official website and that any information you provide is encrypted The following self-care tips may help relieve the discomfort of pityriasis rosea: Take nonprescription allergy medicine (antihistamines), such as diphenhydramine (Benadryl, others). A Yale-led study published in the journal Immunity in May offers a few theories on why some children develop MIS-C and others don't. and transmitted securely. (2020) 83:e5760. Case Report: Pityriasis Rosea-Like Eruption Following COVID-19 Vaccination. Drago F, Broccolo F, Ciccarese G. Pityriasis rosea, pityriasis rosea-like eruptions, and herpes zoster in the setting of COVID-19 and COVID-19 vaccination. doi: 10.1111/bjd.20143. Martora F, Battista T, Marasca C, Genco L, Fabbrocini G, Potestio L. Clin Cosmet Investig Dermatol. The https:// ensures that you are connecting to the COVID-19; SARS-CoV-2; pityriasis rosea; vaccination. 2022 May;35(5):e15391. Lasers Med Sci. In the period May 2021- February 2022 we observed five cases of clinically typical PR that appeared 2 to 3 weeks after anti-SARS-CoV-2 vaccination with BNT162b2 (3 patients) or mRNA- 1273 (2 patients). Herald patch is often absent. -, Welsh E, Cardenas-de la Garza JA, Cuellar-Barboza A, Franco-Marquez R, Arvizu-Rivera RI. Dermatol Ther. Pityriasis rosea after mRNA COVID-19 vaccination Pityriasis rosea after mRNA COVID-19 vaccination Pityriasis rosea after mRNA COVID-19 vaccination Pityriasis rosea after mRNA COVID-19 vaccination Int J Dermatol. This is called the herald patch. Since you said you felt ill at the time getting the vaccine you had covid at the time. Literature data about PR/PRLE after anti-SARS-CoV-2 vaccination may be summarized as follows: i) the infection occurs both in males and females (in several articles the gender was not reported); ii) the age ranges from 19 to 82 years (the count of the mean age is impossible because in several articles patients age was not specified). Pityriasis rosea-like eruption after Pfizer-BioNTech COVID-19 vaccination Pityriasis rosea-like eruption after Pfizer-BioNTech COVID-19 vaccination Pityriasis rosea-like eruption after Pfizer-BioNTech COVID-19 vaccination Pityriasis rosea-like eruption after Pfizer-BioNTech COVID-19 vaccination Br J Dermatol. Clipboard, Search History, and several other advanced features are temporarily unavailable. PMC Available doctors, insurances and verified patient reviews for Optimized Health and Wellness. Qaderi K, Golezar MH, Mardani A, Mallah MA, Moradi B, Kavoussi H, Shamsabadi A, Golezar S. Dermatol Ther. doi: 10.1002/jmv.26549, 9. doi: 10.1111/dth.15040. Although the exact pathogenesis of PR remains unknown, the endogenous systemic reactivation of HHV (i.e., type 6 and 7) in the skin has been implicated as a precipitating factor. Before 7 Articles, This article is part of the Research Topic, Creative Commons Attribution License (CC BY), Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. Viruses, Variants, and Vaccines: How COVID-19 Has Changed the Way We Look at Skin. Table 1 summarizes all reported cases of PR-like eruption following COVID-19 vaccination. Unable to load your collection due to an error, Unable to load your delegates due to an error. J Am Acad Dermatol. National Library of Medicine Federal government websites often end in .gov or .mil. J Eur Acad Dermatol Venereol. Pityriasis rosea has been found to be a symptom of the virus itself not the vaccine In fact there is no evidence the vaccine gives pityriasis rosea but instead getting covid itself does instead. 18. PR has also been reported to follow COVID-19 vaccination (11). official website and that any information you provide is encrypted Pityriasis rosea is a common skin disease that is not contagious. In a Turkish-Egyptian study, the average age was 44.9 years;17 iii) in 30 cases the vaccine used was BNT162b2, in 18 cases it was CoronaVac, in 4 cases it was AZD1222 and in 4 cases it was mRNA-1273; in 5 cases, the vaccine was generically defined as mRNA or recombinant. FOIA Tommy came by Kindig-it Design while on vacation, and after a great meeting with Dave, he decided to trade the ocean for the mountains. The ones found in people with pityriasis rosea are human herpesviruses 6 and 7. doi: 10.1111/jdv.17316, PubMed Abstract | CrossRef Full Text | Google Scholar, 2. It starts with one large round or oval scaly patch. Dermatol Reports. A 3-cm oval plaque with peripheral scale, larger, MeSH Pityriasis rosea after administration of Pfizer-BioNTech COVID-19 vaccine Pityriasis rosea (PR) is an acute papulosquamous cutaneous disorder that classically presents with a herald patch rapidly followed by a widespread rash along skin cleavage lines. Pityriasis rosea-like cutaneous eruption as a possible dermatological manifestation after Oxford-AstraZeneca vaccine: Case report and brief literature review. Keywords: adverse effect, coronavirus, cutaneous eruptions, immunization, pityriasis rosea, SARS-CoV-2, vaccine, case report, Citation: Leerunyakul K, Pakornphadungsit K and Suchonwanit P (2021) Case Report: Pityriasis Rosea-Like Eruption Following COVID-19 Vaccination. official website and that any information you provide is encrypted An official website of the United States government. Khan I, Elsanousi AA, Shareef AM, Tebha SS, Arif A, Gul S. Immun Inflamm Dis. Pityriasis rosea-like rash after messenger RNA COVID-19 vaccination: A case report and review of the literature. Pityriasis rosea (PR) is an acute, exanthematous disease likely caused by human herpesvirus (HHV)-6 and/or HHV-7. Pearls and pitfalls: Adverse cutaneous reactions after COVID-19 vaccination. Among the common cutaneous manifestations of COVID-19 (e.g., morbilliform eruptions, chilblains, and varicella-like vesicles), PR and PR-like eruptions have rarely been described (6, 7). This is called a herald patch and may be up to 4 inches (10 centimeters) across. (2021) 93:18501. Would you like email updates of new search results? Availability of data and material: Data and materials are available by the authors. 2021;35(8):e489e491. J Med Virol. Please enable it to take advantage of the complete set of features! Umakanthan S, Sahu P, Ranade AV, et al. 2022 Feb 3;9 (2):003164. doi: 10.12890/2022_003164. The .gov means its official. An official website of the United States government. 2022 Jun;7:164-168. doi: 10.1016/j.jdin.2022.01.009. MeSH Future studies should investigate oral lesions in SARS-CoV-2-positive subjects and after COVID-19 vaccination in the pediatric population, taking into account viral variants and newly developed vaccines. As a library, NLM provides access to scientific literature. Moreover, almost all lesions faded with associated post-inflammatory hyperpigmentation (Figure 2B). KL and KP collated resources. Accessibility It is possible that a relationship anti- Sars-CoV-2 vaccinationPR/PRLE exists; however, it is very rare, in consideration of millions of vaccinated subjects and the low number of reported cases with PR/PRLE. sharing sensitive information, make sure youre on a federal Learning points: Human herpesvirus-6, -7, and Epstein-Barr virus reactivation in pityriasis rosea during COVID-19. Med. Factors affecting the severity of central centrifugal cicatricial alopecia. J Eur Acad Dermatol Venereol. doi: 10.1111/bjd.20143. Only a few cases of pityriasis rosea (PR)/pityriasis rosea-like eruption (PRLE) after anti-SARS-CoV-2 vaccination have been reported. 2022 Jul 21;14(7):e27108. Results were typical for PR. If so, the reason may be simple: in several countries, BNT162b2 is the most used vaccine; iii) in 55 cases the rash was classified as PR, in 6 cases as PRLE; iv) in 39 cases the eruption appeared 1-12 days after the first dose (around: 4.8 days). Although histopathologic characteristics of PR are also observed in PR-like lesions, the presence of dyskeratotic keratinocytes, interface dermatitis, and eosinophilic infiltration in the dermis may be more prominent in PR-like eruptions (11). Catal A, Muoz-Santos C, Galvn- Casas C, et al.. Cutaneous reactions after SARS-COV-2 vaccination: a crosssectional Spanish nationwide study of 405 cases, Pityriasis rosea-like eruption after Pfizer-BioNTech COVID-19 vaccination. It manifests as oval-shaped, pink or red . doi: 10.1111/ijd.13061. Before Immunity, Inflammation and Disease published by John Wiley & Sons Ltd. In addition to COVID-19 vaccination, she was currently taking medications (i.e., levetiracetam and thyroxin) for glioblastoma, and the two drugs had been prescribed for approximately nine months. *Correspondence: Poonkiat Suchonwanit, poonkiat@hotmail.com, ORCID: Kanchana Leerunyakul orcid.org/0000-0002-0669-5611Kallapan Pakornphadungsit orcid.org/0000-0003-4783-0282Poonkiat Suchonwanit orcid.org/0000-0001-9723-0563, COVID-19 Associated Cutaneous Manifestations and COVID-19 Vaccine Related Skin Reactions, View all The latter is found in a younger age group. -, Cyrenne BM, Al-Mohammedi F, DeKoven JG, Alhusayen R. Pityriasis rosea-like eruptions following vaccination with BNT162b2 mRNA COVID-19 vaccine. This site needs JavaScript to work properly. 2022;S0738-081X(22)00002-5. The duration of the infection ranges from two weeks to three months. The authors declare no conflict of interest. PMC 1. Drago F, Ciccarese G, Javor S, et al. Unauthorized use of these marks is strictly prohibited. doi: 10.1111/dth.13878, 10. Reply to "the significance of investigating clinical, histopathologic and virological features in pityriasis rosea and pityriasis rosea-like eruptions following COVID-19 vaccinations" by Ciccarese G. et al. Complete remission was observed within 14-30 days. doi: 10.1111/ijd.15700, 4. Epub 2021 Jul 21. PRISMA flowchart. 2021 Sep;60(9):1150-1151. doi: 10.1111/ijd.15700. 2022 Aug;35(8):e15602. official website and that any information you provide is encrypted Int J Dermatol. SV, CAM, MC, VB, collected the data. 21% of people who have Covid develop a rash as their only symptom of infection. Epub 2021 Nov 2. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article. In one small study, a majority of women who got pityriasis rosea in . The average age of incidence was calculated to be 44.92 years, and 63 (62.37%) people presented after administration of the first dose. All patients were treated with cetirizine (20 mg/day for 7-14 days). With COVID-19 vaccines being authorized for emergency use, monitoring for potential adverse effects (e.g., cutaneous reactions) is necessary. 2022 Nov 6;15:2369-2382. doi: 10.2147/CCID.S388245. Moles, psoriasis, hives, eczema, and recently associated Covid-19 coronavirus rashes are just a few of the more than 3,000 skin disorders known to dermatology. The association between pityriasis rosea and pityriasis rosea-like eruptions after Covid-19 vaccines was established, but given the scarcity of studies, there is a need to conduct different clinical trials to confirm this association further and study the etiology and mechanism of the disease. (A) Dermoscopic features: dotted and linear vessels forming a network on a yellowish background with some whitish peripheral scales (original magnification x20). There is a growing number of published cases that link PR to COVID-19 infection, with PR appearing either in the acute phase of COVID-19 or, as in our patient, in the post COVID-19 period (4-9). Disclaimer. They are described as small, itchy blisters found on the trunk of the body and filling with blood, present in middle-aged patients. COVID-19 has been reported as one such viral trigger for PR. It is also called Christmas tree rash. We observed Although the exact pathophysiologic mechanisms of PR after vaccination remain unclear, immune responses to COVID-19 vaccines and disruption of T-cell mediated control of latent infections were implicated (12, 1518). Skin lesions appeared in a 49-year-old female 8 days after the first dose of the BNT162b2 mRNA vaccine and in a 53-year-old male 7 days after the second dose of the same vaccine. J Eur Acad Dermatol Venereol 2020; 34: e436-e437. Keywords: 10.7499/J.ISSN.1008-8830.2101133 -. 2021;35(9):e546e548. Numerous scattered erythematous plaques with fine scale oriented along skin cleavage, Herald patch of pityriasis rosea. Please enable it to take advantage of the complete set of features! +39.3465909404. doi: 10.1111/jdv.17316. Clipboard, Search History, and several other advanced features are temporarily unavailable. Rashes show as hives, bumps or . HHS Vulnerability Disclosure, Help To the best of our knowledge, only one case of ChAdOx1 nCoV-19 vaccine-induced PR-like eruption has been reported (2). 2023 The Authors. 2022 Jul 6;15(1):9503. doi: 10.4081/dr.2022.9503. Treatment with topical 0.1% triamcinolone acetonide twice per day showed partial response after seven days. COVID19 MapJohns Hopkins Coronavirus Resource Center. The patients/participants provided their written informed consent to participate in this study. Cyrenne BM, Al-Mohammedi F, DeKoven JG, Alhusayen R. J Eur Acad Dermatol Venereol. He described the appearance of an erythematous centrally scaled lesion at the right part of his abdomen, followed by the spreading of red oval mildly scaling lesions on the trunk, neck, and proximal parts of the upper extremities, which showed in the physical examination (Figure 1, a and b). Please enable it to take advantage of the complete set of features! The coronavirus disease 2019 (COVID-19) pandemic is filling the headlines these days. 2023 Mar 29;13(7):1286. doi: 10.3390/diagnostics13071286. 10.1136/POSTGRADMEDJ-2020-138234 PMC Disclaimer. Veraldi S, Boneschi V, Cusini M, Maronese CA. Allergy Asthma Proc. The pathogenesis of this relationship is unknown. doi: 10.1002/iid3.804. the reactivation of varicella zoster or herpes simplex infections, pityriasis rosea or rosea-like lesions, petechiae, pernicious purpura . Accessibility 2022 Nov 1;43(6):555-558. doi: 10.2500/aap.2022.43.220058. It may or may not be itchy and usually lasts six to eight weeks before resolving on its own. These types cannot cause cold sores or genital herpes. But once it's gone, it doesn't come back. 2023 Mar 3;14(2):207-212. doi: 10.4103/idoj.idoj_449_22. 2021 Sep;34(5):e15040. In a Spanish study,PR/PRLE was observed in 11 patients (6.7%) vaccinated with BNT162b2, in 5 patients (3.4%) vaccinated with mRNA- 1273 and in 4 patients (4.2%) vaccinated with AZD1222.2 Available data suggest that BNT162b2 vaccine is more related to PR/PRLE than other vaccines. JAAD Case Rep. (2018) 4:8001. An official website of the United States government. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). PR 12.7 days (mean) after the vaccination (19 patients after the 1. Before N Engl J Med 2020; 383:260315. 2021 Sep;35(9):e546-e548. Bethesda, MD 20894, Web Policies Pityriasis Rosea-like eruptions following COVID-19 mRNA-1273 vaccination: A case report and literature review. 2022 Jun;7:164-168. doi: 10.1016/j.jdin.2022.01.009. KL drafted the original manuscript. Careers. Six weeks prior to the appearance of the initial skin lesion, the patient had coronavirus disease 2019 (COVID-19) infection with mild clinical presentation (fever up to 38 C lasting for four days and mild headache) and with symptoms of post COVID-19 syndrome (excessive tiredness). In all patients laboratory examinations were within normal ranges. Br J Dermatol. However, in cases of atypical PR, it may present with erythema multiforme-like lesions and purpura (5). FOIA 2 min read January 12, 2022 - 6:26AM A Sydney-based woman has credited her booster dose of the Covid-19 vaccine with removing two persistent warts she's had for five years. Cutaneous Reactions Following COVID-19 Vaccination: A Review of the Current Literature. eCollection 2022. 2023 Apr;11(4):e804. Cutaneous adverse reactions of COVID-19 vaccines: A systematic review. Contributions: SV and CAM, conceived and wrote the article. The study is created by eHealthMe and uses data from the Food and Drug Administration (FDA). walker hayes daughter. J Invest Dermatol. National Library of Medicine Unable to load your collection due to an error, Unable to load your delegates due to an error. Int J Dermatol. Moreover, while dermoscopy may facilitate the diagnosis of PR, its utility for atypical PR or PR-like lesions is still limited. PRISMA flowchart. The https:// ensures that you are connecting to the Other plausible theories include molecular mimicry with viral epitopes and type IV delayed hypersensitivity reaction (12). The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). No use, distribution or reproduction is permitted which does not comply with these terms. and transmitted securely. This article presents a case of PR in a 66-year-old black male 1 week after administration of the Pfizer-BioNTech COVID-19 vaccine. Only a few cases of pityriasis rosea (PR)/pityriasis rosea-like eruption (PRLE) after anti-SARS-CoV-2 vaccination have been reported. Most people with the rash are 10 to 35 years of age. 2022 Sep;21(9):3692-3703. doi: 10.1111/jocd.15209. The cause of pityriasis rosea is not known, but it is commonly believed to be caused by a virus or bacteria. But some patients also are developing delayed skin reactions on. Apply a moisturizer, calamine lotion or a nonprescription . SARS-CoV-2 spike protein positivity in pityriasis rosea-like and urticaria-like rashes of COVID-19. J Am Acad Dermatol. In 3 patients a biopsy for histopathological examinations was carried out. 2022 Jan;114:88-89. doi: 10.1016/j.ijid.2021.10.055. Copyright 2021 Leerunyakul, Pakornphadungsit and Suchonwanit. Epub 2021 Sep 25. Clinical manifestations and histopathologic findings of reported patients with pityriasis-rosea like eruptions following COVID-19 vaccination. Dermoscopy showed dotted and linear vessels forming a network on a yellowish background, with some whitish peripheral scales (Figure 3A). Here, we describe a case of PR-like eruption following ChAdOx1 nCoV-19 (AZD1222) vaccination in a Thai patient with glioblastoma. 2021;35(8):e489e491. The site is secure. National Library of Medicine This site needs JavaScript to work properly. 8:752443. doi: 10.3389/fmed.2021.752443. PR is a self-limiting exanthematous disease and herpes zoster is a treatable condition; therefore, their occurrence does not require discontinuation of the vaccination schedule. National Library of Medicine J Eur Acad Dermatol Venereol 2016; 30: 544-545. Alvin Friedman-Kien, MD, walked through the doorway into the exam room, looked at me and immediately said, "Oh, you have pityriasis rosea." He called in a bunch of residents so he could show them my rash and teach them about the condition, which often has a large patch called the "mother patch" (or herald patch), as well as smaller . tions reported after vaccination include: injection site reactions, urticarial and morbilliform eruptions, per-nio/chilblains, reactions to cosmetic llers, herpes zoster, herpes simplex ares, and pityriasis rosea-like rashes [1]. As our patient did not receive a COVID-19 vaccine, we cannot evaluate the latter based on the present case. doi: 10.1111/jdv.17342. Please enable it to take advantage of the complete set of features! Epub 2022 Jun 13. Following the national COVID-19 vaccination guidelines, she received a shot of ChAdOx1 nCoV-19 (AZD1222) vaccine before the therapy. HHS Vulnerability Disclosure, Help 8600 Rockville Pike doi: 10.1002/iid3.804. MeSH SV, supervised the work. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. National Library of Medicine Hum Vaccin Immunother. Suchonwanit P, Leerunyakul K, Kositkuljorn C. Diagnostic and prognostic values of cutaneous manifestations in COVID-19. Dermatol Ther. Wien Med Wochenschr. We present two cases of COVID-19 vaccine-induced pityriasis rosea. 2021;85(1):4655. Additional evidence that pityriasis rosea is associated with reactivation of human herpesvirus-6 and -7. Accessibility NCI CPTC Antibody Characterization Program, Ritchie H., Mathieu E., Rodes-Guirao L., et al. and transmitted securely. Additionally, differences in incidence of this reaction after Pfizer and Moderna vaccination may suggest a differing host immune response incited by these vaccines which warrants further investigation. Pityriasis rosea (PR), PR-like eruptions (PR-LE), and herpes zoster have been frequently reported during the COVID-19 pandemic and following COVID-19 vaccination. doi: 10.1111/dth.15129. It is possible that a relationship between anti- Sars-CoV-2 vaccination and PR/PRLE exists; however, it is very rare, in consideration of millions of vaccinated subjects and the low number of reported cases of PR/PRLE. 2021;184(6):11941195. They described a patient developing pityriasis rosea (PR) 2 hours after the second dose of Moderna COVID-19 vaccination. However, adverse effects to COVID-19 vaccines, particularly cutaneous reactions, have been reported. However, some hypotheses may be advanced: i) PR/PRLE following anti- Sars-CoV-2 vaccination may be just a coincidence, for instance in those patients in whom PR/PRLE appeared only one day after vaccination;4,12 ii) anti-Sars-CoV-2 vaccines cause a reactivation of HHV-6 and/or HHV-7, which is similar to the reported association with herpes zoster;1,9 iii) vaccines can induce a delayed hypersensitivity response clinically similar to druginduced PRLE.10. Cite this: Skin Reactions After COVID-19 Vaccination . The clinics of HHV-6 infection in COVID-19 pandemic: pityriasis rosea and Kawasaki disease. . However, the etiopathogenetic mechanisms remain largely unknown and further studies are needed in order to clarify the correlation between SARS-CoV-2 and PR. Pityriasis rosea, COVID-19 and vaccination: new keys to understand an old acquaintance. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. doi: 10.1016/j.jaad.2021.03.092, 15. Unable to load your collection due to an error, Unable to load your delegates due to an error. Urbina F, Das A, Sudy E. Clinical variants of pityriasis rosea. In conclusion, we have described the first case of PR-like eruption following ChAdOx1 nCoV-19 (Oxford/AstraZeneca) vaccination. Suchonwanit P, Rojhirunsakool S, Khunkhet S. A randomized, investigator-blinded, controlled, split-scalp study of the efficacy and safety of a 1550-nm fractional erbium-glass laser, used in combination with topical 5% minoxidil versus 5% minoxidil alone, for the treatment of androgenetic alopecia. 2021 Sep 7;8:752443. doi: 10.3389/fmed.2021.752443. . Busto-Leis JM, Servera-Negre G, Mayor-Ibarguren A, et al.. Pityriasis rosea, COVID-19 and vaccination: new keys to understand an old acquaintance, Pityriasis rosea following CoronaVac COVID-19 vaccination: a case report, Pityriasis rosea after administration of Pfizer-BioNTech COVID-19 vaccine. -. J Eur Acad Dermatol Venereol. Human herpesviruses 6 and 7 are common. Pityriasis versicolor is caused by a yeast infection and can be treated with antifungal medicines , including antifungal creams and antifungal shampoos. PMC NS, not specified; PR, pityriasis rosea; PRL, pityriasis rosea-like. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. eCollection 2023 Mar-Apr. Pityriasis rosea (PR) is an acute exanthematous disease. The present study investigated a case of pansclerotic morphea that rapidly progressed a few weeks after infection with COVID-19 in a 57-year-old woman with no history of any autoimmune skin or rheumatic diseases. Some patients may have a cold before the rash. Only some cases of PR/pityriasis rosealike eruption (PRLE) after anti-SARS-CoV- 2 vaccination have been reported.1-18 In the period May 2021-February 2022 we observed five cases of clinically typical PR that appeared after anti-SARS-CoV-2 vaccination with BNT162b2 (3 patients) or mRNA-1273 (2 patients). Epub 2021 Apr 7. Unable to load your collection due to an error, Unable to load your delegates due to an error. Results: The site is secure. COVID-19 vaccine hesitancy is a critical problem that hinders The .gov means its official. official website and that any information you provide is encrypted FOIA Khan I, Elsanousi AA, Shareef AM, Tebha SS, Arif A, Gul S. Immun Inflamm Dis. Pityriasis rosea is a rash that often begins as an oval spot on the face, chest, abdomen or back. Bookshelf J Eur Acad Dermatol Venereol. Bathe or shower in lukewarm water. eCollection 2022 Jul. It has been suggested that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces reactivation of other viruses, such as HHV-6, HHV-7, varicella zoster virus, and Epstein-Barr virus (5). Authors Jordan E Buckley 1 , Laura N Landis 2 , Ronald P Rapini 1 Affiliations It is increasingly recognized that SARS-CoV-2 infection and COVID-19 vaccines have been associated with skin disorders, including pityriasis rosea.
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