To the editor: Pityriasis rosea (PR) is a common, self-limited skin rash that is associated with human herpesvirus (HHV)-7 and HHV-6.1 It has been suggested that PR onset during pregnancy increases risk of overall birth complications and spontaneous abortion (SAB),2 albeit with conflicting evidence.3 Since there is little evidence-based data with which to counsel pregnant patients with PR, our objective was to examine birth outcomes in women diagnosed with gestational PR compared to matched controls.
After institutional board approval, patients with PR diagnosis (International Classification of Diseases (ICD)-9 code 696.3 and ICD-10 code L42) with concurrent pregnancy (ICD-9 codes V22, V23 and ICD-10 codes Z34, Z33, Z3A) 1/1/2010 −12/31/2021 were queried from our institutional electronic health record. Exclusion criteria included pregnancies with elective abortion, and PR diagnosis by a non-dermatologist or more than one month after SAB. Pregnant patients without PR matched by age, race, and ethnicity served as controls. Statistical significance was set at p<0.05 and determined by χ2 test and unpaired t-test.
A total of 31 PR patients and 75 controls were included. PR patients had mean age of 32.9 years, with majority non-White (52%) and non-Hispanic (81%), similar to controls (p=0.29. 0.98, and 0.61, respectively). PR was most often distributed over the trunk (90%), usually pruritic (65%), and most frequently treated with topical steroids (48%) (Table I). Six women with PR (19%) had birth complications including SAB (n=4, 13%), chorioamnionitis (n=1, 3%), and meconium passage before delivery (n=1, 3%) (Table II). Fourteen controls (19%) had birth complications including SAB (n=10, 13%), chorioamnionitis (n=2, 3%), neonatal deformity (n=1, 1%), and nonreassuring fetal status (n=1, 1%). Five of six women with birth complications were diagnosed with PR before 15 weeks’ gestation. There were no differences in the gestational age at PR onset (14.9 weeks vs 12.5 weeks; p=0.48) or age at pregnancy (33.4 years vs 30.7 years; p=0.17) in women without vs. with birth complications, respectively (Table I).
Table I.
Demographics of pregnant PR patients and matched controls
| Gestational PR | Controls | |||||
|---|---|---|---|---|---|---|
| Total (31) | No birth complications (25) | Birth complications (6) | Total (75) | No birth complications (60) | Birth complications (14) | |
| Race | ||||||
| White | 15 | 10 | 5 | 33 | 29 | 4 |
| Black or African American | 5 | 5 | 0 | 12 | 8 | 4 |
| Asian | 7 | 6 | 1 | 19 | 15 | 4 |
| Other | 4 | 4 | 0 | 11 | 9 | 2 |
| Ethnicity | ||||||
| Hispanic or Latino | 3 | 3 | 0 | 8 | 7 | 1 |
| Not Hispanic or Latino | 25 | 19 | 6 | 55 | 42 | 13 |
| Unknown | 3 | 3 | 0 | 12 | 12 | 0 |
| Age, years | 32.9 | 33.4 | 30.7 | 32.3 | 32.0 | 33.4 |
| Gestational age at delivery | ||||||
| Average, weeks | 39.5 | 39.5 | 39.6 | 39.2 | 39.3 | 38.2 |
| Preterm, n | 2 | 2 | 0 | 6 | 4 | 2 |
| Newborn birthweight, kg | 3.3 | 3.3 | 2.9* | 3.3 | 3.3 | 3.0 |
| Gestational age at PR onset, weeks | 14.4 | 14.9 | 12.5 | |||
| Distribution of PR, n | ||||||
| H/N | 6 | 6 | 0 | |||
| UE | 10 | 8 | 2 | |||
| T | 28 | 22 | 6 | |||
| G | 7 | 6 | 1 | |||
| LE | 10 | 9 | 1 | |||
| PR symptoms, n | ||||||
| Pruritis | 20 | 16 | 4 | |||
| Burning | 1 | 1 | 0 | |||
| Asymptomatic | 10 | 8 | 2 | |||
| Unspecified | 0 | 0 | 0 | |||
| PR treatment, n | ||||||
| Topical steroids | 15 | 11 | 4 | |||
| Oral acyclovir | 2 | 2 | 0 | |||
| OTC creams | 9 | 6 | 3 | |||
| None | 8 | 8 | 0 | |||
only data from 1 live birth available
[preterm, birth before 37 weeks’ gestational age; G, groin; H/N, head/neck; LE, lower extremity; PR, pityriasis rosea; OTC, over the counter; T, trunk; UE, upper extremity]
Table II.
Birth complications of pregnant PR patients and matched controls
| Prior pregnancy | Birth outcomes | PR data | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| No. | Age, years | No. | Abort | Gestational age, weeks | Newborn birthweight, kg | 5-min APGAR | Birth notes | PR onset, weeks | PR body area | |
| 1 | 31.29 | 1 | 1 | 38.00 | 2.93 | 9 | C | 11.43 | T | |
| 2 | 32.54 | 0 | 0 | 41.14 | N/A | N/A | M | 23.57 | T | |
| 3 | 36.75 | 6 | 1 | *12.86 | SAB | 12.57 | UE, T, G, LE | |||
| 4 | 32.05 | 1 | 1 | *20.71 | SAB | 10.43 | T | |||
| 5 | 26.72 | 1 | 0 | *6.29 | SAB | 7.43 | T | |||
| 6 | 24.88 | 0 | 0 | *9.71 | SAB | 9.29 | UE, T | |||
| Controls | 1 | 32.71 | 0 | 0 | 39.71 | 2.86 | 9 | NRFS | ||
| 2 | 32.18 | 0 | 0 | 38.57 | 3.54 | 9 | C | |||
| 3 | 26.02 | 1 | 1 | 41.14 | N/A | 9 | C | |||
| 4 | 40.20 | 0 | 0 | 40.29 | 3.71 | 9 | D | |||
| 5 | 31.26 | 1 | 1 | *8.29 | SAB | |||||
| 6 | 30.09 | 2 | 2 | *11.57 | SAB | |||||
| 7 | 35.47 | 1 | 1 | *20.43 | SAB | |||||
| 8 | 38.73 | 3 | 1 | *7.43 | SAB | |||||
| 9 | 33.58 | 0 | 0 | *3.43 | SAB | |||||
| 10 | 40.47 | 0 | 0 | *7.14 | SAB | |||||
| 11 | 25.84 | 2 | 2 | *8.86 | SAB | |||||
| 12 | 29.26 | 1 | 0 | *8.14 | SAB | |||||
| 13 | 40.76 | 0 | 0 | *9.57 | SAB | |||||
| 14 | 29.48 | 3 | 1 | *12.86 | SAB | |||||
gestational age at SAB
[C, chorioamnionitis; D, neonatal deformity; G, groin; LE, lower extremity; M, meconium passage before delivery; NRFS, nonreassuring fetal status; PR, pityriasis rosea; SAB, spontaneous abortion; T, trunk; UE, upper extremity]
We found that birth complications were similar between pregnant patients with PR and matched controls. SAB rate was 13% in both groups, similar to the 15% SAB pooled risk in a 2021 review of over 4.6 million pregnancies.4 Similarly, in a retrospective study of 76 patients with gestational PR, 13% of pregnancies ended in SAB.2 Unlike our findings, there was a difference in mean gestational age of PR onset in patients with vs. without birth complications (14.8 weeks vs. 24.8 weeks, respectively; p<0.001).2 However, a retrospective study of 33 patients reported no SAB cases, and corroborated our finding that PR onset before 15 weeks’ gestation did not increase risk of birth complications.3
Limitations include small sample size at a single institution and retrospective design.
This is the first study using matched controls showing that gestational PR is not associated with increased risk of birth complications and SAB. Women experience substantial physical changes during pregnancy. Dermatologists can play an important role in the collaborative care of pregnant patients, by reassuring them that PR is not associated with worse pregnancy outcomes compared to the general population.
Funding sources:
This investigation was supported by grant UL1TR002384 of the Clinical and Translational Science Center at Weill Cornell Medical College
Abbreviations
- HHV
Human herpesvirus
- ICD
International Classification of Diseases
- PR
Pityriasis rosea
- SAB
Spontaneous abortion
Footnotes
Conflicts of Interest: Michael Ong and Harrison White have no conflicts of interest. Dr. Shari Lipner has served as a consultant for Hoth Therpeutics, BelleTorus Corporation, and Ortho-Dermatologics.
References
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