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Background The association of human herpesvirus 6 (HHV-6) and HHV-7 with pityriasis rosea suggests that systemic drugs directed against HHV may hasten recovery of patients with pityriasis rosea. Objective The purpose of this study was to verify the efficacy of oral acyclovir in the treatment of pityriasis rosea. Methods Eighty-seven consecutive patients were treated for 1 week with either oral acyclovir (800 mg 5 times daily) or placebo. In all patients, the time of lesion clearing and the number of new lesions appearing during treatment were recorded. Results On the 14th day of treatment, 79% of treated patients fully regressed compared with 4% of the placebo group. The lesions cleared in 18.5 days in treated patients and in 37.9 days in the placebo group. Clearance was achieved in 17.2 days in patients treated in the first week from onset and in 19.7 days in the patients treated later. On the 7th day, there were significantly fewer new lesions in patients treated in the first week than in those treated later. Limitations This trial was neither randomized nor double blind. Objectivity was achieved by counting the lesions. Conclusion Acyclovir may be effective in the treatment of pityriasis rosea, especially in patients treated in the first week from onset, when replicative viral activity of HHV is probably very high.

Pityriasis rosea is an acute, self-healing exanthem characterized by oval erythematous-squamous lesions of the trunk and limbs, that usually spares face, scalp, palms, and soles. Constitutional symptoms, which have the character of true prodromes; clinical features, which resemble those of the known exanthems; and many epidemiologic data all suggest an infectious origin. A host of infectious agents have been incriminated, but, recently, human herpesvirus 6 and 7 have been extensively studied. The goal of this review is to outline the epidemiologic, clinical, histologic, and ultrastructural features of pityriasis rosea, but mainly to stress its possible human herpesvirus nature. In addition, clues have been added to help the reader to go through the complex subtleties of the virologic investigation. © 2008 American Academy of Dermatology, Inc.

Background: Antibodies to stratified epithelia characterize chronic ulcerative stomatitis, an entity that very closely resembles erosive lichen planus both clinically and histologically. These antibodies are directed against a 70-kd antigen. Objective: Our aim was to verify whether antibodies to stratified epithelia are present in patients with common lichen planus. Patients and methods: One hundred thirty-eight patients with various forms of lichen planus were studied. Indirect immunofluorescence was performed on both monkey esophagus and HEp2-2000 cells. Immunoblotting was done with cultured keratinocytes used as the source antigen. Results: Nineteen patients had antibodies to stratified epithelia (in 9 directed against an antigen of 70 kd). Forty-eight patients had circulating antibodies detected by indirect immunofluorescence on both monkey esophagus and HEp2-2000 cells (in 7 directed against an antigen of 70 kd). Indirect immunofluorescence was positive only on HEp2-2000 cells in 21 patients. Indirect immunofluorescence was negative in 50 patients on both HEp2-2000 cells and monkey esophagus. None of the last 71 patients had antibodies directed to an antigen of 70 kd. Limitations: This is a serological study; results from direct immunofluorescence studies would be interesting. Conclusion: Antibodies to stratified epithelia directed to an antigen of 70 kd are not exclusive to chronic ulcerative stomatitis, but are also present in some patients with lichen planus. © 2007 American Academy of Dermatology, Inc.

ity except the one by Szlachic et al,10 who conducted a remarkable epidemiologic study. They concluded that “H pylori expressing CagA [is found] in the majority of [rosacea] cases,” that “eradication of H pylori leads to a dramatic improvement of... rosacea,” and that “rosacea could be considered as one of the major extragastric symptoms of H pylori infection.” There are now other indicators of H pylori activity that may yield better information than serology. 5. Oral metronidazole was known to alleviate rosacea long before H pylori was discovered. Only its activity on H pylori can explain why it works in rosacea. So far, other explanations have not been supported by experimental evidence. Demodex folliculorum was found to survive in metronidazole concentrations much higher than those attainable in the blood,11 and the claimed antiinflammatory activity of topical metronidazole still awaits a scientific demonstration. In our experience (unpublished data), topical metronidazole may even have an irritative capacity, which is in contrast with the findings of other reports.