ORIGINAL ARTICLE Oropharyngeal lesions in pityriasis rosea Giulia Ciccarese, MD, a Francesco Broccolo, MD, b Alfredo Rebora, MD, a Aurora Parodi, MD, a and Francesco Drago, MD a Genoa and Monza, Italy Background: Pityriasis rosea (PR) is an exanthematous disease associated with the endogenous systemic reactivation of human herpesvirus-6 (HHV-6) and human herpesvirus-7 (HHV-7). Oropharyngeal lesions may be associated with the exanthema, but anecdotal evidence suggests that few dermatologists are aware of their occurrence. Objective: Classifying oropharyngeal lesions in PR, establishing their prevalence, and assessing their possible association with different PR forms. Methods: The records of all PR cases diagnosed in the Dermatology Clinic of Genoa University between 2003 and 2016 were retrospectively reviewed to examine sex and age of the patients, PR type, presence of enanthema, systemic symptoms, specific antieHHV-6 and or HHV-7 serology, and HHV-6 and/or HHV-7 DNA loads. Results: The oropharyngeal mucosa was carefully examined in 527 patients with PR. Painless oropharyngeal lesions were observed in 149 patients with PR (28%) and classified as erythematomacular, macular and papular, erythematovesicular, and petechial lesions. The petechial and macular and papular patterns were those most frequently observed. There was no statistically significant difference in the levels of HHV-6 and HHV-7 viremia in the plasma of patients with enanthema and those without. Limitations: Because this was a retrospective study, biopsies on mucosal lesions were not performed. Conclusion: Our findings showed that enanthemas are frequently associated with forms of PR different from the classic form. ( J Am Acad Dermatol http://dx.doi.org/10.1016/j.jaad.2017.06.033.) Key words: enanthemas; human herpesvirus 6/7; oropharyngeal lesions; pityriasis rosea. P ityriasis rosea (PR) is an acute, self-limiting exanthematous disease associated with the endogenous systemic reactivation of human herpesvirus 6 (HHV-6) and/or HHV-7. 1-6 The disease typically begins with a single, erythematous scaly plaque (herald patch) that is followed after about 2 weeks by smaller papulosquamous lesions on the cleavage lines of the trunk, giving the back the configuration of a ‘‘Christmas tree,’’ 1-7 or as we prefer, the configuration of a ‘‘theatre curtain.’’ PR lasts from 2 weeks to a few months, and constitu- tional symptoms may precede or accompany the skin eruption. 4 As in other exanthemas, alongside classic PR (ClasPR), different forms of PR have been described and classified according to the pathogen- esis and course of the disease: pediatric PR (PedPR), 8 From the DISSAL Department of Dermatology, IRCCS AOU San Martino-IST, Genoa, a and Department of Health Sciences, University of Milano-Bicocca, Monza. b Funding sources: None. Conflicts of interest: None disclosed. Accepted for publication June 17, 2017. Reprints not available from the authors. Correspondence to: Giulia Ciccarese, MD, DISSAL, Department of Dermatology, IRCCS A.O.U. San Martino-IST, Largo Rosanna Benzi 10, 16132 Genova, Italy. E-mail: giuliaciccarese@libero.it. Published online July 18, 2017. 0190-9622/$36.00 Ó 2017 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2017.06.033 Abbreviations used: ClasPR: classic pityriasis rosea HHV: human herpesvirus PR: pityriasis rosea PedPR: pediatric pityriasis rosea PersPR: persistent pityriasis rosea PregPR: pityriasis rosea in pregnancy RelPR: relapsing pityriasis rosea VHF: viral hemorrhagic fever 1