Internal Medicine

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

1178 Pityriasis Rosea Pleural Diseases: Effusion/Empyema

serology); guttate psoriasis (no collarette of scale, herald patch or

“Christmas tree” pattern)

■Pityriasis rosea-like drug eruptions may occur with gold, captopril,

D-penicillamine, metronidazole, isotretinoin, barbiturates, pyriben-

zamine, ketotifen, combined use of anti-inflammatory and anti-

pyretic drugs, mustard oil, ergotamine, linsinopril

management

■Exclusion of syphilis with VDRL or FTA-ABS if clinical suspicion war-

rants

specific therapy

■Due to the self-limiting nature, therapy needed only for significant

pruritus or cosmetic concerns

■Treatment options include oral erythromycin (for 2 weeks), ultra-

violet B phototherapy or modest amounts of natural sunlight, low-

to mid-potency topical corticosteroids, oral corticosteroids (short

course), and/or antihistamines.

■Recently high-dose oral acyclovir has been advocated as a potential

treatment.

follow-up

■Generally unnecessary

complications and prognosis

■Usual course: 6 to 8 weeks with spontaneous resolution; rarely lasts

longer than 3 months and rarely recurs

PLEURAL DISEASES: EFFUSION/EMPYEMA

GEORGE SU, MD

history & physical

Signs & Symptoms

■Often asymptomatic

■Pleuritic chest pain

■Dyspnea (large effusion)

■Fevers

■Tracheal deviation

■Absent fremitus

■Percussion dullness

■Decreased breath sounds