. Besides the typical presentation of PR, atypical forms have been described. The previous classifications of PR are mainly based on its atypical morphological features rather than on the pathogenetic mechanisms that underlie the different presentations of the disease. Notably, most of the morphologically atypical forms follow a course amenable to the classic form. The classification that we propose, taking into account the pathogenesis, clinical features, and course of the disease, is easy and intuitive and may be helpful in identifying the atypical forms of PR in order to avoid misdiagnosis and establish the best treatment options. Finally, this classification provides indications for managing potentially harmful forms of PR (such as PR in pregnancy) and PR-like eruptions.

Francesco Broccolo - One of the best experts on this subject based on the ideXlab platform.

  • oropharyngeal lesions in Pityriasis Rosea
    Journal of The American Academy of Dermatology, 2017
    Co-Authors: Giulia Ciccarese, A Rebora, Aurora Parodi, Francesco Broccolo, Francesco Drago
    Abstract:

    Background Pityriasis Rosea (PR) is an exanthematous disease associated with the endogenous systemic reactivation of human herpesvirus-6 (HHV-6) and human herpesvirus-7 (HHV-7). Oropharyngeal lesions may be associated with the exanthema, but anecdotal evidence suggests that few dermatologists are aware of their occurrence. Objective Classifying oropharyngeal lesions in PR, establishing their prevalence, and assessing their possible association with different PR forms. Methods The records of all PR cases diagnosed in the Dermatology Clinic of Genoa University between 2003 and 2016 were retrospectively reviewed to examine sex and age of the patients, PR type, presence of enanthema, systemic symptoms, specific anti–HHV-6 and or HHV-7 serology, and HHV-6 and/or HHV-7 DNA loads. Results The oropharyngeal mucosa was carefully examined in 527 patients with PR. Painless oropharyngeal lesions were observed in 149 patients with PR (28%) and classified as erythematomacular, macular and papular, erythematovesicular, and petechial lesions. The petechial and macular and papular patterns were those most frequently observed. There was no statistically significant difference in the levels of HHV-6 and HHV-7 viremia in the plasma of patients with enanthema and those without. Limitations Because this was a retrospective study, biopsies on mucosal lesions were not performed. Conclusion Our findings showed that enanthemas are frequently associated with forms of PR different from the classic form.

  • Pityriasis Rosea a comprehensive classification
    Dermatology, 2016
    Co-Authors: Francesco Drago, Giulia Ciccarese, A Rebora, Francesco Broccolo, Aurora Parodi
    Abstract:

    Pityriasis Rosea (PR) is an acute, self-limiting exanthematous disease associated with the endogenous systemic reactivation of human herpesvirus (HHV)-6 and/or HHV-7. The disease typically begins with a single, erythematous plaque followed by a secondary eruption with lesions on the cleavage lines of the trunk (configuration of a 'Christmas tree'). The duration may vary from 2 weeks to a few months. Besides the typical presentation of PR, atypical forms have been described. The previous classifications of PR are mainly based on its atypical morphological features rather than on the pathogenetic mechanisms that underlie the different presentations of the disease. Notably, most of the morphologically atypical forms follow a course amenable to the classic form. The classification that we propose, taking into account the pathogenesis, clinical features, and course of the disease, is easy and intuitive and may be helpful in identifying the atypical forms of PR in order to avoid misdiagnosis and establish the best treatment options. Finally, this classification provides indications for managing potentially harmful forms of PR (such as PR in pregnancy) and PR-like eruptions.

  • the role of cytokines chemokines and growth factors in the pathogenesis of Pityriasis Rosea
    Mediators of Inflammation, 2015
    Co-Authors: Francesco Drago, Giulia Ciccarese, Francesco Broccolo, Paola Contini, Hajdhica Thanasi, Massimo Ghio, Aurora Parodi
    Abstract:

    Introduction. Pityriasis Rosea (PR) is an exanthematous disease related to human herpesvirus- (HHV-) 6/7 reactivation. The network of mediators involved in recruiting the infiltrating inflammatory cells has never been studied. Object. To investigate the levels of serum cytokines, growth factors, and chemokines in PR and healthy controls in order to elucidate the PR pathogenesis. Materials and Methods. Interleukin- (IL-) 1, IL-6, IL-17, interferon- (IFN-) γ, tumor necrosis factor- (TNF-) α, vascular endothelial growth factor (VEGF), granulocyte colony stimulating factor (G-CSF), and chemokines, CXCL8 (IL-8) and CXCL10 (IP-10), were measured simultaneously by a multiplex assay in early acute PR patients' sera and healthy controls. Subsequently, sera from PR patients were analysed at 3 different times (0, 15, and 30 days). Results and discussion. Serum levels of IL-17, IFN-γ, VEGF, and IP-10 resulted to be upregulated in PR patients compared to controls. IL-17 has a key role in host defense against pathogens stimulating the release of proinflammatory cytokines/chemokines. IFN-γ has a direct antiviral activity promoting NK cells and virus specific T cells cytotoxicity. VEGF stimulates vasculogenesis and angiogenesis. IP-10 can induce chemotaxis, apoptosis, cell growth, and angiogenesis. Conclusions. Our findings suggest that these inflammatory mediators may modulate PR pathogenesis in synergistic manner.

  • persistent Pityriasis Rosea an unusual form of Pityriasis Rosea with persistent active hhv 6 and hhv 7 infection
    Dermatology, 2015
    Co-Authors: Francesco Drago, Giulia Ciccarese, A Rebora, Francesco Broccolo, Aurora Parodi
    Abstract:

    Pityriasis Rosea (PR) is an acute, self-limiting exanthematous disease, associated with the reactivation of the human herpesvirus 6 (HHV-6) and/or human herpesvirus 7 (HHV-7) that usually lasts 6-8 weeks. We studied, from a clinical and virological point of view, 12 patients in whom the features of PR lasted longer than 12 weeks, defining this form of the disease as persistent PR (PPR). As in typical PR, in most of the PPR patients the disease begins with a herald patch, but compared to typical PR, systemic symptoms and oral lesions are more common. Moreover, in PPR we found a persistent reactivation of HHV-6 and/or HHV-7 with higher viral loads than in typical PR, accounting for the unusual persistence of the illness, the more frequent and severer systemic symptoms and the oral lesions. In conclusion, we describe an unusual persistent form of PR, whose prevalence has probably been underestimated so far and which should be added to the other variants of PR.

  • Pityriasis Rosea in children clinical features and laboratory investigations
    Dermatology, 2015
    Co-Authors: Francesco Drago, Giulia Ciccarese, Francesco Broccolo, Emanuele Cozzani, Aurora Parodi
    Abstract:

    Pityriasis Rosea (PR) is a common, self-limiting exanthematous disease associated with a systemic reactivation of human herpesvirus 6 (HHV-6) and/or HHV-7. It usually occurs in the second or third decade of life whereas it is uncommon in patients younger than 10 years. We studied the clinical features and virological parameters of 31 children with PR, comparing them with those in adults. Our findings indicate that PR presents different characteristics between children and adults, mainly consisting of time lapse between herald patch and generalized eruption, duration of the exanthem, oropharyngeal involvement and persistence of HHV-6 and HHV-7 plasma viremia. Overall, these results suggest that, following HHV-6 and/or HHV-7 systemic active infection, the pathogenetic mechanisms involved in PR may at least partly be different in children and adults.