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BMJ 2004; 329 doi: (Published 01 July 2004) Cite this as: BMJ 2004;329:60

The name pityriasis rosea was given to the exanthematous illness in 1860—a long time ago—but its exact cause remains uncertain. The clinical signs (herald patch and secondary eruption) and complete resolution within 8-12 weeks point to an infection, but at present all that can be said is that the role of the human herpes viruses 7 and 6 is controversial, while “not guilty” verdicts have been given to five or more other viruses and several bacteria. A review in Epidemiology and Infection (2004;132: 381-90) concludes that the clinical picture is strong evidence for an infection, and that further investigation is needed to identify it.

Sixty per cent of deaths from breast cancer occur in women aged over 65, but until recently the treatment of women of this age was empirical, largely because elderly women were excluded from most clinical trials. Several randomised trials including older women have now reported (British Journal of Surgery 2004;91: 655-6). These have shown that tamoxifen alone is inadequate treatment (and so, probably, is treatment with aromatase inhibitors alone) and should be given only to very frail women with a life expectancy of less than a year. Local treatment is important not only to control local disease but also for improved survival.

Randomised clinical trials do not need to be blind. A pilot study for a randomised controlled trial …

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