Pityriasis rosea presenting with a heraldic patch within a tattoo

Pityriasis rosea (PR) is an acute, self-healing exanthema, affecting mainly young patients, that can disclose various clinical presentation.¹ The elective location to traumatised areas has not been reported during PR.

A 21-year-old otherwise healthy woman presented with small rose scaly ovoid patches of the trunk (Figure 1). She reported having profuse rhinorrhea 2–3 weeks before the appearance of the rash and no other symptoms. She recalled an initial larger patch within a thin black tattoo of the left side of the trunk (Figure 2) before the rash spread to the rest of the body. A diagnosis of PR was made.

Except Koebner phenomenon—prone diseases like psoriasis, lichen or vitiligo, many dermatoses have been anecdotally described in tattoos.² PR is not known to display affinity to traumatised areas^{1, 3} and, to our knowledge, PR has never been reported within tattoos.⁴ The elective localisation to a tattoo in our case is most likely merely fortuitous, but we cannot rule out that previous cases might have gone unnoticed or been unreported. The possible occurrence of a herald patch in a tattoo is to be kept in mind as it could be mistaken initially for psoriasis or tinea corporis⁵

Lidiya N. Todorova contributed to the collection of data and management of the patient. Nicolas Kluger wrote the first draft of the manuscript. Lidiya N. Todorova and Nicolas Kluger revised the manuscript and prepared the final version. All authors have read and approved the final manuscript and agree to take full responsibility for the integrity and accuracy of the work.

The authors declare no conflicts of interest.

The patient in this manuscript has given written informed consent for participation in the study and the use of their deidentified, anonymized, aggregated data and their case details (including photographs) for publication. Ethical Approval: not applicable.