Letter to the Editor
Pityriasis Rosea in a Confirmed COVID-19 Pediatric Patient
Pitiriasis rosada en un paciente pediátrico con diagnóstico confirmado de COVID-19
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Öncü, D. Güler, G. Gürel, G.Ş. Yalçın" "autores" => array:4 [ 0 => array:4 [ "nombre" => "I.N.S." "apellidos" => "Öncü" "email" => array:1 [ 0 => "oncuisin@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "D." "apellidos" => "Güler" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "G." "apellidos" => "Gürel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "G.Ş." "apellidos" => "Yalçın" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Dermatología, Facultad de Medicina, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Patología, Facultad de Medicina, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pitiriasis rosada en un paciente pediátrico con diagnóstico confirmado de COVID-19" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 490 "Ancho" => 1305 "Tamanyo" => 61357 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Focal mounds of parakeratosis, mild exocytosis of lymphocytes, mild perivascular mononuclear inflammatory cells and some extravasated erythocytes (Hematoxylin & eosin, ×200).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">On December 31, 2019, the World Health Organization identified a novel coronavirus (SARS-CoV-2) in the city of Wuhan in China that spread very quickly and has to date resulted in the deaths of thousands of people by causing COVID-19 disease. Various Coronavirus disease-19 (COVID-19) associated dermatological manifestations have been reported. Among these, Pityriasis rosea (PR) and PR-like rash have been published previously. During the COVID-19 pandemic, the diagnosis of PR has become more common<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–5</span></a>.</p><p id="par0010" class="elsevierStylePara elsevierViewall">PR is a self-limited inflammatory skin disease that can be induced viral agents especially HHV-6 (Human herpes virus 6), HHV-7 (Human herpes virus 7), autoimmunity, psychogenic factors, vaccines and drugs<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a>.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We present here a case of PR in a confirmed COVID-19 pediatric patient.</p><p id="par0020" class="elsevierStylePara elsevierViewall">A 10-year-old boy presented with a 20-day history of skin rash. It was learned that he had Covid-19 infection about 1 month ago and he did not use any medication. In dermatological examination, there were small plaques with erythema and collary scaly located parallel to the ribs on the body (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Complete blood count, liver and kidney function tests, hepatitis markers, sedimentation and CRP values were in normal ranges. Histopathology of one lesion's biopsy showed focal parakeratotic peaks, spongiosis, focal spongiotic vesiculation, lymphocyte exocytosis, mildly irregular acanthosis with mild homogenization of collagen in the dermis, mild to moderate perivascular erythocyte infiltration in the superficial vascular plexus, scattered lymphocyte infiltration, sparse lymphocytes was seen (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The diagnosis of PR after Covid -19 infection was established with clinical and histopathologic findings. The patient was treated with betamethasone valerate ointment, 10% urea and cetirizine. Lesions regressed one month later.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The association between PR and COVID‐19 infection is not clearly known. In the literature, patients with confirmed COVID-19 developed PR and PR-like rash, some of them while asymptomatic or symptomatic disease, others after COVID-19 infection<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–5</span></a>. Therefore, in a patient presenting with PR and PR-like rash, it is necessary to keep in mind Covid-19 infection and suggest SARs-CoV-2 testing for necessary patients. PR could be directly dependent to COVID-19 infection, or to viral reactivation (HHV-6, HHV-7, EBV)<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–5</span></a>. In addition, the increased psychological stress caused by the pandemic period may have contributed to the trigger<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. Due to the limited number of data, it is very difficult to prove a causal relation in these cases.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, dermatologists should be aware that cutaneous symptoms may be linked to COVID-19 infection.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Öncü INS, Güler D, Gürel G, Yalçın GŞ. Pitiriasis rosada en un paciente pediátrico con diagnóstico confirmado de COVID-19. Actas Dermosifiliogr. 2021;112:864–865.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1205 "Ancho" => 905 "Tamanyo" => 164098 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Diffuse erythematous lesions on the trunk and many of lesions had peripheral scales.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 490 "Ancho" => 1305 "Tamanyo" => 61357 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Focal mounds of parakeratosis, mild exocytosis of lymphocytes, mild perivascular mononuclear inflammatory cells and some extravasated erythocytes (Hematoxylin & eosin, ×200).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The clinics of HHV-6 infection in COVID-19 pandemic: Pityriasis rosea and Kawasaki disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. 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Spigariolo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Med Virol." "fecha" => "2020" "volumen" => "18" "numero" => "10" "paginaInicial" => "1002" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pityriasis rosea in otherwise asymptomatic confirmed COVID-19-positive patients: a report of 2 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Johansen" 1 => "S.S. Chisolm" 2 => "L.D. Aspey" 3 => "M. Brahmbhatt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jdcr.2020.10.035" "Revista" => array:6 [ "tituloSerie" => "JAAD Case Rep." "fecha" => "2021" "volumen" => "7" "paginaInicial" => "93" "paginaFinal" => "94" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33195784" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack560502" "titulo" => "Acknowledgment" "texto" => "<p id="par0035" class="elsevierStylePara elsevierViewall">The patient and his family in this manuscript have given written informed consent to publication of his case details.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011200000009/v1_202110091021/S1578219021002067/v1_202110091021/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011200000009/v1_202110091021/S1578219021002067/v1_202110091021/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021002067?idApp=UINPBA000044" ]
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| 2022 March | 711 | 93 | 804 |
| 2022 February | 1044 | 61 | 1105 |
| 2022 January | 1163 | 112 | 1275 |
| 2021 December | 1190 | 81 | 1271 |
| 2021 November | 560 | 233 | 793 |
| 2021 October | 96 | 507 | 603 |
| 2021 September | 36 | 460 | 496 |
| 2021 August | 46 | 128 | 174 |
| 2021 July | 40 | 52 | 92 |
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