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Anaesthetic management of a parturient with pityriasis rosea: first report of an uneventful use of spinal anaesthesia
Abstract Number: SU-55
Abstract Type: Case Report/Case Series
Background: Pityriasis rosea is a disease of unknown etiology presenting with characteristic skin rash. It may impose challenges on anaesthetic management of labour and delivery as neuraxial techniques need a judicious approach. To our knowledge, there are no literature reports regarding neuraxial techniques in such cases. We report the first case of caesarean section under spinal anaesthesia in patient with pityriasis rosea.
Case report: 42-years-old woman was admitted to our unit at 37 weeks of gestation. In view of twin pregnancy she was scheduled to undergo an elective caesarean section. Two weeks before her admission she developed a pink, itchy, squamopapular rash over her trunk and back which was diagnosed to be pityriasis rosea. Differential diagnosis included pruritic urticarial papules and plaques of pregnancy (PUPPPs). After discussion between anaesthetists, obstetricians and dermatologists, a plan of regional anaesthesia was made. Skin was disinfected with three repeated applications of 0.5% chlorexidine spray and it was allowed to dry between each application.
A single shot spinal with 2 ml of hyperbaric bupivacaine 0.5% and 150 mcg of diamorphine was performed. The intra-and postoperative course was unremarkable and patient was discharged home after 48 hours.
Discussion: Pityriasis rosea is a dermatological condition presenting as a truncal rash. It is usually self-limiting and lasts for around 6-8 weeks. Exact etiology is unknown, but a viral causation such as human herpes virus HHV-6 is speculated. Prevalence during pregnancy is around 18% and complications described are premature delivery with neonatal hypotonia and fetal demise (1,2).
Diagnosis and management of dermatological conditions in parturients may represent a challenge for anaesthetists. We report for the first time an uneventful use of spinal anaesthesia in patient with an active pityriasis rosea.
Learning points: Infection at the site of needle insertion is still considered a contraindication to neuraxial techniques. We suggest to reconsider the long-standing belief that regional techniques are contraindicated in patients with active local skin infection, especially if it is not bacterial in nature, as in case of pityriasis rosea. However further reports are necessary to make definitive conclusions on patients' safety.
References: 1.Drago F et al. Pregnancy outcome in patients with pityriasis rosea. J Am Acad Dermatol 2008;58(suppl 1):S78-S832.
2. Cruz MJ et al. Atypical pityriasis rosea in pregnant woman:first report associating local herpes simplex virus 2 reactivation. The Journal of Dermatology 09/2011;39(5):490-2.