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Pityriasis rosea and activation of latent herpesvirus infections

2013; Elsevier BV; Volume: 70; Issue: 1 Linguagem: Inglês

10.1016/j.jaad.2013.09.032

1097-6787

Robert A. Schwartz, W. Clark Lambert,

Viral-associated cancers and disorders

To the Editor: The comments of Professor Drago and associates1Drago F. Broccolo F. Agnoletti A. Drago F. Rebora A. Parodi A. Pityriasis rosea and pityriasis rosea-like eruptions.J Am Acad Dermatol. 2013; 70: 196Abstract Full Text Full Text PDF Scopus (22) Google Scholar concerning pityriasis rosea (PR), PR-like drug eruptions, and herpesvirus infections are noteworthy.2Evangelia P. Ioannis P. Michael M. Sophia G. Maria D. Stavrianeas N. et al.Pityriasis rosea-like eruption associated with lamotrigine.J Am Acad Dermatol. 2013; 68: e180-e181Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar, 3Drago F. Broccolo F. Rebora A. Pityriasis rosea: an update with a critical appraisal of its herpesvirus origin.J Am Acad Dermatol. 2009; 61: 303-318Abstract Full Text Full Text PDF PubMed Scopus (141) Google Scholar The concept of a chronic persistent herpesvirus infection becoming active to cause or exacerbate disease is an intriguing one, with the drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and Kaposi sarcoma representing salient examples.4Schwartz R.A. Micali G. Nasca M.R. Scuderi L. Kaposi's sarcoma: a continuing conundrum.J Am Acad Dermatol. 2008; 59: 179-206Abstract Full Text Full Text PDF PubMed Scopus (192) Google Scholar, 5Husain Z. Reddy B.Y. Schwartz R.A. DRESS syndrome, part I: clinical perspectives.J Am Acad Dermatol. 2013; 68: 693-705Abstract Full Text Full Text PDF PubMed Scopus (309) Google Scholar Clearly, activating a lifelong latent herpesvirus infection may have substantial consequences. Clinical and histopathologic features do help to distinguish typical PR from PR-like eruptions.6González L. Allen R.A. Janniger C.K. Schwartz R.A. Pityriasis rosea: an important papulosquamous disorder.Int J Dermatol. 2005; 44: 757-764Crossref PubMed Scopus (67) Google Scholar Virologic investigations for herpesvirus 6 and 7 may as well,1Drago F. Broccolo F. Agnoletti A. Drago F. Rebora A. Parodi A. Pityriasis rosea and pityriasis rosea-like eruptions.J Am Acad Dermatol. 2013; 70: 196Abstract Full Text Full Text PDF Scopus (22) Google Scholar but are less likely to be practical even if they prove helpful. Pityriasis rosea and pityriasis rosea–like eruptionsJournal of the American Academy of DermatologyVol. 70Issue 1PreviewTo the Editor: We read with great interest the case of pityriasis rosea (PR)–like eruption associated with lamotrigine by Papadavid et al.1 This article may raise the issue of why a drug eruption presents with clinical features that strikingly resemble genuine PR. It may be speculated that the drug could have triggered human herpesvirus (HHV) 6 and/or HHV 7, recently implicated in the pathogenesis of PR,2-4 to abandon their latency and to reactivate. This phenomenon has been demonstrated in drug reactions associated with eosinophilia and systemic symptoms (DRESS). Full-Text PDF