Ljubojević Hadžavdić, Suzana

Prtajin, Marta

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265ACTA DERMATOVENEROLOGICA CROATICAActa Dermatovenerol Croat                              2022;30(4):265-266                                       LETTER TO THE EDITORPityriasis Rosea after COVID-19 InfectionDear Editor,Pityriasis rosea (PR) is a common, self-limited ery-thematous papulosquamous dermatosis that mainly affects young adults. It is believed to represent a de-layed reaction to viral infections and is usually asso-ciated with endogenous systemic reactivation of hu-man herpesvirus (HHV) 6 and / or 7 (1).A 46-year-old man presented to our Department with a two-week history of skin rash associated with mild pruritus. He described the appearance of an ery-thematous centrally scaled lesion at the right part of his abdomen, followed by the spreading of red oval mildly scaling lesions on the trunk, neck, and proxi-mal parts of the upper extremities, which showed in the physical examination (Figure 1, a and b). He was otherwise healthy and taking no medications. Six weeks prior to the appearance of the initial skin le-sion, the patient had coronavirus disease 2019 (COV-ID-19) infection with mild clinical presentation (fever up to 38 °C lasting for four days and mild headache) and with symptoms of post COVID-19 syndrome (ex-cessive tiredness). He denied oropharyngeal lesions. Potassium hydroxide, syphilis, and laboratory tests were within normal limits. Within two weeks of topi-cal betamethasone dipropionate treatment, the le-sions disappeared completely.In addition to reactivation of HHV-6 or HHV-7, PR can be triggered by some drugs (like angiotensin-converting enzyme inhibitors alone or in combination with hydrochlorothiazide, sartans plus hydrochloro-thiazide, allopurinol, nimesulide, and acetyl salicylic acid (2) and vaccines (such as smallpox, poliomyelitis, influenza, human papillomavirus, diphtheria, tuber-culosis, hepatitis B, pneumococcus, and yellow fever vaccines) (3). There is a growing number of published cases that link PR to COVID-19 infection, with PR ap-pearing either in the acute phase of COVID-19 or, as in our patient, in the post COVID-19 period (4-9). Unlike in our patient, oropharyngeal lesions were observed Figure 1. Scattered erythematous patches, some with a collarette of scale, in a Blaschkoid distribution on (a) the frontal and (b) lateral sides of the trunk.266 ACTA DERMATOVENEROLOGICA CROATICAin approximately 16% of patients with typical PR (10). It has been suggested that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces reacti-vation of other viruses, such as HHV-6, HHV-7, varicel-la zoster virus, and Epstein-Barr virus (5). PR has also been reported to follow COVID-19 vaccination (11). As our patient did not receive a COVID-19 vaccine, we cannot evaluate the latter based on the present case.We speculate that PR could be a delayed skin manifestation of COVID-19 infection, triggered either by SARS-CoV-2 immediately or indirectly by the re-activation of other viruses such as HHV-6 or HHV-7. However, the etiopathogenetic mechanisms remain largely unknown and further studies are needed in order to clarify the correlation between SARS-CoV-2 and PR.References:1. Drago F, Ciccarese G, Rebora A, Broccolo F, Parodi A. Pityriasis rosea: a comprehensive classifica-tion. Dermatology. 2016;232:431-7.2. Atzori L, Pinna AL, Ferreli C, Aste N. Pityriasis ro-sea-like adverse reaction: review of the literature and experience of an Italian drug-surveillance center. Dermatol Online J. 2006;12:1. 3. Drago F, Ciccarese G, Javor S, Parodi A. Vaccine-induced pityriasis rosea and pityriasis rosea-like eruptions: a review of the literature. J Eur Acad Dermatol Venereol. 2016;30:544-5.4. Birlutiu V, Birlutiu RM, Iancu GM. Pytiriasis rosea Gibert triggered by SARS-CoV-2 infection: a case report. Medicine. 2021;100:e25352.5. Veraldi S, Spigariolo CB. Pityriasis rosea and CO-VID-19. J Med Virol. 2021;93:4068.6. Ehsani AH, Nasimi M, Bigdelo Z. Pityriasis rosea as a cutaneous manifestation of COVID-19 infection. J Eur Acad Dermatol Venereol. 2020;34:e436-7.7. Merhy R, Sarkis AS, Stephan F. Pityriasis rosea as a leading manifestation of COVID-19 infection. J Eur Acad Dermatol Venereol. 2021;35:e246-7.8. Ng SM. Prolonged dermatological manifesta-tion 4 weeks following recovery of COVID-19 in a child. BMJ Case Rep. 2020;13:e237056.9. Drago F, Ciccarese G, Rebora A, Parodi A. Human herpesvirus-6, -7, and Epstein barr virus reactiva-tion in pityriasis rosea during COVID-19. J Med Virol. 2021;93:1850-1.10. Ciccarese G, Broccolo F, Rebora A, Parodi A, Drago F. Oropharyngeal lesions in pityriasis rosea. J Am Acad Dermatol. 2017;77:833-7.e4.11. Busto-Leis JM, Servera-Negre G, Mayor-Ibargu-ren A, Sendagorta-Cudós E, Feito-Rodríguez M, Nuño-González A, et al. Pityriasis rosea, CO-VID-19 and vaccination: new keys to understand an old acquaintance. J Eur Acad Dermatol Vene-reol. 2021;35:e489-91.Marta Prtajin1, Suzana Ljubojević Hadžavdić*1 Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, CroatiaCorresponding author: Professor Suzana Ljubojević Hadžavdić, MD, PhDDepartment of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medi-cine, University of Zagreb suzana.ljubojevic@gmail.comReceived: September 28, 2022Accepted: December 1, 2022Letter to the editor Acta Dermatovenerol Croat  2022;30(4):265-266

Pityriasis Rosea after COVID-19 Infection

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