Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:57

Pituitary Tumors Pityriasis Rosea 1177

complications and prognosis

■Pituitary apoplexy

■Visual field changes

■Patients require lifelong observation

PITYRIASIS ROSEA

DENISE W. METRY, MD

history & physical

■Most common in adolescents and young adults in spring and

autumn months

■Most patients are asymptomatic prior to onset; viral prodrome (mild

malaise and/or sore throat) is uncommon

■Usually begins with a single, large, oval “herald” patch, followed 1–2

weeks later by oval or annular patches or plaques with thin “col-

larette” of scale near inner side of lesion

➣Symmetrical distribution with long axis of lesions parallel to lines

of the ribs on trunk and proximal extremities (“Christmas tree”

pattern); face, palms and soles usually spared

➣Pruritus common with onset of generalized eruption

■Atypical variants (more common in children): pustular, purpuric,

erythema-multiforme-like, “inverse” (axillae and groin)

■Oral lesions consisting of petechiae, ulcers, erythematous macules or

vesicles/bullae may occur and seem to be more common in children,

black patients and more severely affected individuals

■Viral etiology is highly suspected because of the seasonal occurrence

and finding of human herpes virus6&7insomepatients

tests

■No specific laboratory abnormalities

■Histopathology may be helpful in atypical cases and demon-

strates perivascular lymphohistiocytic infiltrate in the dermis with

extravasated red blood cells.

differential diagnosis

■Herald patch: tinea corporis (fungal hyphae apparent on KOH/

microscopic exam)

■Generalized symmetrical eruption: secondary syphilis (involvement

of palms, soles and mucous membranes, shotty adenopathy, positive