Pityriasis Rosea or Nummular Dermatitis?

[greg51]

Hello Dr. Rockoff, first let me just say thanks for your time and help. Around late November I noticed some lesions pop up on my abdomen and hips and thought they might be ringworm as I have had that once before in hihgschool. As i examined them i noticed that another larger spot had seemingly come and had already begun to fade without my noticing it was there , just of my ribcage. The rash got increasingly worse though never out of control, peaking at about thanksgiving when it lined my ribcage on both sides, covered parts of my back, buttocks, upper thighs and arms. The lesions were salmon pink to light red, circular and seemed to get much redder after a shower. Some grew larger than others but none ever got larger than a dime and they never itched. They were just unsightly. At a about a week and half before christmas the rash leveled off, with no new lesions occuring and began in certain areas to develop small scales. At first my doctor said it was tinea versicolr but selenium sulfide did no good and a second doctor told me it was not Tinea but that it was either pityriasis rosea or nummular dermatitis and that a biopsy would not distinguish the two so that was useless. Now right around a week after christmas it began to get much better on its own. By the time i was told it was p.r. or nummular dermatitis it was already beginning to improve on its own accord. Now all that seems to be left is some dryness of the skin and hyperpigmentation where the lesions were. I have been applying fluticasone ointment, perscribed by my dr., in case its nummular derm. but it doesnt seem to be doing anything one way or another. What I would like to know is if there is any way for me to tell if it was one or the other. Obviously i would not like it to be nummular dermatitis as that seems to be both a chronic and persistent condition to have. As I said, I never experienced itching, there was scaling, but no weeping or fluid leaking from the lesions and simultaneously the rash began to improve in all spots at the same time. If it helps I am a twenty-two year old male with no known history of dermatitis in my family. I'd just like to know if this is something I am going to have to continually deal with or if it was a one time thing. Thank you so much for whatever help you can give. This is a great service you offer to people who need some answers!

[missjlove]

My 7 year old daughter has pityriasis rosea for the secondtime in four years.  The first case was mild and just flared up under her clothes.  The doctor told me last time she would never get it again but here it is again worse than ever it itches this time it is on her face, in her hair, under her arms very bad between her legs and private area all over her back arms chest and belly.  This started with one apot on her bottom that lasted around 2 weeks then all of a sudden they started popping up every where.  The doctor gave her zyrtec.  What else can relieve the itching.  She scratches them until they bleed.  I took her to 2 doctors its confirmed PR again.

[Alan Rockoff, MD]

The appearance you describe and the course (fading over several weeks) are indicative of pityriasis rosea, which is generally a one-time affair.  Nummular eczema, among other things, keeps coming off and on.  Your skin doctor was correct to say that a biopsy would not have been useful.  It sounds as though you're all clear (the marks will go away), and shouldn't expect any recurrence.  If you get any other rashes, show a doctor, but it will probably be something else.

Take care.

Dr. Rockoff