https://orcid.org/0000-0001-5940-0592
Dear editor
We have read with great interest the letter by dos Santos et al entitled “L-lysine as an Alternative Treatment for Pityriasis Rosea (PR)”,Citation1 commenting our previously published manuscript reviewing current literature on the PR and PR-like eruption following COVID-19 vaccination.Citation2 It is well known that there is an association between PR and human herpesvirus (HHV) 6–7, which, like all HHV, is characterized by the ability to establish lifelong latency.Citation3 Among the several cutaneous reactions and viral reactivations reported following COVID-19 vaccination, PR was one of the commonest.Citation4,Citation5 Among the proposed pathogenetic mechanisms, despite the exact correlation is not still understood, it has been hypothesized that the exposure to the viral antigen boosts the cell-mediated immune response, and this immune response can sometimes become dysregulated, leading to inflammation and reactivation of latent viral infections, including human herpesviruses HHV6 and HHV7, linked to PR.Citation6 Moreover, therapeutic approaches to PR have not been discussed in our review, since this disease is usually self-limited.Citation2
In this context, dos Santos et al showed that one case of PR following the second dose of AZD1222 was treated with the L-lysine + L-arginine protocol, based on the capacity of lysine to inhibit the availability of arginine through competitive antagonism, leading to viral replication impairment.Citation7
According to authors, this therapeutic approach should be suggested in severe cases of PR, regardless the COVID-19 vaccination.
Despite the watchful waiting strategy, coupled with the treatment of eventually associated symptoms such as pruritus with oral antihistamines, it is the mainstay of treatment of PR; patients with severe disease or requiring faster resolution may benefit from other therapies such as antivirals (acyclovir) and phototherapy.Citation8–10 In this context, L-lysine + L-arginine protocol may be an interesting option, also as monotherapy. Certainly, further studies are required to establish the best treatment algorithm for PR.
Disclosure
The authors report no conflicts of interest in this communication.
References
- Dos Santos VAB, Pedrazini MC. L-lysine as an alternative treatment for pityriasis rosea (PR) [Letter]. Clin Cosmet Invest Dermatol. 2024;17:433–434. doi:10.2147/CCID.S461722
- Potestio L, Martora F, Cacciapuoti S, Megna M, Villani A, Ruggiero A. Pityriasis rosea and pityriasis rosea-like eruption following COVID-19 vaccination: a narrative review. Clin Cosmet Invest Dermatol. 2024;17:51–57. doi:10.2147/CCID.S447834
- Pantry S, Medveczky P. Latency, integration, and reactivation of human herpesvirus-6. Viruses. 2017;9(7):194. doi:10.3390/v9070194
- Ruggiero A, Megna M, Fabbrocini G, Martora F. Video and telephone teledermatology consultations during COVID-19 in comparison: patient satisfaction, doubts and concerns. Clin Exp Dermatol. 2022;47(10):1863–1864. doi:10.1111/ced.15286
- Martora F, Villani A, Battista T, Fabbrocini G, Potestio L. COVID-19 vaccination and inflammatory skin diseases. J Cosmet Dermatol. 2023;22(1):32–33. doi:10.1111/jocd.15414
- Khan I, Elsanousi AA, Shareef AM, Tebha SS, Arif A, Gul S. Manifestation of pityriasis rosea and pityriasis rosea-like eruptions after Covid-19 vaccine: a systematic review. Immun Inflamm Dis. 2023;11(4):e804. doi:10.1002/iid3.804
- Pedrazini MC, Silva MH. Pityriasis rosea‐like cutaneous eruption as a possible dermatological manifestation after Oxford‐ASTRAZENECA vaccine: case report and brief literature review. Dermatologic Therapy. 2021;34(6). doi:10.1111/dth.15129
- Rodriguez-Zuniga M, Torres N, Garcia-Perdomo H. Effectiveness of Acyclovir in the treatment of pityriasis rosea. A systematic review and meta-analysis. An Bras Dermatol. 2018;93(5):686–695. doi:10.1590/abd1806-4841.20187252
- Villalon-Gomez JM. Pityriasis rosea: diagnosis and treatment. Am Fam Physician. 2018;97(1):38–44.
- Marasca C, Ruggiero A, Napolitano M, Fabbrocini G, Megna M. May COVID-19 outbreaks lead to a worsening of skin chronic inflammatory conditions? Med Hypotheses. 2020;143:109853. doi:10.1016/j.mehy.2020.109853