PITYRIASIS ROSEA AND PRURITUS ---------------------------------------------------- A pediatrician in our group has developed an extremely pruritic PR like eruption on the upper torso, axilla, and inguinal regions. Classic collarette. No history of herald patch (though he may not have noticed if it was on his back etc.). He had 10 days of severe itching preceding the rash.....he wanted to know from the group if itch before rash was at all common in PR. His physician did a mini PUO work-up when he initially presented, all negative. Diane Thaler ------------- Itching in PR is very uncommon in the adult. Could it be a PR-like drug eruption? Any history of medication intake? Jerry Litt ----------- An excellent thought. Don't forget the outside possibility of secondary lues. Jay McCarty ------------ What meds is he taking????? Jeff Marmelzat, M.D. -------------------- He takes advil prn, tylenol prn, and possibly tried zoloft-I am not sure of the timing here. I will be more persistant in my history taking tomorrow). You know the old problem of not taking good care of friends, neighbors (and colleagues)-not wanting to be as "invasive." He had no palmar lesions. I would be interested to know if Dr.Litt has received reports of Zoloft PR-like eruption. Diane Thaler ------------ I would have to respectfully disagree with Dr Litt who states that itching is uncommon in adults with PR. At lease here in the south itching is a common occurance in adults with PR and less of a problem in children. W H Burrow MD ------------- Dr. Thaler wondered about Zoloft causing a PR like eruption. Yesterday I saw a colleague with a PR/LP like eruption possibly from Paxil, which as you know, is in the same group as Zoloft. He had lesions on the palate, which were more in keeping with LP. A biopsy is pending. These lesions did not itch, in contrast to Diane's patient. I searched Dr. Litt's drug base and did not find an LP like eruption reported with Paxil. Physicians Silver Platter had no citations concerning the association. Elliot Puritz -------------- I agree with Dr Burrow. Here in Europe, pruritus is common as well in adults with PR. Maybe this explains the "success" of topical steroid treatment. Dr. med. H. Kammler ------------------- In addition to PR-like drug eruption I would offer one experience of an extremely itchy "Classic" PR that turned out to be multiple areas of M. Canis. Unfortunately this was only discovered after the patient had used topical steroids of 10 days and the 1-2cm ovals all became 5cm annules. As for therapy UVb is at least free and abundant this time of year. L.J. Gregg,MD ------------- The patient took Zoloft too many months ago to count, so if it is drug, it is Advil or Tylenol. I neglected to KOH, I will tomorrow (per Dr.Gregg). The sun finally appeared in Wisconsin today, so, I sent him out jogging without a shirt over lunch. He states he now has much empathy for his patients skin problems and symptoms! Diane Thaler ------------ According to the Rook textbook, 'Subjective symptoms are usually absent, but there may be slight or moderate pruritus.' Jerry Litt -----------