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Pityriasis rosea (PR), an acute illness marked by a papulosquamous eruption, mainly affects children and young adults. Some studies implicate a viral cause, especially a primary or reactivated infection with human herpes viruses (HHVs) 6 and 7, but the evidence is inconclusive. Although the disease is self-limited, usually resolving after 6 to 8 weeks without any apparent residua, one concern is its effects in pregnancy. Investigators in Italy examined 38 women who developed PR during pregnancy.
Of these women, five miscarried (13%), but the miscarriage rate was 62% in those who developed PR in the first 15 weeks of pregnancy. Hypotonia and weak motion were common in the infants of women who developed PR between 16 and 20 weeks’ gestation; only 33% of these pregnancies produced healthy infants at delivery. Nine women (24%) had premature deliveries. However, all premature neonates survived and were healthy at the time of the report.
PR was exceptionally severe in all the mothers who miscarried. These women had longer courses, more-widespread skin lesions, and more frequent than usual systemic complaints, such as headache, insomnia, anorexia, and fatigue. Detailed study of one woman who miscarried indicated active infection with HHV-6 in both the mother and the fetus.
Drago F et al. Pregnancy outcome in patients with pityriasis rosea. J Am Acad Dermatol 2008 May; 58:S78.
Comment
This report demonstrates a high risk for fetal loss and for neonatal weakness and hypotonia in pregnancies affected by PR during the early weeks of gestation. Clinicians should alert women who develop PR in pregnancy about the potential risks of this presumed viral infection, although there is no known effective intervention to prevent these complications. Nor is there a clear way to avoid this illness. The detailed study of the miscarried fetus suggested reactivation of HHV-6, rather than primary infection, based on observation in the mother of specific serum IgG antibody but no IgM antibody.