Itching All Over

Pityriasis rosea is a skin disease marked by patches of pink, oval rash. Although its exact cause is unknown and its onset is not linked to food, medicines or stress, it is thought that this essentially non-contagious condition is set off by a virus. Pityriasis rosea can affect members of either sex of any age. Pityriasis rosea is uncommon in those over 60 years old. It may last months longer when it occurs in this age group. A single scaling patch often appears one to twenty days before the general rash. It is an oval plaque 2-5 cm in diameter, with a scale trailing just inside the edge of the lesion. The herald patch is often mistaken as ringworm. It can also be confused with psoriasis. Often, the patches are confined to the upper body and may follow the ribs in lines. The rash lasts around one or two months then clears up completely.

What causes it?

Pityriasis rosea may be set off by a viral infection but it does not appear to be contagious. Herpes viruses 6 and 7 have sometimes been associated with pityriasis rosea. It is not related to foods, medicines, or stress.

Pityriasis rosea clears up by itself in about six to twelve weeks. When clear, the skin returns to its normal appearance. It leaves no scars, although pale marks or brown discolouration may persist for a few months in dark skinned people.

What are the symptoms?

Pityriasis rosea causes a rash.

* The rash often begins with a single, round-to-oval, pink patch that is scaly with a raised border (herald patch). Its size ranges from 2 cm to 10 cm. The larger size is more common. See an illustration of a herald patch.

* Days to weeks later, salmon-colored, 1 cm to 2 cm oval patches appear in batches on the abdomen, chest, back, arms, and legs. Patches sometimes spread to the neck but rarely to the face.

*Itching of the lesions (mild to severe)

* Fever & fatigue (but rare)

Pityriasis Rosea Treatment

Treatment may include external and internal medications for itching. Aveeno oatmeal baths, anti-itch medicated lotions and steroid creams may be prescribed to combat the rash. Lukewarm, rather than hot, baths may be suggested. Strenuous activity, which could aggravate the rash, should be discouraged. Ultraviolet light treatments given under the supervision of a dermatologist may be helpful. Recently, both the antiviral drug Famvir and the antibiotic erythromycin have been claimed to produce healing in one to two weeks. For severe cases a few days of oral anti-inflammatory medications such as prednisone may be necessary to promote healing

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Psariasis

Annular patterns are particularly likely to be found in psoriasis when individual lesions undergo resolution. In such a situation the central portion of a plaque fades, leaving an erythematous border at the periphery. This border is generally wider (5 to 8 mm) than that found in the other annular diseases, and there is a tendency for the border to break up into individual papules. The size of the annular lesions and their configuration depend on the appearance of the plaque that preceded them. Since annularity usually occurs during resolution, centrifugal growth is not commonly seen. Typical psoriatic scale is usually present on the border, but when the disease is under active treatment, the formation of scale is minimal or absent. Diagnosis is not ordinarily difficult, since more typical lesions of psoriasis can be found elsewhere on the body.

Tinea Corparis

Annular lesion’s are found in Microsporum. sp. infections of children and in TrichoPhyton rubrum. infections of adults. In children the lesions are solitary or are few in number. They are usually only 2 to 4 cm in diameter and are generally found on exposed surfaces. Complete circles are formed, and there is relatively little tendency for coalescent growth of adjacent lesions. Scale is always present at the active border. The amount of inflammation and thus the intensity of the redness are highly variable. Potassium hydroxide (KOH) preparations, fungal cultures, or both should be carried out to confirm a clinical diagnosis.

The annular lesions of tinea corporis in adults are quite different. Larger rings are noted, and coalescent growth frequently results in the development of very large lesions with serpiginous borders. Complete circles are not often found, and in fact, gaps in the ring-like border may be large enough to interfere with recognition of the annular pattern. The active, advancing border is quite narrow (1 to 3 mm) and is usually scaling. Postinflammatory hyperpigmentation may be found within the central portion of the lesions as centrifugal growth occurs. New circles can sometimes redevelop in the cleared central area of the larger rings. Tinea corporis in the adult usually begins on the upper, inner thighs and from there extends onto the buttocks and lower trunk around the belt line. Less commonly, the face or dorsal surface of the hands may be involved. The disease is pruritic, and excoriations (fungal eczema) are often present. KOH preparations, fungal cultures, or both should be used to confirm a clinical diagnosis.

Lupus Erythematosus

The lesions of discoid Lupus Erythematosus (LE) regularly assume an annular configuration when the central portions of otherwise-solid plaques begin to undergo resolution. This resolution often results in the development of hypopigmentation and scarring in the central area. The presence of scarring is a pathognomonic feature of discoid LE. Some of these annular plaques are stable in size, while others show evidence of very slow centrifugal growth. The active border is usually thin, with some evidence of scale formation. Most lesions are 2 to 5 cm in diameter. Lesions are most often found on the face, scalp, and neck, but occasionally the upper trunk and arms are involved. A clinical diagnosis can be confirmed by biopsy.

Annular lesions are also seen in subacute cutaneous LE and, sometimes, in systemic LE. They are located on the trunk and proximal arms rather than on the face and scalp. These lesions greatly resemble those of the gyrate erythemas . On the other hand, they lack the central hypopigmentation and scarring found in discoid-type disease. Pityriasis Hosea. The herald patch of pityriasis rosea regularly demonstrates an annular configuration. The border is brown-red, and fine (pityriasis-type) scale is present. The lesion is usually 3 to 5 cm in diameter and, once present, does not grow in size. The herald patch when seen in the presence of full-blown pityriasis rosea is not difficult to recognize. Unfortunately, when it occurs before the rest of the disease develops, it is easily misdiagnosed as tinea corporis. KOH preparations will, of course, distinguish between the two. The smaller lesions of pityriasis rosea are only rarely annular.

Lichen Planus

Ringed lesions are sometimes seen in lichen planus, but they are generally outnumbered by more typical flat-topped papules and plaques. Annular lesions when present are quite small, rarely measuring more than 2 or 3 cm in diameter. Both partial and complete circles may be formed. It is sometimes possible to distinguish, within the annulus, individual papules that have not completely coalesced. The color is distinctively violaceous, and the surface is shiny because of the reflective properties of compacted lichenoid scale. Annular lesions are particularly likely to be found on the volar surface of the wrists and on the shaft of the penis. The presence of one or more linear lesions occurring as a result of the Koebner phenomenon is a very helpful diagnostic sign. Biopsy is pathognomonic.

Secandary SyPhilis

Annular lesions are occasionally seen in secondary syphilis. As in lichen planus, the annular lesions are small, with most being less than 2 cm in diameter. The color is red rather than violaceous. Linear lesions are not found. The annular lesions of secondary syphilis are particularly common on the face and genitalia. Clinical recognition is assisted by the regular presence of other symptoms and signs of secondary syphilis. The serologic test for syphilis will be positive. Biopsy of the lesions is highly distinctive.

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Ringworm is the most common fungal skin infection seen in cats. Contrary to the name, ringworm is caused by a microscopic group of parasitic fungal organisms known as dermatophytes (which means “plants that live on the skin”). Ringworm invades the dead, outer layers of the skin, claws & hair.

Ringworm is often a misdiagnosis for other conditions, especially numular eczema and pityriasis rosea.

Remember that athlete’s foot is unusual in preteen children. These children often have Juvenile Plantar Dermatosis or a contact dermatitis when they have an itchy red rash on their feet.

Ringworm is only mildly contagious, so children undergoing treatment may continue to attend school or daycare. In addition to infected people, you can get ringworm from infected cats and dogs. So examine your pets if someone in your family develops ringworm.

Wash the rash with soap and water, remove flaky skin, and dry thoroughly. For large areas of blistered sores, use compresses such as those made with Burow’s solution (available without a prescription) to soothe and dry out the blisters.

Apply antifungal cream beyond the edge or border of the rash.

Follow the directions on the package. Don’t stop using the medicine just because your symptoms go away. You will probably need to continue treatment for 2 to 4 weeks.

Shampoos/Dips: Lime sulfur dips are the most effective. Sometimes clipping the cat (especially longhaired cats) is recommended to increase the effectiveness of treatment & also decrease environmental contamination. The cat must not be allowed to lick it’s coat before it dries as this can cause vomiting. Bathing should be done every 4 – 6 days for approximately 2 – 4 weeks. Lime sulfur dips can cause yellowing of the coat, this however will fade in time.

Anti-fungal creams can be purchased for this infection, and are usually combined with a mild antiseptic and a mild steroid to reduce your itching. Keeping the infected area clean and well aired plays an important role in healing this infection. If your over the counter treatment fails, or the infection is widespread, you should see your doctor. He can prescribe you some oral medication such as fluconazole.

The first order of business with treating this is for the person to avoid self-diagnosis and to get a correct diagnosis from a doctor. Treatment for Ringworm is either topically or orally. Several medications are clotrimazole and miconazole and ketoconazole and terbinfine (Lamisil cream and lotion) which are creams that comes in many brands. These medications are often good for foot fungus also. Oral medications are itraconazole and fluconazole and contrary to popular belief these are not harmful to the liver.

Israel compensates for ringworm treatment

The Israeli government has announced that it will give financial compensation to former patients with ringworm who were given radiation treatment and who then developed cancer. In common with other countries, Israel treated patients with ringworm over four decades ago with high dose radiation. Now the Israeli government–while insisting that radiation was then a “treatment of choice” for the fungal disease–has decided to compensate these victims or their dependants financially.

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Pityriasis lichenoides chronica, short form PLC, is the chronic version of the Pityriasis lichenoides et varioliformis acuta, also called Mucha Habermann’s Disease. Pityriasis lichenoides encompasses a spectrum of clinical presentations ranging from acute papular lesions that rapidly evolve into pseudovesicles and central necrosis (pityriasis lichenoides et varioliformis acuta or PLEVA) to small, scaling, benign-appearing papules (pityriasis lichenoides chronica or PLC). The condition can range from a relatively mild chronic form to a more severe acute eruption. The mild chronic form is known as pityriasis lichenoides chronica. It is characterised by the gradual development of symptom less, small, scaling papules that spontaneously flatten and regress over a period of weeks. It is a disease of the immune system.

Causes:

A number of acute exanthems (eg, Mucha-Habermann disease, pityriasis rosea, acute lichen planus, guttate psoriasis, erythema multiforme) are believed to be caused by a hypersensitivity reaction to infectious agents. Familial outbreaks, clustering of cases, and comorbid symptoms have been used to support these relationships in Mucha-Habermann disease, although clear causality is lacking.

Signs and Symptoms of Pityriasis lichenoides chronica

Pityriasis Lichenoides start out as a small rash that is red-brown in color that appears to be raised. Sometimes these bumps can have a clear fluid inside them. Unlike pityriasis lichenoides et varioliformis acuta, lesions are not painful, itchy or irritable. Pityriasis lichenoides chronica most commonly occurs over the buttocks, arms and legs, trunk. It almost feels like you are coming down with a case of the flu.

Treatment of pityriasis lichenoides

Pityriasis lichenoides may not always respond to treatment and relapses often occur when treatment is discontinued. If the rash is not causing symptoms, treatment may not be necessary. Large ulcerations found in febrile ulceronecrotic Muchas-Habermann disease require local wound care.

In cases where treatment is necessary, there are several different therapies available. Current recommended first-line therapies include:

* Sun exposure may help to resolve lesions but sunburn should be avoided.

* Topical steroids to reduce irritation. In more recent years concerns raised about their side effect profile has led to the increased use of nonsteroidal topical immunomodulators.

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• Therapy For the Treatment of Psoriasis
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Pityriasis Rosea

The cause of this skin rash is unknown, although some physicians suspect a virus is responsible. It starts as one or more large, red, scaly spots, generally on the trunk. Over the next few days the spots grow and spread to cover the trunk and upper arms (the same area that aT-shirt would cover) and perhaps the upper legs. The spots become oval patches of copper-colored skin with scaly surfaces. They often itch, and may persist for four to eight weeks. A slight sore throat may occur as the rash develops. The condition affects mainly children and young adults.

What Should be Done?

Pityriasis rosea is not dangerous, but you should visit your physician to be sure that you do not have some other similar, but more serious, skin disorder. Your physician may advise you to wait for the rash to disappear naturally. You can relieve any minor itching by applying cold cream to the rash. If the rash is very bad, the doctor may prescribe a steroid cream, and severe itching can be treated with antihistamine tablets. During the worst weeks of the condition, you should avoid hot baths or showers.

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