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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_141_библиотеки_им_акад_М_И_Перельмана
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77 Pityriasis Rosea
matches the direction of the skin cleavage lines, giving it a
“Christmas tree” shape. At this time, the scales spread from
the inside out, leaving a typical ring of scale peeling (peripheral collarette scaling) inside the edge. Second, it appears as
a small, round, papular lesion without scale. The secondary
rashes mainly occur on the trunk, neck, and limbs and do not
usually occur in sun-exposed areas, so it can be explained
that they mainly occur in women within the area where they
are wearing a one-piece skirt.
The itching varies from patient to patient, but statistically,
about 25% complain of severe itching, about 50% are moderate, and about 25% may have no symptoms. Atypical pityriasis rosea occurs in about 20% of patients. There are various
variants, the herald patch may not appear or may occur multiply, and the herald patch may be the only lesion. The secondary rash can be distributed only peripherally and can also
appear unilaterally. It can occur in various parts such as the
face, mucous membranes, armpits, inguinal region, and palms
and soles, especially facial involvement is common in children. Clinically, vesicles, pustules, urticarial lesions, purpuric
lesions, hemorrhagic lesions, erythema multiforme-like
lesions are also observed. The course of the disease naturally
disappears after 6–8weeks regardless of treatment (Figs.77.2,
77.3, 77.4, 77.5, 77.6, 77.7, 77.8, 77.9, 77.10, 77.11, 77.12,
77.13, 77.14, 77.15, 77.16, 77.17, 77.18–77.25, 77.26, 77.27,
77.28, 77.29, 77.30, 77.31, 77.32, 77.33, 77.34, 77.35, 77.36,
77.37, 77.38, 77.39, 77.40, 77.41 and 77.42).
Many patients with pityriasis rosea have already devel-
oped a secondary rash when they rst visit the clinic. Typical
pityriasis rosea is easily diagnosed due to its characteristic
clinical features and typical lesion distribution. However,
there are various variants of pityriasis rosea in addition to the
classical pityriasis rosea, so in the case of subtypes such as
papular, vesicular, bullous, pustular, urticarial, follicular,
hemorrhagic, and purpuric PR, differential diagnosis from
other diseases is necessary, and in some cases, a skin biopsy
may be performed. Generally, histological ndings play a
supportive rather than essential role in the diagnosis of pityriasis rosea. There are no established diagnostic criteria for
pityriasis rosea that are widely used. The herald patch is
similar to tinea corporis and erythema annulare centrifugum,
and the secondary rash must be differentiated from second-
Fig. 77.2 and 77.3 Herald patch and secondary eruptions of pityriasis rosea
Figs. 77.4 and 77.5 Herald patch and secondary eruption of pityriasis rosea
77 Pityriasis Rosea
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Fig. 77.6 Pityriasis rosea with herald patch observed in the left armpit
area
Fig. 77.7 Herald patch of pityriasis rosea
327
ary syphilis, nummular eczema, seborrheic dermatitis, guttate psoriasis, pityriasis versicolor, pityriasis lichenoides,
drug eruption, and viral rash. In most cases, it is a disease
that naturally disappears, so treatment is not necessary if
there are no symptoms, but it should be understood that it
can take about 6–8 weeks for the rash to disappear. Soap
water, sweat secretion, wool, and stimulating treatments can
worsen the disease and turn it into exfoliative dermatitis, so
contact with or use of these substances is prohibited during
the acute phase. For mild itching and rash, apply zinc oxide
or calamine lotion, or apply 0.5–1% hydrocortisone ointment topically. For severe itching and rash, use UVB radiation (2–3 times/week), oral antihistamines, or topical
steroids, and for severe systemic rash and exfoliative dermatitis, apply wet dressing, steroids, and antihistamines systemically. There are old reports of using dapsone for vesicular
PR, and reports that the antiviral drug acyclovir reduces
symptoms and shortens the duration of the disease, but there
are also reports that it is ineffective. In Korea, it is assumed
that famciclovir will be effective for patients with pityriasis
rosea, similar to or superior to acyclovir, and the treatment
effect was judged after orally administering 250mg of famciclovir three times a day for a week in 17 cases of pityriasis
rosea, but it did not show statistically signicant effects compared to the control group, so the hypothesis that famciclovir
is effective for the treatment of pityriasis rosea failed. There
are reports that macrolide antibiotics such as erythromycin
and azithromycin are effective, but there are also reports that
they are ineffective, so there is still controversy. Based on
personal clinical experience, oral administration of the antiviral drug acyclovir is very effective in shortening the
duration of the disease, so I immediately prescribed acyclovir for Mr. S.
Figs. 77.8 and 77.9 Herald patch of pityriasis rosea
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Figs. 77.10 and 77.11 Pityriasis rosea
77 Pityriasis Rosea
Figs. 77.12 and 77.13 Pityriasis rosea in children
Figs. 77.14 and 77.15 Pityriasis rosea in children
77 Pityriasis Rosea
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Figs. 77.16 and 77.17 Herald patch of pityriasis rosea—10x magnied image
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77 Pityriasis Rosea
Figs. 77.18–77.25 Collarette scaling of secondary rash in pityriasis rosea—10× magnied
77 Pityriasis Rosea
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Figs. 77.26 and 77.27 Lesions with clearly observed peripheral collarette scaling
331
Fig. 77.28 Secondary rashes observed in pityriasis rosea
Figs. 77.30 and 77.31 Secondary rashes observed in pityriasis rosea
Fig. 77.29 Secondary eruptions of pityriasis rosea
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Figs. 77.32 and 77.33 Secondary rashes observed in pityriasis rosea
77 Pityriasis Rosea
Figs. 77.34 and 77.35 Secondary rashes of pityriasis rosea
Fig. 77.36 Rashes showing a Christmas tree pattern matching the skin
cleavage lines
Fig. 77.37 Lesions of pityriasis rosea distributed along the skin cleavage lines
77 Pityriasis Rosea
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Fig. 77.38 Rash showing a Christmas tree pattern matching
the skin cleavage lines
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Figs. 77.39 and 77.40 Pityriasis rosea lesions in children observed on the face and trunk
Fig. 77.41 Pityriasis rosea that only occurred on the arm
Fig. 77.42 Herald patch found on the leg
Allergic Contact Dermatitis
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DuetoAdhesives
78
After attaching an adhesive dressing for wound treatment on my face, the area became itchy and swollen red.
Is it an allergy?
Ms. F, a 12-year-old girl, had a minor wound on her face,
so she bought a translucent dressing at a pharmacy and
applied it, but after removing it, the area became itchy, red,
and swollen. “This is the rst time this has happened to my
child. Is it an allergy?” her mother asked (Figs. 78.1 and
78.2).
Allergic contact dermatitis can also commonly occur due to
adhesives. Adhesives refer to substances used to stick two
objects together, which can be divided into natural adhesives
such as lacquer, glue, milk coagulant, dextrin, starch paste,
soybeans, pine resin, plant mucus, natural rubber, cement,
etc. and synthetic adhesives such as synthetic rubber cement,
synthetic rubber latex, urea and melamine formaldehyde
resin, phenol formaldehyde resin, epoxy resin, polyurethane,
polyvinyl acetate, hot melt, etc. Each of these can come in
various forms depending on their use. Also, during the manufacturing process, softeners, solvents, and additives are
mixed in, among which substances known to commonly
cause allergic reactions include colophony, formaldehyde
resin, epoxy resin, plasticizers, dyes, emulsiers, acrylic
resin, and preservatives such as formaldehyde, α-naphthol,
chloroacetamide, etc. In particular, formaldehyde can be
used as a preservative in adhesives and also as a component
of synthetic adhesives like melamine formaldehyde, phenol
formaldehyde, and carbamide formaldehyde. Formaldehyde
is an irritating gas that easily polymerizes, and formalin is a
37–50% aqueous solution of formaldehyde gas, widely used
in daily life, a potent allergenic sensitizer and a primary irritant. Dermatitis caused by formaldehyde mostly appears as
allergic, and at high concentrations, irritant contact dermatitis can also occur. According to a study investigating the formalin concentration in 43 types (1 natural, 42 synthetic) of
adhesives sold in Korea, most detected formalin at low concentrations below 50ppm, but 4 types detected high concentrations above 150 ppm. Adhesives detected at high
concentrations are mainly wallpaper adhesives used by
housewives and wallpaper workers, and one type of stationery adhesive used in children, which requires caution
(Figs.78.3, 78.4, 78.5, 78.6, 78.7, 78.8 and 78.9).
Figs. 78.1 and 78.2 Allergic contact dermatitis that occurred after applying a translucent polyurethane lm dressing with adhesive on one side
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024
J. Y. Jeong, Dermatology Diaries, https://doi.org/10.1007/978-981-97-1578-7_78
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Fig. 78.3 Allergic contact dermatitis that occurred after applying a
hydrocolloid dressing
78 Allergic Contact Dermatitis DuetoAdhesives
If dermatitis on the foot does not respond to treatment, a
patch test may be necessary to rule out shoe contact dermatitis. Allergic contact dermatitis caused by shoes can be triggered by numerous substances used in the shoe manufacturing
process, including rubber, leather, adhesives, and additives.
Among these, para- tertiary- butylphenol formaldehyde resins
(PTBP-FR) is a widely used adhesive in the footwear industry due to its excellent adhesion, durability, and elasticity and
is known as one of the allergenic substances. Lesions of
allergic contact dermatitis caused by shoes typically appear
on both sides, mainly on the top of the foot and toes. Unlike
athlete’s foot, there are often no lesions between the toes,
and the thicker keratinized part of the sole is reported to be
more resistant to allergens.
Epoxy resin, which has been mass-produced since the
1950s, is widely used in insulators, adhesives, paints, and the
Figs. 78.4 and 78.5 Allergic contact dermatitis that occurred after applying a dressing with adhesive
Figs. 78.6 and 78.7 Allergic contact dermatitis caused by a hydrogel dressing used for burns
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