It was a summer afternoon when Melanie and her mother entered my examining room. The young lady was clearly upset. “What’s the problem?” I asked.
“You tell him, Mom,” she retorted. I couldn’t help but thing this 15-year-old is undoubtedly willing to state her mind on curfew, dating and telephone rights, but she demands that her mother tell me why she is here.
“Well, doctor,” the mother began. “Melanie has a large red plaque on her chest and more red itchy ones are coming out all over her upper body. She is so distressed that she will not go to the beach for fear that someone will see them! We’ve simply got to do something about it, right away!”
From the high tension of emotion in the air one might have thought we were going to have to manage a case of leprosy or some other desperate problem. Cautiously Melanie showed me the offending lesions that were keeping her skin hidden from society. With a sigh of relief I told them that the frustrated teen had Pityriasis Rosea. I quickly followed this with an explanation.
Pityriasis Rosea is a relatively common skin condition that is seen most frequently in children and young adults. Its cause is unknown. Investigators have tried to implicate a virus as the causative agent, but none has been identified. Patients with this condition are not isolated because there is no clinical evidence of immediate contagious spread.
Although textbooks describe a period of not feeling well prior to the eruption of the rash, those symptoms are not commonly encountered in a practice setting. The patient usually appears with the patchy, red, itchy, scaly rash predominantly on the trunk, but minus any other symptoms. The patient will usually state that the rash started as a single ½ to 2-inch patch on the body. Then, after several days, the other lesions begin appearing. This first lesion is referred to as “the herald spot”.
The patches are distributed primarily on the chest but are frequently seen on other areas of the body. The itching is usually mild-to-moderate, but very rarely severe. There are no generalized or systemic symptoms. Fortunately, complications or long-term effects are not seen in these patients.
The condition can be divided into three phases: 1) 2-to-6 weeks of increasing rash. 2) 2-to-6 weeks of the lesions remaining fairly constant and 3) 2-to-6 weeks of the eruptions gradually fading. In some patients the lesions leave either a de-pigmentation or increased pigmented appearance in the skin that persists for several weeks. The condition usually does not recur.
The treatment is limited to control of the itching using either topical preparations or oral antihistamines. The main problem to the patient is the appearance of the skin. Teenagers usually do not tolerate such eruptions and refuse to go out in public if the lesions are visible at all. Often parents forget this and are not aware of their child’s emotional needs. An understanding parent can go a long way toward making this disease tolerable for the young adult.
After this lengthy but necessarily detailed explanation Melanie suddenly burst into tears. “I can’t wait for them to go away! I have too many things to do!” The mother turned to me and pleaded, “What can we do? This will make her very sad and limit her social life at a very critical age.”
My last three patients were a child with severe ADHD, a teen with chronic asthma and a child with cerebral palsy. Pityriasis Rosea was, of course, minor compared to these life-altering conditions. Nevertheless, the last thing Melanie wanted to hear was ”It could be worse.” I looked directly at the teen and said, “It will go away very quickly without scars or after-effects.”
Now, addressing the mother, I gave her this sensible advice. “Understand that this is a self-limiting condition. When it is gone the skin is normal. Buy her some stylish T-shirts and let her adjust to this temporary problem. Parents cannot always fix everything. Growing up is adjusting to your own problem--by yourself.”