The papulovesicular and pityriasis rosea . Under the treatment that was initiated a partial remission of the lesions after 7 days was observed. government site. Parakeratosis with minimal acanthosis and spongiosis of the epidermis. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Interventions: An official website of the United States government. National Library of Medicine Drago F, Ciccarese G, Rebora A, et al. Ramot Y, Nanova K, Faitatziadou SM, Assab DA, Berkun Y, Zlotogorski A. J Dtsch Dermatol Ges. Dos Santos PG, Vieira HCVS, Wietholter V, Gallina JP, Andrade TR, Marinowic DR, Zanirati GG, da Costa JC. 2022 May;11(2):222-225. doi: 10.7774/cevr.2022.11.2.222. Drago F, Ciccarese G, Parodi A. Pityriasis rosea and pityriasis rosea-like eruptions: How to distinguish them? J Eur Acad Dermatol Venereol. Pityriasis rosea (PR)-like eruption is a rare cutaneous complication of immunization. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). COVID-19; HHV, human herpes virus; Moderna; PR; PR, pityriasis rosea; PR-LE; PR-LE, pityriasis rosea-like eruption; Pfizer; coronavirus; dermatology; mRNA vaccine; mRNA, messenger RNA; pityriasis rosea; pityriasis rosealike eruption; vaccine. Some people see the rash disappear within 6 to 8 weeks, but it can take 5 months or longer for the skin to clear. A woman. Epub 2022 Jan 31. (2021) 93:18501. 2022 Sep-Oct;40(5):586-590. doi: 10.1016/j.clindermatol.2022.01.002. Disclaimer. PS conceptualized the case report and revised the manuscript. Epstein-Barr virus reactivation after COVID-19 vaccination in a young immunocompetent man: a case report. Akdas E, Ilter N, Ogut B, Erdem O. Pityriasis rosea following CoronaVac COVID-19 vaccination: a case report. We present the case of a female patient in whom the diagnosis of pityriasis rosea led to the investigation and diagnosis of the SARS-CoV-2 infection. Please enable it to take advantage of the complete set of features! While my particular flare-up itched a lot, that's not always the case. See this image and copyright information in PMC. However, pityriasis rosea can look similar to other skin conditions, including: If theres any doubt, your healthcare provider may perform the following tests: In most cases, pityriasis rosea goes away without any treatment in six to eight weeks. (b) haematoxylineosin, original magnification 20. JAAD Int. government site. J Eur Acad Dermatol Venereol. eCollection 2022. It said blood spots under the skin might also be present, either as spots or dots or on larger areas. 2022 Nov;36(11):1947-1968. doi: 10.1111/jdv.18294. Among patients who received COVID-19 vaccines, PR-like eruptions have been reported following the first (n = 1) or second dose (n = 2) of BNT162b2 mRNA-based vaccines (3, 4). doi: 10.12998/wjcc.v5.i6.203, 6. Medicines (Basel). Luckily, it's not contagious. headache.2 Several cutaneous adverse events after anti-COVID-19 vaccination are described in the literature, such as delayed large local reaction, urticaria, morbilliform eruptions, herpes zoster, "COVID arm," pityriasis rosea.3,4,5 Here, we report a case of a patient who presented with herpes zoster ophthalmicus (HZO) after the third dose J Formos Med Assoc. Suchonwanit P, Leerunyakul K, Kositkuljorn C. Diagnostic and prognostic values of cutaneous manifestations in COVID-19. Dermoscopy showed dotted and linear vessels forming a network on a yellowish background, with some whitish peripheral scales (Figure 3A). I put on some hydrocortisone and went to sleep, then woke up with another mark on my side, a couple inches below my armpit. Keywords: sharing sensitive information, make sure youre on a federal Published by Wolters Kluwer Health, Inc. Ciccarese G, Parodi A, Drago F. SARS-CoV-2 as possible inducer of viral reactivations. Cutis. 2021 Nov 2;17(11):4097-4098. doi: 10.1080/21645515.2021.1963173. doi: 10.1111/jdv.17342, 5. The .gov means its official. The site is secure. doi: 10.1111/dth.15601. "It's usually not from head to toe that's more atypical but there are some people that get it more in the groin area or in the armpit rather than on the trunk predominantly, which is just a variant.". Cutaneous manifestation has been reported in 0.2% of patients infected by COVID-19 in China, and 18 out of 88 patients from Italy. J Eur Acad Dermatol Venereol. Federal government websites often end in .gov or .mil. See your skin clear. doi: 10.1016/j.jaad.20.2103.092. Alamri A, Alghamdi Y, Alamri SJ, Althaqafi MK, AlQurashi W, Bader BA, Mohanna AT, Almahdi B. Cureus. (2016) 30:5445. It often presents with diffuse and confluent severely pruritic dusky-red erythematous lesions in the absence of herald patch (11). HHS Vulnerability Disclosure, Help Please enable it to take advantage of the complete set of features! Pityriasis rosea, COVID-19 and vaccination: new keys to understand an old acquaintance. A virus may cause pityriasis rosea, but experts aren't sure. doi: 10.1111/ijd.13061. 8600 Rockville Pike Epub 2021 Nov 2. doi: 10.1111/j.0022-202X.2005.23719.x. Bethesda, MD 20894, Web Policies J Investig Dermatol 2005;124:123440. We present a case of a pityriasis rosea-like rash occurring after Pfizer COVID-19 vaccination and review cases of pityriasis rosea (PR)/PR-like eruption (PR-LE) after mRNA COVID-19 vaccine published in the medical literature. Studies show that some skin conditions may appear with COVID-19, including pityriasis rosea. Cazzato G, Ambrogio F, Pisani MC, Colagrande A, Arezzo F, Cascardi E, Dellino M, Macorano E, Trilli I, Parente P, Lettini T, Romita P, Marzullo A, Ingravallo G, Foti C. Vaccines (Basel). While unusual, one patient developed pityriasis rosea once a year for five years in a row. She diagnosed it as pityriasis rosea, a benign but frustratingly itchy rash that in her words just happens sometimes. Cutis. The authors have no conflicts of interests to disclose. National Library of Medicine and transmitted securely. JAAD Case Rep 2018; 4: 800801. It has been reported that pityriasis rosea has been triggered by several vaccines, as a rare side-effect. doi: 10.1002/ccr3.6096. Other plausible theories include molecular mimicry with viral epitopes and type IV delayed hypersensitivity reaction (12). McMahon DE, Amerson E, Rosenbach M, Lipoff JB, Moustafa D, Tyagi A, et al. Pityriasis rosea developing after COVID-19 vaccination. retailers. doi: 10.1111/bjd.20143. Pityriasis rosea-like Covid-arm Erythema multiforme Erythroderma Psoriasis Others Grover-like eruptions Herpes simplex reactivation: 24 1 17 4 2 2 1 1 20 15 9 5 2 1 1 1 3 3: 21.5 0.9 15 3.5 1.8 1.8 0.9 0.9 Pityriasis rosea (PR)-like eruption is a cutaneous complication associated with several medications and vaccinations. Keywords: adverse effect, coronavirus, cutaneous eruptions, immunization, pityriasis rosea, SARS-CoV-2, vaccine, case report, Citation: Leerunyakul K, Pakornphadungsit K and Suchonwanit P (2021) Case Report: Pityriasis Rosea-Like Eruption Following COVID-19 Vaccination. FOIA Epub 2022 Jun 26. Pityriasis rosea is a benign inflammatory rash that starts with a single red rash, also known as the "herald patch," which eventually gives way to a larger, similar-looking rash on the trunk. 2021 Jun 25;118(25):431. doi: 10.3238/arztebl.m2021.0257. Pityriasis rosea. Your skin may develop discolored patches (lesions) that look like scales or dry, crinkly paper. FOIA ", Though there's no single-known cause, King says, "pityriasis rosea is associated with reactivation of herpesviruses 6 and 7 [HHV-6 and HHV-7, respectively], which cause the primary rash, roseola, in infants. I tell my patient to use a gentle non-soap cleanser." Bookshelf Unable to load your collection due to an error, Unable to load your delegates due to an error. J Eur Acad Dermatol Venereol 2020; 34: e436-e437. Physicians should be aware that pityriasis rosea is a rare side-effect of COVID-19 vaccination.Pityriasis rosea is self-limiting and no medical treatment is usually required. (a) haematoxylineosin, original magnification 10. Pityriasis rosea commonly affects the skin on your trunk, arms or legs. Disseminated erythematous-papulosquamous lesions, with right laterocervical herald patch (clinical aspect on admission). An official website of the United States government. Bookshelf Some rare cases can take up to three months. In: Knoop KJ, Stack LB, Storrow AB, et al., eds. 2022 Nov 6;15:2369-2382. doi: 10.2147/CCID.S388245. Considering the actual epidemiological context, we performed a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay from nasal and pharyngeal swabs for coronavirus disease 2019 (COVID-19) to investigate the PR etiology. (2016) 55:e33843. An official website of the United States government. You may initially develop a fever, headache or upper respiratory infection. . -, Cyrenne BM, Al-Mohammedi F, DeKoven JG, Alhusayen R. Pityriasis rosea-like eruptions following vaccination with BNT162b2 mRNA COVID-19 vaccine. J Am Acad Dermatol. 2022 Jul 8;101(27):e29823. Few scattered dyskeratotic keratinocytes are seen in the lower epidermis. National Library of Medicine Please enable it to take advantage of the complete set of features! doi: 10.1111/jdv.17316. Front. How can you tell that I have pityriasis rosea? (2017) 9:7399. doi: 10.4081/dr.2017.7399, 17. I figured a very determined mosquito had snuck into my room and attacked me through my tank top. Despite this rare complication, our report highlights that the presence of PR-like eruption is not a contraindication for subsequent vaccinations. doi: 10.1111/bjd.20143. However, some people believe that eating an anti-inflammatory diet may relieve itching. Human herpesvirus6, 7, and EpsteinBarr virus reactivation in pityriasis rosea during COVID19. Cutaneous reactions after COVID-19 vaccination in Turkey: A multicenter study. Herein, we are reporting a unique. Br J Dermatol. Conflicts of Interests: The authors declare there are no competing interests. -, Johansen M, Chisolm SS, Aspey LD, Brahmbhatt M. Pityriasis rosea in otherwise asymptomatic confirmed COVID-19-positive patients: a report of 2 cases. Epub 2021 Apr 7. Federal government websites often end in .gov or .mil. Pityriasis Rosea Associated With COVID-19 Vaccination: A Common Rash Following Administration of a Novel Vaccine. 2022 Jul 21;14(7):e27108. 2022 Nov;36(11):1947-1968. doi: 10.1111/jdv.18294. Bookshelf 2022 by the American Academy of Dermatology, Inc. -. Some patients may have a cold before the rash. Get many smaller patches or bumps on your skin. Recurrent and persistent pityriasis rosea: an atypical case presentation. Our reported case adds to the other findings regarding the association of PR with SARS-CoV-2 infection, in the context of the pandemic, suggesting the need to test patients with PR skin lesions for SARS-CoV-2 infection. Disclaimer. This site needs JavaScript to work properly. Herald patch in the right hypochondrium followed by typical oval-shaped secondary plaques, Pityriasis rosea lesions on the upper extremities, MeSH The symptoms of pityriasis rosea usually develop in stages: Pityriasis rosea doesnt hurt. eCollection 2022 Jul. It has been reported that pityriasis rosea has been triggered by several vaccines, as a rare side-effect. Pityriasis Rosea According to the Mayo Clinic, pityriasis rosea is a rash that usually begins as a large circular or oval spot on your chest, abdomen, or back. A few days later, the cluster came: Ten little dots arranged themselves in a perfect alien-like crop circle on my upper back, and they itched so much that I scratched them raw. Temiz SA, Abdelmaksoud A, Dursun R, Durmaz K, Sadoughifar R, Hasan A. J Cosmet Dermatol. Pityriasis lichenoides has distinct acute and chronic forms, which are usually distinct . Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: a registry-based study of 414 cases. Br J Dermatol. Vaccine-induced pityriasis rosea and pityriasis rosea-like eruptions: a review of the literature. 2021 Dec;108(6):317-318. doi: 10.12788/cutis.0411. It is likely that a new viral trigger of pityriasis rosea is the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Rybak-d'Obyrn J, Placek W, Owczarczyk-Saczonek A, Derkaczew M, Joniec E, Hofman R, Stompr M. Clin Cosmet Investig Dermatol. 8 In some cases, antibodies against HHV6/7 as well as viral DNA in plasma and PBMCs were detected. If you need help purchasing a product directly from Allure, go to our FAQ. Br J Dermatol. The site is secure. Suchonwanit P, Hector CE, Bin Saif GA, McMichael AJ. Cutaneous Reactions Following COVID-19 Vaccination: A Review of the Current Literature. 2021 Aug;35(8):e491-e493. (b) Patient 1: Closeup of a plaque. Dermatology. 2022 Sep;21(9):3692-3703. doi: 10.1111/jocd.15209. Influenza viruses and vaccines have triggered pityriasis rosea in some cases.". Despite this rare complication, our report highlights that the presence of PR-like eruption is not a contraindication for subsequent vaccinations. An official website of the United States government. [Epub ahead of print]. Clipboard, Search History, and several other advanced features are temporarily unavailable. Kroumpouzos G, Paroikaki ME, Yumeen S, Bhargava S, Mylonakis E. Microorganisms. ", The 29 Best Valentines Day Gifts for the Men in Your Life. Pityriasis rosea usually resolves on its own without treatment in most cases, King says, but topical corticosteroids can be used for itchy control if necessary, which is what I used. 2022 Aug;20(8):1123-1124. doi: 10.1111/ddg.14784. 78 PDF Pityriasis rosea following CoronaVac COVID19 vaccination: a case report Elin Akda, N. Ilter, B. t, . Erdem Foods that have anti-inflammatory properties include: Foods that may increase inflammation include: There isnt any way to prevent pityriasis rosea. 8600 Rockville Pike Numerous scattered erythematous plaques with fine scale oriented along skin cleavage lines, most appreciable on the upper portion of the chest. HHS Vulnerability Disclosure, Help Few brownish patches also appeared, suggestive of post-inflammatory hyperpigmentation. Borgia F, Li Pomi F, Alessandrello C, Vaccaro M, Pioggia G, Gangemi S. J Dermatol. Unable to load your collection due to an error, Unable to load your delegates due to an error. Epub 2022 Jun 14. 2023 Cond Nast. They were found on hands and feet, showing up as red or purple spots caused by bleeding under the skin. 2021;185(2):e34. 2021;35(8):e489e491. Unfortunately, due to her deteriorating neurologic status, her associated symptoms were not evaluated properly. Careers. Pityriasis rosea: An update on etiopathogenesis and management of difficult aspects. Pityriasis Rosea. Moreover, while dermoscopy may facilitate the diagnosis of PR, its utility for atypical PR or PR-like lesions is still limited. and transmitted securely. There isnt a cure, but it isnt contagious. The patient presented to the Department of Dermatology for a 3 week duration of an extremely pruritic erythematous-squamous lesion, initially on the trunk and upper limbs, with extension to the lower limbs in the last week and the lesion respected the cephalic extremity, palms, and soles. 2022 Aug;35(8):e15601. Atzori L, Pinna AL, Ferreli C, Aste N. Pityriasis rosea-like adverse reaction: review of the literature and experience of an Italian drug-surveillance center. Epub 2022 Jan 5. 2022 Mar 15;10(3):624. doi: 10.3390/microorganisms10030624. Bathe or shower in lukewarm water. Vote for your favorite beauty products now! 2020 Jul;33(4):e13730. Pityriasis rosea Gibert type rash in an asymptomatic patient that tested positive for COVID-19. For most people, it resolves without treatment. doi: 10.1111/jdv.17342. -, Mahajan K, Relhan V, Relhan AK, et al. As vaccine reactogenicity reports continue to surface, dermatologists and other health care providers should understand the landscape of the latest cutaneous reactions to guide and address patients' concerns. 2022 Sep-Oct;40(5):586-590. doi: 10.1016/j.clindermatol.2022.01.002. Unauthorized use of these marks is strictly prohibited. It was described as "clinically reminiscent" of pityriasis rosea by the authors, from the divisions of dermatology and venereology, pathology, intensive care, and the virology laboratory, of the Hpital Cochin, Paris. This site needs JavaScript to work properly. Careers. Accessibility Children often get infected when someone sneezes or kisses them. Federal government websites often end in .gov or .mil. 2022 Mar 15;10(3):624. doi: 10.3390/microorganisms10030624. One case of pityriasis rosea is reported in a patient infected with COVID19, and the most commonly reported features are exanthomatous rash, urticaria, chickenpox like vesicles, petechiae, and acute hemorrhagic edema of infancy. Keywords: N Engl J Med 2020; 383: 26032615. official website and that any information you provide is encrypted -, Drago F, Ciccarese G, Javor S, Parodi A. Vaccineinduced pityriasis rosea and pityriasis rosealike eruptions: a review of the literature. Cutaneous Reactions Following COVID-19 Vaccination: A Review of the Current Literature. Unable to load your collection due to an error, Unable to load your delegates due to an error. If you have pityriasis rosea, the rash with go away without treatment. eCollection 2022. A variant called inverse pityriasis rosea can affect the skin on your neck, face, armpits (axillae) and groin, though it isnt common. The https:// ensures that you are connecting to the *Correspondence: Poonkiat Suchonwanit, poonkiat@hotmail.com, ORCID: Kanchana Leerunyakul orcid.org/0000-0002-0669-5611Kallapan Pakornphadungsit orcid.org/0000-0003-4783-0282Poonkiat Suchonwanit orcid.org/0000-0001-9723-0563, COVID-19 Associated Cutaneous Manifestations and COVID-19 Vaccine Related Skin Reactions, View all Histopathologic features: (B) microscopic image at a low power field showing psoriasiform epidermal hyperplasia, perivascular infiltration, and interface dermatitis (hematoxylin-eosin; scale bar represents 100 m); (C) microscopic image at a high power field showing focal spongiotic dermatitis, interface dermatitis, and perivascular infiltration of lymphocytes and eosinophils (hematoxylin-eosin; scale bar represents 40 m). How long will it take my body to clear the rash? Careers. Pityriasis rosea-like eruptions following vaccination with BNT162b2 mRNA COVID-19 Vaccine. To the best of our knowledge, only one case of ChAdOx1 nCoV-19 vaccine-induced PR-like eruption has been reported (2). Marcantonio-Santa Cruz OY, Vidal-Navarro A, Pesqu D, Gimnez-Arnau AM, Pujol RM, Martin-Ezquerra G. J Eur Acad Dermatol Venereol. eCollection 2022. 2022 Nov 6;15:2369-2382. doi: 10.2147/CCID.S388245. Yes, There Is a Correct Order for Everything You Do in the Shower, Each Zodiac Sign's Unique Personality Traits, Swoopy 1960s Hair Was Everywhere at the SAG Awards, Christina Aguilera Opened Up About Getting Injections and Why She Doesn't Care If People Judge Her, "I think we all can rely on a little help. Refined carbohydrates, such as sugar, pastries and white bread. Clin Dermatol. Disclaimer. Treatment may include various topical and oral drugs. Bethesda, MD 20894, Web Policies The cause of pityriasis rosea is not known, but it is commonly believed to be caused by a virus or bacteria. (a) Patient 1: Thin, Histopathological findings of pityriasis rosealike, Histopathological findings of pityriasis rosealike eruption in patient 1. Adya KA, Inamadar AC, Albadri W. Post Covid-19 vaccination papulovesicular pityriasis rosea-like eruption in a young male. Shingles was another fear, as I had chicken pox when I was four, but we ruled that out too: "Shingles is a nerve-mediated process; it tends to be very painful, not so itchy," Lam says. Pityriasis rosea following SARS-CoV-2 vaccination: A case series. Of the 30 cases found, none experienced severe adverse effects and the rash resolved in an average of 5.6 weeks. Global prevalence and clinical manifestations of cutaneous adverse reactions following COVID-19 vaccination: A systematic review and meta-analysis. All rights reserved. The most commonly inoculated vaccines include those against smallpox, followed by tuberculosis, poliomyelitis, influenza, and human papillomavirus virus (12, 13). For instance, the rash sometimes appears only under the arms or on the flanks. Histopathological Patterns of Cutaneous Adverse Reaction to Anti-SARS-CoV-2 Vaccines: The Integrative Role of Skin Biopsy. The authors of one 2014 case report of a 71-year-old man who suffered from pityriasis rosea one month after receiving an influenza vaccine concluded that "altered immunity" could result in reactivation of HHV-6 and/or HHV-7 which may have triggered an atypical presentation of PR. Em Rata Just Debuted a Chic Italian Bob With Baby Bangs. Coronavirus disease 2019 and pityriasis rosea: A review of the immunological connection. This tiny glimpse of her natural texture is thrilling. Epub 2022 May 3. JAAD Case Rep. (2018) 4:8001. Pityriasis rosea following SARS-CoV-2 vaccination: A case series. See this image and copyright information in PMC. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Bookshelf 2021 Aug;185(2):e34. Europe PMC is an archive of life sciences journal literature. Department of Dermatology, Graduate School of Medicine, Kyusyu University, Japan. J Am Acad Dermatol. The https:// ensures that you are connecting to the Int J Dermatol. Pityriasis rosea (PR)-like eruption is a cutaneous complication associated with several medications and vaccinations. This site needs JavaScript to work properly. 2021;184(6):11941195. A 3-cm oval plaque with peripheral scale, larger, MeSH Get useful, helpful and relevant health + wellness information. Although the exact pathogenesis of PR is unknown, current evidence suggests that an inflammatory reaction due to a viral trigger may lead to the cutaneous manifestations. Oueijan RI, Hill OR, Ahiawodzi PD, Fasinu PS, Thompson DK. government site. In darker-skinned or Black people, the patches may be more raised (papular), and the centers of the patches may look like the tissue is dying (necrotic). Temiz SA, Abdelmaksoud A, Dursun R, Durmaz K, Sadoughifar R, Hasan A. J Cosmet Dermatol. However, several adverse effects of COVID-19 vaccination have been identified. Epub 2022 Feb 9. Careers. HHS Vulnerability Disclosure, Help Pityriasis means scaly, and rosea means pink, but the rashes may look red, gray, brown or purple. Pityriasis rosea as a cutaneous manifestation of COVID-19 infection Pityriasis rosea as a cutaneous manifestation of COVID-19 infection Pityriasis rosea as a cutaneous manifestation of COVID-19 infection Pityriasis rosea as a cutaneous manifestation of COVID-19 infection J Eur Acad Dermatol Venereol. Urbina F, Das A, Sudy E. Clinical variants of pityriasis rosea. Although histopathologic characteristics of PR are also observed in PR-like lesions, the presence of dyskeratotic keratinocytes, interface dermatitis, and eosinophilic infiltration in the dermis may be more prominent in PR-like eruptions (11). (2019) 34:185764. official website and that any information you provide is encrypted Among patients who received inactivated vaccines, another case of PR-like eruption was reported four days after the first dose of CoronaVac (SinoVac) (1). 2021;35(9):e546e548. Int J Infect Dis. Washrawirul C, Triwatcharikorn J, Phannajit J, Ullman M, Susantitaphong P, Rerknimitr P. J Eur Acad Dermatol Venereol. Generalized Papulovesicular Eruption as a Side Effect of the Pfizer-BioNTech COVID-19 Vaccine. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753512/), Visitation, mask requirements and COVID-19 information, sexually transmitted disease or infection. Abdullah L, Hasbani D, Kurban M, Abbas O. Pityriasis rosea after mRNA COVID-19 vaccination. Careers. Epub 2021 Nov 2. JAAD Int. Pityriasis Rosea-like eruptions following COVID-19 mRNA-1273 vaccination: A case report and literature review. Numerous scattered erythematous, Pityriasis rosea. "Covid arm," a red, rashlike skin reaction that can occur at the injection site days after inoculation, has been well-publicized. SARS-CoV-2 spike protein positivity in pityriasis rosea-like and urticaria-like rashes of COVID-19. KL and KP collated resources. It is important for physicians to be aware of this self-limited reaction so they can reassure and appropriately counsel patients that it is safe to receive subsequent vaccine doses despite the cutaneous eruption. You cant spread pityriasis rosea to another person through unprotected sex or skin-to-skin contact. National Library of Medicine Though there's no single-known cause, it may be brought on by a drug interaction, or the reactivation of herpes simplex virus 6 or 7.
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