Pityriasis Rosea Not Associated with Increased Adverse Outcomes in Pregnant Women

Lena Wenger-Oehn, PhD

Data from a recent study on pregnant women with pityriasis rosea (PR) found that the skin condition did not adversely influence pregnancy or birth outcomes in most cases.

Pityriasis rosea has predominantly affected young adults aged 15-35, and has been associated with symptoms such as fever, headache, malaise, and lymph node swelling.

Notably, a differential diagnosis of PR in pregnant patients has included polymorphic and atopic eruptions during pregnancy, and a previous study of 61 women with PR recorded instances of miscarriage, preterm delivery, low birth weight, weak motility, hypotonia, and low Apgar score at birth, in addition to high spontaneous abortion rates in women who developed PR in the first 15 weeks of gestation.

Given the limited number of studies, an investigative team led by Lena Wenger-Oehn, PhD, of the Medical University of Graz, Austria, sought to determine the potential influence of PR on pregnancy outcomes.

The retrospective study – carried out at the Department of Dermatology at the Medical University of Graz- included data from 59 pregnant women who presented with PR between January 2003 and July 2018. A total of 63 births and miscarriages were recorded from these 53 participating women.

Potential candidates were initially identified through the hospital database using keywords such as pityriasis, rosea, exanthema, and pregnancy. The team then manually scrutinized electronic and available paper hospital records of eligible patients and amassed data on when PR appeared in patients, previous pregnancies, pregnancy week when PR first occurred, rash duration, additional symptoms, rash location, gestation week at time of birth, and body weight and length at time of birth.

Additionally, a questionnaire was sent to all women enrolled in the study that assessed the course of PR-associated pregnancy and previous pregnancies, the course of PR disease, and the outcome of medical examinations.

A case series analysis was also performed using PubMed databases for the period of 1968-2020. A total of 7 papers were identified, and the team extracted datasets for 53 women.

The median age of PR onset for the 59 pregnant women included in the study was 28 years, and more than half of the women were primiparous (54.5 %), while the others already had o1(31 %) or more children (14.5 %).

The investigative team found that unfavorable pregnancy outcomes such as miscarriage, preterm delivery before week 37, or low birth weight were significantly less frequent in the current study than seen in previous studies (10.9% vs. 39.6%) (P=0.0012).

Notably, an analysis of pooled data from the current study and prior studies indicated that the week of pregnancy at onset of PR was inversely associated with an unfavorable outcome (odds ratio [OR] = 0.937, 95 % CI 0.883 to 0.993), and that the duration of PR (OR = 1.432, 95 % CI 1.129 to 1.827), additional extracutaneous symptoms (OR = 4.112, 95 % CI 1.580 to 10.23), and widespread rash distribution (OR 5.203, 95 % CI 1.702 to 14.89) were directly associated with unfavorable outcomes.

“If PR starts early in pregnancy, is long-lasting, spreads widely, and is accompanied by extracutaneous symptoms, the risk of an unfavorable outcome may increase,” the team wrote. “Consequently, close gynecological monitoring of pregnant women with PR is recommended.”

The study, "Pityriasis rosea in pregnancy: A case series and literature review," was published online in the Journal of the German Society of Dermatology.