Allergy Asthma Proc. (2021) 93:18501. Polack FP, Thomas SJ, Kitchin N et al. Six days later, she developed a rash on her. Drago F, Broccolo F, Ciccarese G. Pityriasis rosea, pityriasis rosea-like eruptions, and herpes zoster in the setting of COVID-19 and COVID-19 vaccination. In a registry-based study, PR-like eruption was observed in only 12% of patients (14). A total of 111 people were identified to have developed pityriasis rosea or pityriasis rosea-like eruptions after vaccination, out of which 36 (55.38%) were female. Contributions: SV and CAM, conceived and wrote the article. Department of Dermatology, Graduate School of Medicine, Kyusyu University, Japan. A 3-cm oval plaque with peripheral scale, larger than the other lesions, was present on the inferior portion of the right breast. doi: 10.1111/jdv.12942, 13. Several vaccines have been created to counteract the morbidity and mortality associated with COVID19 and stop viral transmission, including the Moderna vaccine (Mrna1273).The mRNA1273 vaccine is a lipid nanoparticle-encapsulated mRNAbased vaccine that encodes the prefusion stabilized fulllength spike . 2021;35(9):e546e548. Akdas E, Ilter N, Ogut B, Erdem O. Pityriasis rosea following CoronaVac COVID-19 vaccination: a case report. The study is created by eHealthMe and uses data from the Food and Drug Administration (FDA). The coronavirus disease 2019 (COVID-19) pandemic is filling the headlines these days. sharing sensitive information, make sure youre on a federal Martora F, Battista T, Marasca C, Genco L, Fabbrocini G, Potestio L. Clin Cosmet Investig Dermatol. 2022 Jun;7:164-168. doi: 10.1016/j.jdin.2022.01.009. Careers. 2022 Sep;21(9):3692-3703. doi: 10.1111/jocd.15209. In conclusion, we have described the first case of PR-like eruption following ChAdOx1 nCoV-19 (Oxford/AstraZeneca) vaccination. The four stages of pityriasis rosea are: Preliminary stage: You feel ill for a day or two. I got tested for covid after I got the vaccination because . Epub 2022 Feb 9. Disclaimer. KL drafted the original manuscript. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Before SPSS statistical software version 25 was used for appropriate inferential statistics. Epub 2022 Jan 31. The .gov means its official. Busto-Leis JM, Servera-Negre G, Mayor-Ibarguren A, Sendagorta-Cuds E, Feito-Rodrguez M, Nuo-Gonzlez A, et al. 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). J Eur Acad Dermatol Venereol. Please enable it to take advantage of the complete set of features! A Yale-led study published in the journal Immunity in May offers a few theories on why some children develop MIS-C and others don't. Clin Dermatol. Unauthorized use of these marks is strictly prohibited. Literature data about PR/PRLE after anti-SARS-CoV-2 vaccination may be summarized as follows: i) the infection occurs both in males and females (in several articles the gender was not reported); ii) the age ranges from 19 to 82 years (the count of the mean age is impossible because in several articles patients age was not specified). Pityriasis rosea is a type of skin rash. NCI CPTC Antibody Characterization Program. Moreover, almost all lesions faded with associated post-inflammatory hyperpigmentation (Figure 2B). Erythematous-squamous, annular plaque on the presternal region. An official website of the United States government. the contents by NLM or the National Institutes of Health. Bethesda, MD 20894, Web Policies Pityriasis rosea-like eruption after Pfizer-BioNTech COVID-19 vaccination Pityriasis rosea-like eruption after Pfizer-BioNTech COVID-19 vaccination Pityriasis rosea-like eruption after Pfizer-BioNTech COVID-19 vaccination Pityriasis rosea-like eruption after Pfizer-BioNTech COVID-19 vaccination Br J Dermatol. doi: 10.1007/s10103-019-02783-8, 16. 8600 Rockville Pike N Engl J Med 2020; 383:260315. Epub 2022 Feb 9. Epub 2021 May 10. Pityriasis rosea, pityriasis rosea-like eruptions, and herpes zoster in the setting of COVID-19 and COVID-19 vaccination. Few brownish patches also appeared, suggestive of post-inflammatory hyperpigmentation. 2022 Sep-Oct;40(5):586-590. doi: 10.1016/j.clindermatol.2022.01.002. It manifests as oval-shaped, pink or red . Unauthorized use of these marks is strictly prohibited. Epub 2021 Aug 26. FOIA Many Americans become infected with them at an early age. eCollection 2021. Int J Infect Dis. official website and that any information you provide is encrypted Xing K, Tu XY, Liu M, et al. Welsh E, Cardenas-de la Garza JA, Cuellar-Barboza A, et al. MeSH Pityriasis rosea and pityriasis rosea-like eruption after anti-SARS-CoV-2 vaccination: a report of five cases and review of the literature. National Library of Medicine 2021 Dec;108(6):317-318. doi: 10.12788/cutis.0411. Pityriasis is linked mainly with herpesviruses 6 and 7; only a small number of cases have been reported in association with vaccinations (e.g., yellow fever, influenza, hepatitis B, human. J Am Acad Dermatol. Unable to load your collection due to an error, Unable to load your delegates due to an error. Department of Pathophysiology and Transplantation, Universit degli Studi, Foundation IRCCS Ca Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122 Milan, Italy. Table 1. She was prescribed outpatient COVID-19 treatment of azithromycin, vitamins D and C, and then quarantined for 2 weeks. Pityriasis Rosea Induced by COVID-19 Vaccination Eur J Case Rep Intern Med. A history of viral infection preceding the disease was reported SARS-CoV-2 vaccine; cutaneous side-effects; infection; papulosquamous; skin diseases; vaccine hesitancy. [Epub ahead of print]. Previously, PR has been reported in temporal association with various viral inoculations. -, Busto-Leis J.M., Servera-Negre G., Mayor-Ibarguren A., et al. J Am Acad Dermatol. Suchonwanit P, Leerunyakul K, Kositkuljorn C. Cutaneous manifestations in COVID-19: Lessons learned from current evidence. Of the 30 cases found, none experienced severe adverse effects and the rash resolved in an average of 5.6 weeks. Four patients were subjected to the second vaccination, but no skin lesions appeared. Dursun R, Temiz SA. In a Turkish-Egyptian study, the average age was 44.9 years;17 iii) in 30 cases the vaccine used was BNT162b2, in 18 cases it was CoronaVac, in 4 cases it was AZD1222 and in 4 cases it was mRNA-1273; in 5 cases, the vaccine was generically defined as mRNA or recombinant. 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. Pityriasis rosea developing after COVID19 vaccination. In the period May 2021- February 2022 we observed five cases of clinically typical PR that appeared 2 to 3 weeks after anti-SARS-CoV-2 vaccination with BNT162b2 (3 patients) or mRNA- 1273 (2 patients). SARS-CoV-2 spike protein positivity in pityriasis rosea-like and urticaria-like rashes of COVID-19. It often presents with diffuse and confluent severely pruritic dusky-red erythematous lesions in the absence of herald patch (11). Although the exact pathophysiologic mechanisms of PR after vaccination remain unclear, immune responses to COVID-19 vaccines and disruption of T-cell mediated control of latent infections were implicated (12, 1518). Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases. Peripheral eosinophilia is often present. PR 12.7 days (mean) after the vaccination (19 patients after the 1. doi: 10.1016/j.jaad.20.2103.092. The site is secure. The authors declare no conflict of interest. Federal government websites often end in .gov or .mil. It starts with one large round or oval scaly patch. Please enable it to take advantage of the complete set of features! J Am Acad Dermatol. Dermatol Ther. He denied oropharyngeal lesions. 2022;S0738-081X(22)00002-5. Conclusions: We report a spectrum of cutaneous reactions after mRNA COVID-19 vaccines. Mohta A, Nyati A, Mohta A, Ghiya BC, Mehta RD, Kumar V. Indian Dermatol Online J. 2022 by the American Academy of Dermatology, Inc. the reactivation of varicella zoster or herpes simplex infections, pityriasis rosea or rosea-like lesions, petechiae, pernicious purpura . doi: 10.1111/jdv.17342. The site is secure. government site. However, several adverse effects of COVID-19 vaccination have been identified. Lasers Med Sci. Disclaimer. 2022 Jan;114:88-89. doi: 10.1016/j.ijid.2021.10.055. Viruses, Variants, and Vaccines: How COVID-19 Has Changed the Way We Look at Skin. J Med Virol. Bookshelf Cutis. The https:// ensures that you are connecting to the Unauthorized use of these marks is strictly prohibited. Physical examination revealed that lesions were distributed along cleavage lines, similar to PR, without herald patch or prominent scales (Figure 1C). Cases of pityriasis rosea/pityriasis rosea-like eruption after anti-SARS-CoV-2 vaccination reported in the literature. The .gov means its official. Unable to load your collection due to an error, Unable to load your delegates due to an error. HHS Vulnerability Disclosure, Help No HHV-6 and HHV-7 reactivation is detected. eCollection 2023 Mar 7. PMC 2022 Aug;35(8):e15601. Erin Riley said she made the discovery two weeks after receiving a mRNA Covid vaccine, which currently include Pfizer-BioNTech or Moderna. Inclusion in an NLM database does not imply endorsement of, or agreement with, Background: After introducing Covid-19 vaccines, a few side effects were reported, pityriasis rosea being one of them.Therefore, this study will systematically review its manifestation afteradministration.Methods: Databases were searched, covering a timeline from December 1, 2019 to February 28, 2022.Data were independently extracted and accessed for bias. Drago F, Ciccarese G, Parodi A. Pityriasis rosea and pityriasis rosea-like eruptions: How to distinguish them? Pityriasis rosea-like eruption after Pfizer-BioNTech COVID-19 vaccination. Dermatol Res Pract. government site. SARS-CoV-2 disease, COVID-19 infection, is a multi-system illness that has afflicted people all over the world. These types cannot cause cold sores or genital herpes. -, Welsh E, Cardenas-de la Garza JA, Cuellar-Barboza A, Franco-Marquez R, Arvizu-Rivera RI. An official website of the United States government. Abdullah L, Hasbani D, Kurban M, Abbas O. Int J Dermatol. Bookshelf Pityriasis rosea is a common self-limiting rash that usually starts with a herald patch on the trunk and progresses along the Langer lines to a generalized rash over the trunk and limbs. Due to the rising incidence of coronavirus disease 2019 (COVID-19) worldwide, mass vaccination has been the cornerstone in preventing viral spread and decreasing morbidity and mortality. COVID-19; SARS-CoV-2; pityriasis rosea; vaccination. See this image and copyright information in PMC. The condition is more prevalent in spring and fall. Book appointments online with Optimized Health and Wellness of Hudson, FL. (2019) 34:185764. J Invest Dermatol. He was otherwise healthy and taking no medications. (2006) 12:1. doi: 10.5070/D380D8301D, 11. PR is a self-limiting exanthematous disease and herpes zoster is a treatable condition; therefore, their occurrence does not require discontinuation of the vaccination schedule. FOIA 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. 2022 Jul 21;14(7):e27108. Br J Dermatol 2021. Alvin Friedman-Kien, MD, walked through the doorway into the exam room, looked at me and immediately said, "Oh, you have pityriasis rosea." He called in a bunch of residents so he could show them my rash and teach them about the condition, which often has a large patch called the "mother patch" (or herald patch), as well as smaller . Pityriasis versicolor is caused by a yeast infection and can be treated with antifungal medicines , including antifungal creams and antifungal shampoos. 2021 Nov 2;17(11):4097-4098. doi: 10.1080/21645515.2021.1963173. Epub 2022 Jan 5. The condition is clinically featured by blisters on the skin of the legs, buttocks and arms. sharing sensitive information, make sure youre on a federal doi: 10.1111/bjd.20143. The latter is found in a younger age group. Pityriasis rosea, COVID-19 and vaccination: new keys to understand an old acquaintance. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License (, Anti-SARS-CoV-2, AZD1222, BNT162b2, mRNA-1273, Pityriasis rosea, Pityriasis rosea-like eruption. See this image and copyright information in PMC. As a library, NLM provides access to scientific literature. Pityriasis rosea is a common rash that usually begins as a round or oval-shaped patch and spreads in stages in a characteristic pattern. Bethesda, MD 20894, Web Policies Epub 2021 Aug 7. To the best of our knowledge, there have been no reports of PR-like eruptions following inoculation with Oxford/AstraZeneca ChAdOx1 nCoV-19 (AZD1222) vaccine. Manifestation of pityriasis rosea and pityriasis rosea-like eruptions after Covid-19 vaccine: A systematic review. -. 1. PMC Would you like email updates of new search results? Pityriasis rosea after mRNA COVID-19 vaccination Pityriasis rosea after mRNA COVID-19 vaccination Pityriasis rosea after mRNA COVID-19 vaccination Pityriasis rosea after mRNA COVID-19 vaccination Int J Dermatol. Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. The disease begins with a single erythematous plaque, the so-called herald patch that usually appears on the trunk: it is roundish, pink to red in color and remains the only clinical manifestation for some days, when widespread, clinically similar, although smaller lesions appear. Unauthorized use of these marks is strictly prohibited. 2021;35(8):e489e491. 8600 Rockville Pike 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). But there are important differences between these 2 conditions. Accessibility Unlike in our patient, oropharyngeal lesions were observed in approximately 16% of patients with typical PR (10). Bathe or shower in lukewarm water. official website and that any information you provide is encrypted Federal government websites often end in .gov or .mil. Once a person has pityriasis rosea, it rarely recurs. Availability of data and material: Data and materials are available by the authors. Int J Dermatol. -, Carballido Vzquez A.M., Morgado B. Pityriasis rosea-like eruption after Pfizer-BioNTech COVID-19 vaccination. 2021;184(6):11941195. doi: 10.1111/dth.13650, 7. Careers. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The https:// ensures that you are connecting to the 2021;172:6369. However, the etiopathogenetic mechanisms remain largely unknown and further studies are needed in order to clarify the correlation between SARS-CoV-2 and PR. Cyrenne BM, Al-Mohammedi F, DeKoven JG, Alhusayen R. J Eur Acad Dermatol Venereol. HHS Vulnerability Disclosure, Help In 4 patients PR appeared after the first vaccination; in one patient after the second one. 18. If so, the reason may be simple: in several countries, BNT162b2 is the most used vaccine; iii) in 55 cases the rash was classified as PR, in 6 cases as PRLE; iv) in 39 cases the eruption appeared 1-12 days after the first dose (around: 4.8 days). All patients were treated with cetirizine. Other plausible theories include molecular mimicry with viral epitopes and type IV delayed hypersensitivity reaction (12). (a) Pityriasis rosea (chest, flank, and axilla); (b) pityriasis rosea (back). Most people with the rash are 10 to 35 years of age. eCollection 2022. Gianotti-Crosti Syndrome is a rare skin disease affecting children at the first years of age. Polack FP, Thomas SJ, Kitchin N, et al. 2020;96(1142):753758. (2021) 60:11501. Six weeks prior to the appearance of the initial skin lesion, the patient had coronavirus disease 2019 (COVID-19) infection with mild clinical presentation (fever up to 38 C lasting for four days and mild headache) and with symptoms of post COVID-19 syndrome (excessive tiredness). sharing sensitive information, make sure youre on a federal PMC Typically preceded by a primary solitary herald patch followed by the onset of smaller scaly papulo-squamous lesions on the skin tension lines within days to weeks.1 Reactivation of herpes virus 6 and 7 has been incriminated as a . It can take 1 to 3 months to go away. The site is secure. Here, we describe a case of PR-like eruption following ChAdOx1 nCoV-19 (AZD1222) vaccination in a Thai patient with glioblastoma. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). It was found popularly in the trunk area, either asymptomatically or with mild symptoms. 2022 Jul 6;15(1):9503. doi: 10.4081/dr.2022.9503. It is updated regularly. Future studies should investigate oral lesions in SARS-CoV-2-positive subjects and after COVID-19 vaccination in the pediatric population, taking into account viral variants and newly developed vaccines. 2021 Sep;35(9):e546-e548. Only a few cases of pityriasis rosea (PR)/pityriasis rosea-like eruption (PRLE) after anti-SARS-CoV-2 vaccination have been reported. 2021 Sep;60(9):1150-1151.doi: 10.1111/ijd.15700. Unable to load your collection due to an error, Unable to load your delegates due to an error. Careers, Unable to load your collection due to an error. An official website of the United States government. doi: 10.1111/jdv.17316, PubMed Abstract | CrossRef Full Text | Google Scholar, 2. Methods: Histopathological Spectrum of Cutaneous Reactions following COVID-19 Vaccine - An Observational Study. Epub 2021 May 29. Adya KA, Inamadar AC, Albadri W. Post Covid-19 vaccination papulovesicular pityriasis rosea-like eruption in a young male. It has been suggested that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces reactivation of other viruses, such as HHV-6, HHV-7, varicella zoster virus, and Epstein-Barr virus (5). An official website of the United States government. We report 10 . The https:// ensures that you are connecting to the Clin Dermatol. Br J Dermatol. This site needs JavaScript to work properly. The advent of vaccines has drastically reduced the incidence, morbidity, and mortality related to COVID-19 [1]. Numerous scattered erythematous plaques with fine scale oriented along skin cleavage, Herald patch of pityriasis rosea. World J Clin Cases. Leerunyakul K, Pakornphadungsit K, Suchonwanit P. Case report: pityriasis rosea-like eruption following COVID- 19 vaccination. Learning points: It is possible that a relationship between anti- Sars-CoV-2 vaccination and PR/PRLE exists; however, it is very rare, in consideration of millions of vaccinated subjects and the low number of reported cases of PR/PRLE. However, there are limited data on the negative effects of immunological reactivation following vaccination. 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. Pityriasis rosea-like eruptions following vaccination with BNT162b2 mRNA COVID-19 Vaccine. official website and that any information you provide is encrypted Chanprapaph K, Pomsoong C, Tankunakorn J, Eden C, Suchonwanit P, Rutnin S. Comparative analyses of clinical features, histopathology, and CD123 immunohistochemistry of oral lupus erythematosus, lichen planus, and other lichenoid lesions. After introducing Covid-19 vaccines, a few side effects were reported, pityriasis rosea being one of them. and transmitted securely. The https:// ensures that you are connecting to the Drago F, Ciccarese G, Javor S, et al. J Eur Acad Dermatol Venereol. and the adverse cutaneous effects of COVID-19 . Epub 2022 Jan 5. The site is secure. Bethesda, MD 20894, Web Policies doi: 10.1002/iid3.804. Abdullah L, Hasbani D, Kurban M, Abbas O. Pityriasis rosea after mRNA COVID-19 vaccination. Epub 2021 Apr 7. Dermatol Online J. Histopathologic examination revealed epidermal focal spongiosis, interface dermatitis with necrotic keratinocytes, perivascular lymphocytic infiltration, and few eosinophilic infiltrations in the superficial dermis (Figures 3B,C). In 3 patients a biopsy for histopathological examinations was carried out. FOIA Treatment with topical 0.1% triamcinolone acetonide twice daily showed partial response after seven days. Results: Thirty-one studies were included for data extraction after screening following the eligibility criteria. The .gov means its official. Dermatol Reports. 1 Several vaccines have been developed to fight against COVID19, to prevent the transmission among susceptible individuals and to decrease the morbidity 2022 May;35(5):e15391. PRISMA flowchart. Veraldi S, Boneschi V, Cusini M, Maronese CA. sharing sensitive information, make sure youre on a federal The mechanisms behind these COVID-19-related symptoms remain unclear. National Library of Medicine 8600 Rockville Pike McMahon DE, Amerson E, Rosenbach M, et al.. Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: a registry-based study of 414 cases. The .gov means its official. The rash typically lasts 6-9 weeks, rarely extending longer than 12 weeks. COVID-19 vaccine hesitancy is a critical problem that hinders The site is secure. Pityriasis rosea (PR)-like eruption is a cutaneous complication associated with several medications and vaccinations. Suchonwanit P, Leerunyakul K, Kositkuljorn C. Diagnostic and prognostic values of cutaneous manifestations in COVID-19. Pityriasis rosea is a common viral infection that usually affects individuals between 10-35 years of age. and transmitted securely. Vaccinations have been identified to rarely cause several cutaneous reactions. Conflict of interest: The authors declare no potential conflict of interest. Figure 2. Here, we report the first case of PR-like eruption following ChAdOx1 nCoV-19 (Oxford/AstraZeneca) vaccination. 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. SV, CAM, MC, VB, collected the data. Would you like email updates of new search results? . Please enable it to take advantage of the complete set of features! Epub 2021 Jun 10. The vaccination campaign has been the most important strategy to combat the COVID-19 pandemic. Bethesda, MD 20894, Web Policies This site needs JavaScript to work properly. SV, supervised the work. Before Variable dermatological manifestations including acral erythema, urticaria, vasculitis, vesicular or pustular eruptions, maculopapular rash have all been reported during the course of COVID19. "Covid arm," a red, rashlike skin reaction that can occur at the injection site days after inoculation, has been well-publicized. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Vaccine-induced pityriasis rosea and pityriasis rosea-like eruptions: a review of the literature. sharing sensitive information, make sure youre on a federal NCI CPTC Antibody Characterization Program. PMC Central dusky-red erythematous on some plaques (A); almost all lesions fading with associated post-inflammatory hyperpigmentation after treatment (B). But some patients also are developing delayed skin reactions on. -. Epub 2022 Oct 17. The https:// ensures that you are connecting to the Dermatol Reports. Limitations: Registry analysis does not measure incidence. There are four main types of vaccines and over 240 candidate vaccines in development. In 3 patients a biopsy for histopathological examinations was carried out. Pityriasis rosea is a common skin disease that is not contagious. +39.3465909404. doi: 10.1111/jdv.17342, 5. official website and that any information you provide is encrypted Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article. 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. Morphologic misclassication is possible. McMahon DE, Kovarik CL, Damsky W, et al.. Clinical and pathologic correlation of cutaneous COVID-19 vaccine reactions including V-REPP: a registry-based study. PR has also been reported to follow COVID-19 vaccination (11). Conflicts of Interests: The authors declare there are no competing interests. SARS-CoV-2 spike protein positivity in pityriasis rosea-like and urticaria-like rashes of COVID-19. Changes in color or texture can result from inflammation, infection, or allergic reactions anywhere on the body. and transmitted securely. However, pityriasis rosea is a selflimiting benign exanthema and does not require . Zhongguo Dang Dai Er Ke Za Zhi.
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