News & Events: Member Articles

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 limitations 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. Academy of Medicine of Toledo and Lucas County