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Introduction
Introduction to rose pity Pityriasisrosea (Pityriasisrosea) is a common inflammatory skin disease, which occurs in the trunk and the proximal extremities. The number of rosy patches is variegated, with sugary scales, conscious itch, self-limiting, and the disease. Spring and autumn season is good, more common in adolescents, generally 4-8 weeks can be cured on their own, rarely relapse, but a small number of patients are prolonged and difficult to heal. This disease is similar to the "wind sputum" recorded in the medical literature of the motherland. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: skin allergies pruritus
Cause
Rose pity cause
(1) Causes of the disease
It is not clear, there are mother spots at the beginning, and the subsequent plaques are widely distributed. There are certain seasonality, self-limiting and rarely recurring characteristics. Because the disease has seasonal attacks, the rash has self-limiting and rarely relapses. It is a pre-existing plaque, and no specific allergic substance has been found to cause this disease. Therefore, most of them are considered to be related to viral infection. Recently, the relationship between rose peony and Coxsackie B virus infection has been studied in China. The positive rate of virus-specific IgM in the serum Coxsackie B group was significantly higher than that in the healthy control group. The acute phase of serum circulating immune complex was significantly higher than the recovery period, and the neutralization test and virus isolation were both positive. Prove that the patient has Coxsackie B virus infection, these results suggest that the incidence of rose rash is directly related to Coxsackie B virus infection.
In addition, the pathogens of other microorganisms such as fungi, bacterial infections or spirochetes have not been confirmed, and some people think that it is an allergic or gastrointestinal poisoning skin manifestation of an infection.
(two) pathogenesis
It is thought that it may be related to viral infection, but the virus has not been isolated so far. It has been reported that arsenic, bismuth, metronidazole (metidazole), captopril (captopril) and other drugs can cause pityriasis-like damage. Other scholars believe that it is related to bacterial, fungal or parasitic infections, and some scholars believe that it is related to allergic factors, but it has not been confirmed. Recent studies have shown that cellular immune responses are involved in the disease.
Prevention
Rose pityriasis prevention
Early diagnosis, treatment of primary disease, acute stimulation should avoid all kinds of irritation and humidity.
Reduce access to public places, increase resistance, and avoid infection.
Pediatric prevention of home disease care points
1. Pay attention to the mental state of children during high fever: When the rose rash is infested, the spirit of the child is good, but if the child is in poor mental condition or has other conditions, it is necessary to go to the pediatric clinic to see if there are other diseases.
2, antipyretics: high fever can take the doctor to open antipyretics.
3, drink plenty of water: let the children drink more water, rest.
Complication
Rose pityriasis complications Complications, skin allergies, skin pruritus
Pityriasis rosea is a self-limiting disease, which means that it can be cured without treatment, and can be accompanied by symptoms of upper respiratory tract infection such as general malaise, headache, sore throat.
Symptom
Symptoms of rose pityriasis Common symptoms scaly rash pustular lymph nodes swollen papules itching itching appetite loss small blisters on the back
The initial damage is a rose-colored erythema with a diameter of 1 to 3 cm in the trunk or limbs. It has thin scales and is called a precursor plaque. The number is 1 to 3, and the torso is about 1 to 2 weeks later. Red patches of varying sizes appear in the limbs, often symmetrically distributed, starting from the trunk, and gradually developing to the limbs. The patch size varies from 0.2 to 1 cm in diameter, often oval, with finely divided scales in the middle of the patch. On the circumference of the ring-like edge, there is a layer of free scales with free edges. The long axis of the patch is parallel to the ribs or skin lines, which may be accompanied by varying degrees of itching. The lesions of a few patients are limited to the head and neck or limbs. The disease is self-limiting, the course of the disease is generally 4 to 8 weeks, but there are also months, or even 7 to 8 months of unhealed, self-healing or recovery generally does not recur.
A small number of patients began to have red papules, which can be fused together into patches. These patients often have itchy, called pimples-type rose rash.
Another type of patient has a rapid onset, no pre-existing plaque, and a large red patch or maculopapular rash on the inside of the lower abdomen or thigh. It is itchy, and the damage spreads rapidly to the trunk and limbs. These lesions gradually become scarred in the central part. The ecdysis of the ecdysis is a rose rash-like skin lesion. These patients may be caused by their own sensitive reactions. Therefore, it is called rose-type home-sensitive dermatitis. The relationship with rose rash is still to be further studied.
A small number of patients may have systemic symptoms, especially in patients with rose-type home-sensitive dermatitis, who may have a fever.
The disease occurs mostly in young people or middle-aged people, with multiple occurrences in spring and autumn.
1. Typical rose pityriasis
(1) Prodromal symptoms: About 5% of patients developed general malaise, nausea, vomiting, loss of appetite, fever, joint pain and swollen lymph nodes before rash.
(2) mother patch: occurs in 50% to 90% of cases: starting as an isolated pimples, rapidly increasing in the next few days, diameter up to 2 ~ 10cm, round or oval Orange-red or light-colored spots, slightly elevated, clear boundary, covered with fine white scales, when the plaque is stimulated, there may be vesicular vesicular vesicles, and the mother spots appear in the trunk or thighs, sometimes visible Neck or limbs, but the face and penis are rare, the mother spot is good, there is no difference between men and women, the mother spot usually has no symptoms, can be ignored by the patient without paying attention.
(3) Secondary eruption: After several days or 2 months after the appearance of the mother spot, most of the erythema with the same shape and smaller shape as the mother spot appear on the trunk and the proximal extremities, called the sub-spot or secondary The rash and the lesion are elliptical, the long axis is consistent with the dermatoglyph, the center is slightly wrinkled, the boundary is clear, the edge is not uniform, slightly jagged, most of the isolation is not integrated, and the surface is accompanied by a small amount of white enamel-like small scales, secondary After the appearance of the rash, the color of the mother spot becomes lighter, the general nature is dry, and does not tend to be moist. The course of the secondary rash is between 2 and 10 weeks. There is a rash caused by eczema or drug, and the course of the disease will be slightly longer. Generally, there are different degrees. Itching.
(4) Oral damage: often erythema, erosion, punctiform bleeding and ulcers, as well as ring and plaque damage.
(5) Good prognosis: If it is not treated, it usually resolves naturally in about 4 to 8 weeks. Generally, it begins from the middle inside, and gradually changes from yellowish red to yellowish brown, light brown and disappears, and edge inflammation subsides slightly later. The scaly forms a ring, which is similar to body sputum. It has temporary hypopigmentation or pigmentation spots. It usually does not recur after healing. In a few cases, the rash appears repeatedly in batches, and the course of disease can be delayed for more than half a year to heal.
2. Atypical rose pityriasis
Atypical rose pityriasis occurred in 20% of cases, showing no mother spot, or mother spot not found, or only mother spot, no secondary rash, or asymmetry or atypical wide distribution, patient lesions Blisters, pustules, exudates, molting, vesicular and pustular rose pityriasis may also appear on the skin. There are also purpura on the skin lesions, not necessarily the formation of scales, called purpura rose pityriasis, and some Frequently, there is a huge rash around the mother spot. The number of lesions is small and the shape is large. It is good to occur in the armpit or groin. It is often ring-shaped and tends to fuse. It can be accompanied by typical skin lesions, but it can also be used alone. Appeared, called ring-shaped marginal rose pityriasis, some skin lesions are mainly gray-black, similar to multiple plaque-like melanosis, a longer course, called pigmented pityriasis rosea, in addition, there is still papular, Measles, recurrent rose pityriasis, etc.
Examine
Rose pity check
1, blood routine, urine routine, fecal routine.
2, liver function.
3. X-ray inspection.
Histopathology: changes in non-specific chronic dermatitis, epidermal focal keratosis and sponge formation, mild acanthosis hypertrophy, intracellular edema, blister formation in the epidermis, lymphocytes in the epidermis to form a small abscess, Sometimes there may be eosinophilic, keratinized keratinocytes in the epidermis, sparse lymphocytes and tissue cells infiltrating around the superficial blood vessels of the dermis, edema of the dermal papilla, and a number of extravascular red blood cells.
Diagnosis
Diagnosis of rose pityriasis
diagnosis
1. According to its typical clinical manifestations, predilection sites, not easy to relapse, etc., it is not difficult to diagnose.
2. Chinese medicine pathogenesis and dialectic
(1) The disease is caused by blood heat, complex feelings of wind and evil, internal and external evil, hot and evil stagnation, stagnation on the skin, occlusion of the disease and the onset or sweat out of the wind, sweat clothes caused by wet skin.
(2) TCM syndrome differentiation:
Main card: rapid onset, rash pale red, dry skin, debrided scaly, different itchiness, often upset, thirsty, irritability, dry stool, yellow urine, red tongue, thin yellow greasy fur, veins The string slides to a small number.
Dialectical: blood and heat, external sense of wind and evil.
According to the pre-existing plaque, the location of the rash, the shape of the rash has a typical red circle-like free edge inward scaly scaly patch, and the long axis of the rash is parallel to the dermatoglyph, which is not difficult to diagnose.
Histopathology: manifested as non-specific chronic inflammation changes, epidermal keratosis, mild acanthosis, sponge formation and intracellular edema, moderate vasodilation of the dermis, edema and lymphocytic infiltration.
Differential diagnosis
1. Seborrheic dermatitis without mother spots, occurs in the strong sebaceous glands, scales are more greasy, if not treated, the skin lesions will persist, and will not subside.
2. The onset of spotted psoriasis is indefinite, with a reddish inflammatory infiltration, covered with silvery white scales, a bit of bleeding after removal, a longer course, easy to relapse.
3. The second-stage syphilis rash is copper red or dark red, distributed throughout the body, and there is a copper-red round desquamative erythema in the palm and ankle. The syphilis seropositive can confirm the diagnosis.
4. The body tends to occur on the face or torso, the skin lesions are ring-shaped lesions, there are small papules or blisters on the edges, and fungi can be found in the scales.
5. Drug rash arsenic, bismuth, metronidazole (metidazole) and other drugs can cause pityriasis rosea, a history of medication, short course of disease, no mother spots.
6. The incidence of eclipse eczema is uncertain, the inflammation is obvious, the lesion is polymorphous, there are papules, blisters or herpes, which tend to be moist and erosive, and itching is intense.
7 syphilis rash syphilis lesions of the same size, and soon turned pale brown, no scaly or only a few scaly, systemic lymphadenopathy, seropositive.
8 psoriatic rash occurs in the limbs and the knees in time, there are silvery white scales, scrape the scales to see the Auspitz sign, early rash in winter, the summer subsided or reduced, long course, easy to relapse.
9 The rash of the tinea versicolor in the trunk area has no specificity, and the fungal examination is positive.
