PINK
BRAN FLAKE DISEASE AND OTHER RASHES
by
Warren
Kleinberg, MD, MPH
This Fall, my colleagues and I have seen quite a few
patients with troubling but harmless rashes. Many children have been sent
home from school and require a doctor’s note clearing them to return.
Although there have been many other types of rashes, three that last for
weeks are most prominent.
The first and most prominent has been pityriasis
rosea (translated, pink bran flake – it “looks” like Wheaties pasted on
the skin). Often starting as an inch diameter round or oval, scaly pink
or tan patch on the back or underarms, it is sometimes mistaken for
ringworm (a fungal infection of the skin). After 5 to 7 days, smaller
scaly pink or tan patches (Wheaties) appear spreading down from the center
of the chest or back like ornaments on a Christmas tree. Occasionally
they will be clustered at the neck and shoulders or the hips. Because of
the dryness, the rash may itch slightly.
No specific treatment other than soothing lotions is
effective and the rash may last up to 8 or 9 weeks. There is usually no
scarring (unless scratched repeatedly) and the skin color changes fade
over 1 to 2 months. The cause is unknown, but a number of viruses have
been implicated. It is not contagious in the usual sense, and no
limitation on activities are needed. The rash fades faster when exposed
to sunlight.
The second has been papular acrodermatitis
(translated, small bumps on the arms and legs). Clusters of tiny pink to
flesh colored bumps appear around the knees, elbows, wrists, ankles, and,
occasionally, the face and neck. The rash is seen during the recovery
phase from a virus, most often Coxsackie (a common Summer and Fall virus)
and Ebstein-Barr (causing infectious mononucleosis in older children,
teens, and adults, but a mild illness in young children). Often, the
child has not been sick at all, and the rash is the only indication of
infection with the virus. The child is not contagious when the rash
appears. The rash may last up to 6 to 8 weeks, requires no treatment, and
usually does not itch.
Finally, we have been seeing “fifth disease” or
erythema infectiosum (translated, infectious, red rash). The rash is the
recovery stage of infection with the human parvovirus B-19 (no relation,
other than similar microscopic features, to the puppy parvovirus). Most
people do not get a rash nor ill at all. The virus is dangerous to people
with certain anemias (especially, sickle cell disease) and in early
pregnancy (causing miscarriage), but harmless to most others. The rash is
characterized by “rosy” cheeks followed by a faint, lace-like rash on the
rest of the body that can come and go for months. There is no itching and
the child looks “healthy” because of the rosy cheeks.
Warren Kleinberg, M.D.,M.P.H.
