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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 15  |  Issue : 1  |  Page : 77-80

One-year review of pityriasis rosea among outpatients in Kano, Northwestern Nigeria


Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria

Date of Web Publication23-Mar-2018

Correspondence Address:
Dr. M S Mijinyawa
Department of Medicine, Aminu Kano Teaching Hospital, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njbcs.njbcs_10_16

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  Abstract 


Background: Pityriasis rosea (PR) is an acute self-limiting papulo-squamous skin disorder commonly observed in otherwise healthy children and young adults. Objective: To describe the clinical pattern of PR in Kano, Northwest Nigeria. Materials and Methods: This was a descriptive cross-sectional study that was carried out between June 2010 and May 2011 among out-patients attending three dermatology clinics in Kano, Nigeria. Patients with rashes that met the clinical diagnostic criteria of PR were recruited and followed up until there was resolution of lesions. The demographic characteristics of the patients were recorded along with the clinical manifestations of the lesions. All the data obtained were analysed using SPSS for Windows. Results: Out of 1,528 patients seen over the 12 months study period, 56 patients had PR out of which 23 (41.1%) were males and 33 (58.9%) were females, giving a male:female ratio of 1:1.4. PR, therefore, accounted for 3.6% of all dermatology out-patient visits in Kano. The patients' ages ranged from 6 years to 55 years with most of them in the age range of 11–20 years. The peak month of incidence was January in which about a quarter (21%) of the patients were seen. Only 5 (8.9%) patients had prodromal symptoms preceding the onset of the rash. Herald patch, which was mainly located on the trunk, was present in 45 (80%) of the studied patients. Secondary eruptions appeared within 7 days after the herald patch in 69% and had a typical Christmas tree pattern of distribution along the line of skin cleavage in 70% of the patients. Approximately three-quarter (73 %) of the patients had complete resolution of the rash by the 4th week. Recurrence was not reported 24 weeks after the last patient was seen. Conclusion: The pattern of presentation of PR was not different from that observed by other researchers. However, contrary to earlier reports from south Nigeria, our study shows that PR occurs more frequently during the cold dry season.

Keywords: Herald patch, incidence, Kano, pityriasis rosea, season


How to cite this article:
Yusuf S M, Tijjani U A, Nashabaru I, Saidu H, Gezawa I D, Mijinyawa M S. One-year review of pityriasis rosea among outpatients in Kano, Northwestern Nigeria. Niger J Basic Clin Sci 2018;15:77-80

How to cite this URL:
Yusuf S M, Tijjani U A, Nashabaru I, Saidu H, Gezawa I D, Mijinyawa M S. One-year review of pityriasis rosea among outpatients in Kano, Northwestern Nigeria. Niger J Basic Clin Sci [serial online] 2018 [cited 2021 Jun 16];15:77-80. Available from: https://www.njbcs.net/text.asp?2018/15/1/77/228350




  Introduction Top


Pityriasis rosea (PR) is an acute self-limiting papulo-squamous skin disorder commonly observed in otherwise healthy children and young adults, though it may develop at any age.[1],[2] The disease has a worldwide distribution with a global incidence of approximately 2% of out-patient dermatologic visits.[3] Both sexes seem to be equally affected, though a female preponderance has been observed in a few studies. The disease is widely reported to exhibit seasonal variation with more cases occurring during spring and fall in temperate regions.[4],[5] Reports from Africa, however, show variable seasonal relationship.[6] PR has variable morphological patterns and disease course in different geographical regions. Therefore, we set out to describe the pattern of the disease encountered in out-patients attending dermatology clinics in Kano, Nigeria.


  Materials and Methods Top


This was a prospective observational study carried out in three out-patient dermatology clinics in Kano, Nigeria (Aminu Kano Teaching Hospital, Kano; Mohammed Abdullahi Wase Specialist Hospital, Kano and General Hospital, Yadakunya, Kano) between June 2010 and May 2011. The study commenced after obtaining clearance from the Health Research Ethics Committee. All new patients seen at these clinics were registered and clinically evaluated. Those who satisfied the inclusion criteria for the study were recruited.

For this study, clinical diagnosis of PR was made if 3 of the following 4 clinical features were observed: (1) herald patch, (2) peripheral collarette scaling, (3) mainly truncal and proximal limb distribution and (4) orientation of lesions along lines of skin cleavage, parallel to the ribs, or in a Christmas tree or anti-Christmas tree pattern. These diagnostic criteria were validated and applied in other studies.[7],[8],[9] Detailed history was obtained and examination of the rashes was carried out on each respondent using an interviewer administered questionnaire.

Investigations including skin biopsy, Venereal disease research laboratory (VDRL) and fungal studies were done, especially in doubtful cases to further exclude other diseases that may have similar presentation.

The patients were then followed up at regular intervals and at each visit changes were recorded until complete resolution of the lesion occurred. The data obtained were analysed using SPSS for Windows (version 13.0; SPSS Inc. Chicago, Illinois, USA) statistical software package. Continuous variables were expressed as mean (SD), whereas categorical variables were expressed as proportions. Student's t-test was used to compare differences between quantitative variables, whereas chi-square test was used to compare qualitative variables. Statistical significance was set at P< 0.05.


  Results Top


A total of 1,528 new patients were seen in the three out-patient dermatology clinics over the period of study (June 2010 to May 2011). Of these, 56 patients satisfied the inclusion criteria and were recruited for the study, yielding an incidence of 3.6%. Of the 56 patients with PR, 23 were males and 33 were females giving a male-female ratio of 1:1.4. The youngest patient in the study was 6 years old whereas the oldest was 55 years old with a mean age of 18.1 ± 12.27 years. The highest incidence of PR was observed in the age group 11–20 years [Table 1].
Table 1: The age and sex distributions of patients

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The peak month of incidence was January as depicted in [Figure 1], during which about one-quarter (21%) of the patients were seen. Prodromal symptoms preceding the onset of the rash were reported by 5 (9.8%) patients.
Figure 1: Bar diagram showing the number of PR cases by months.

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Presence of herald patch was observed in 45 (80%) of the patients studied. Of them, 42 (93%) had only one herald patch, whereas the remaining 3 (7%) had two or more herald patches. The clinical characteristics of the patients with PR are given in [Table 2]. Herald patch was located on the trunk in 32 (72%) patients. It occurred on the upper limbs in 10 (22 %), the lower limbs in 2 (4%) and the neck in 1 (2%) patients. The interval between the herald patch and the appearance of secondary eruptions was within 7 days in 38/56 (69%) of the patients, but by the 14th day, 54/56 (97%) of the patient had developed an eruption. The distribution of secondary eruptions was mainly the trunk, followed by the trunk and extremities. Six (10%) patients had facial involvement. The classic pattern with the rash in the typical Christmas tree pattern along the line of skin cleavage was seen in 39/56 (70%) of our patients. Atypical forms were encountered in relatively small proportions. Localised PR was observed in 6 (9%) patients, inverse in 10 (18%) and unilateral in only 1 patient.
Table 2: Clinical characteristic of the rash

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The plaques type was the most common morphology of the secondary rashes, which occurred in 33 (59%) of the patients. This was followed by the papular variant that was seen in 22 (39%) patients, whereas the urticarial type was seen in 1 (2%) patient [Table 2].

History of contact with anyone with similar rashes was obtained in only 4% and history of similar rashes was obtained in 9% of the patients.

Fifteen percent of the patients had complete resolution of the rash within 2 weeks. By the 4th week, 73% of the patients had complete resolution. Only 6 patients (13%) had rashes extending up to and beyond 12 weeks. Recurrence was not reported 24 weeks after the last patient was seen.

Other significant changes observed were post-inflammatory pigmentary changes, with hyperpigmentation (PIH) being more common, which was observed in 4 (7%) patients at 4th week follow-up. Post-inflammatory hypopigmentation was seen in only 1 patient by the 8th week follow-up. Secondary bacterial infection of the lesions was not observed. None of the cases studied was positive for VDRL, whereas only one case of HIV was encountered. The patient was diagnosed with the HIV about 3 years earlier and was on HAART (highly active anti-retroviral treatment). Only 40% of the patients with PR had lymphocytosis, whereas 22% had elevated ESR.


  Discussion Top


The incidence of PR in the present study was 3.7%, which falls within the range obtained from similar studies from different regions of Nigeria. These studies reported a range of incidence from 2.4[10] to 3.7[11] per 100 dermatological patients. In various studies, PR has been reported to be equally common in both sexes.[3] The slight female preponderance obtained from this study was also reported by earlier study in Nigeria.[11],[12] A few other studies have also shown female preponderance.[13],[14] These observations could possibly have been caused by greater cosmetic concern in women. There is likely no real sex predisposition as reported in some studies.[15]

Previous studies have reported contradicting results for seasonal variation of PR. Studies in the UK,[16] USA [17] and Sudan [18] reported higher incidence of PR in the colder months. One study from southern Nigeria [12] reported higher incidence in the early part of the rainy season. A study in Brazil [19] and another in Singapore [20] reported a bimodal distribution. No seasonal variation was reported by studies from Turkey [14] and Singapore.[21] The present study showed the highest incidences of PR occurring from the month of November -to January, which coincided with the onset of dusty, cold dry season. Our finding is, thus, in agreement with those reporting that most cases occurring in winter.

Prodromal illness such as upper respiratory tract infection (cough/catarrh) was seen in 5 (9.8%) patients; this rate was similar to what was reported by other researchers.[22],[23],[24]

In this study, herald patch was reported in 45 (80%) patients, with the most common location being the trunk. This was seen in 32 (71.1%) patients. These findings were similar to what was reported previously, where the occurrence of herald patch was seen in 40–76%,[18],[25] with the most common reported site being the trunk in 48.7–57.2.[18],[25],[26]

The classical PR constituted 70% (39/56) of the studied cases, which is in tandem with other studies that reported herald patch in 80%.[26] Atypical PR was seen in 17 (30%) patients; inverse PR was found in 10 (18%) patients, localised PR in 6 (10%) patients and unilateral in 1 (2%) patient. These values are similar but slightly higher than that in other studies.[21],[27],[28] Tay et al. reported inverse PR of 6% in their studied patients,[21] while localised PR was present in 4% in a study by Egwin.[26] Our findings support an earlier study that showed inverse distribution of PR is more frequent in black patients.[15]

Findings from this study showed that secondary eruptions occurred within the first 2 weeks of the appearance of the HP in 97%, which is in disagreement with the study of Sharma et al. who reported that secondary eruptions occurred within 10 days after HP in 62.5% of the patients.[29]

Secondary eruptions were most commonly distributed on the trunk in 94%, which is similar to previous studies.[18],[26]

The secondary lesions may be papules, vesicles, pustules or urticarial or purpuric plaques. The plaque type was the dominant morphological variant seen in our study, which occurred in 59% of the cases. This finding was similar to what Bernardin et al. found in their study.[27] Papular PR was seen in 39% of the cases. This corroborates with the findings in black Americans where the papular and vesicular varieties accounted for approximately 35% of their cases.[15]

Oral mucosal involvement was reported to vary in frequency from 1% to 16%.[30],[31]

In comparison, none of our study patients presented with mucosal involvement. PR may be asymptomatic or it may present with pruritus. This symptom is mild in 25% of the cases, mild to moderate in 50%, and severe in 25% itching.[3],[15] Itching was the predominant symptom reported in this study as it was reported in 53 (84%) patients. This finding is similar to what was reported by Egwin et al. in India.[26]

Only a few patients reported detecting aggravating or relieving factors for their disease, most of which was the worsening of the rashes after taking ampicillin either taken on self-medication or prescribed by the general practitioner (GP). A similar observation was made by earlier studies in Nigeria.[11],[12]

PR is a self-limiting disorder that spontaneously remit within 6 to 8 weeks.[12],[15],[23],[25] In our study, 73% of our patients had complete resolution of the rash by the 4th week and 15% had resolution of the rash within 2 weeks. Only 6 patients (13%) had rashes extending up to 12 weeks and beyond.


  Conclusion Top


The pattern of presentation of PR was not different from what was observed by other researchers. However, contrary to earlier reports from the southern part of Nigeria, our study shows that PR occurs more frequently during the cold dry season.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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