Roseola

ROSEOLA (roseola), small hyperemic bright red spots the size of a lentil, representing merely skin manifestations of various diseases. Thus, according to Darier, 4 groups of roseola are distinguished: 1) febrile roseolous rashes (measles, rubella), 2) infectious symptomatic roseola (in syphilis, typhus, cholera, smallpox, cerebrospinal meningitis, and certain forms of septicemia), 3) medicinal roseola (see Dermatitis), 4) emotional roseola (during agitation) in the form of rapidly disappearing spotted or reticular redness, appearing in some individuals on the chest, neck, and shoulders when undressing, which represents a physiological phenomenon similar to the reddening of the face during excitement. Syphilitic roseola (spotted or erythematous syphilid) consists of round or oval, sharply demarcated pale red or bright red spots lying at the level of the skin or slightly rising above it due to hyperemic edema, which never peel or itch. Upon the first eruption, an abundant, symmetrically located, small-spotted roseola usually appears, reaching a size of about 0.5 cm in diameter. The preferred localization is the lateral surfaces of the trunk, the skin of the abdomen, the flexor surfaces of the upper extremities, and more rarely the neck and face. In emaciated and weak people, especially in women, a slight fever, headaches, loss of appetite, and general malaise occur upon the appearance of roseola. Under the influence of specific treatment or without it, the roseola gradually pales and disappears without a trace. Roseola develops in the 4th–6th week after the appearance of a chancre. Its duration of existence is from 2 to 6 weeks, which depends to a significant extent on whether the patient underwent specific treatment. In late relapses, roseola appears mostly sparse and pale, asymmetrically scattered in the form of larger spots with a tendency to group in the form of arcs and ring-shaped figures. Such ring-shaped or garland-like large-spotted roseola, sometimes recurring up to 5 times, can appear even after the expiration of 3–4 years after infection (late recurrent roseola, roseole tardive Fournier). Histologically: hyperemia and slight small-cell infiltration of the papillary and subpapillary layers of the skin in the vicinity of dilated vessels, the walls of which are thickened. Pale spirochetes are found mostly in sparse quantities. Diagnosis is usually easy, but in doubtful cases, it is necessary to look for concomitant signs of infection (remnants of sclerosis, swelling of lymph glands, lesions of mucous membranes, focal hair loss, etc.) or to perform the Wassermann reaction. In differential-diagnostic terms, one must take into account Pityriasis rosea of Gibert, exudative erythema multiforme, ringworm, marmorescence, and blue spots from louse bites. Roseola in febrile diseases (measles, rubella) is characterized by a pale pink color; the spots quickly acquire a saturated redness, merge, and turn into a papule; the eruption is accompanied by a sharp increase in temperature; the regression of the measles rash is accompanied by peeling; roseola in rubella usually passes without peeling and pigmentation. Medicinal roseola (after taking balsamic preparations) is characterized by itching and a bright red color.