1. PATIENT PRESENTATION
A 16‐year‐old female with type 1 diabetes mellitus presented to the emergency department with a progressive rash of 1 month's duration. The rash first appeared on the dorsum of her hands and spread to her bilateral arms, legs, and face. She denied any new medications, foods, soaps, or detergents. In the outpatient setting, the rash was first treated with oral cephalexin, hydroxyzine, topical, and oral steroids. Complete blood count (CBC), serum electrolytes, C reactive protein, and erythrocyte sediment rate were within normal limits. She was asymptomatic; however, occasionally some spots were mildly tender. Physical examination revealed a well appearing afebrile teenager who had 3–6 mm erythematous macules and papules with scaling and hemorrhagic crusting (Figure 1A,B).
FIGURE 1.
Eleven‐year‐old female with 3–6 mm erythematous papules, with some scale and heme‐crusted lesions in the (A) bilateral upper extremities and (B) lower extremities, also present in the face, eyelids, ear, neck, back, chest, and abdomen.
2. DIAGNOSIS: PITRYRIASIS LICHENOIDES ET VARIOLIFORIS ACUTA
Pitryriasis lichenoides et varioliforis acuta (PLEVA) is also known as Mucha–Habermann disease. 1 It is a rare, self‐limited cutaneous inflammatory rash. 2 The etiology is unknown; it is a non‐typical immune response to viral/bacterial infections, inflammatory reaction to medications are some hypotheses. 1 , 3 The incidence, prevalence, and risk factors of PLEVA are unknown, which makes the diagnosis more challenging. It is characterized by diffuse papules red‐purple‐brown macules in various stages. Occasionally, it may progress to pustules and ulcers. It can be associated with pruritis/burning sensation. PLEVA favors the truck and proximal extremities.
The diagnosis is mainly clinical; complemented by examination under the dermatoscope. The first‐line treatment is photo therapy multiple times a week. Due to the benign nature of PLEVA, pharmacotherapy is often unnecessary. Patients may benefit from doxycycline and erythromycin. Topical corticosteroids are utilized as adjunctive therapy; systemic antihistamines may offer symptomatic relief for itching. 3
Magargee C, Krishnaprasadh D. Teenager with benign progressive rash. JACEP Open. 2024;5:e13161. 10.1002/emp2.13161
REFERENCES
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