A Child with Multiple Erythematous, Crusted Papules on the Trunk and Extremities

Zoey R. Glick; Vanessa Lichon; Shahbaz A. Janjua; Marianna Blyumin-Karasik; Amor Khachemoune

Disclosures

Dermatology Nursing. 2010;22(1) 

In This Article

Abstract and Introduction

Abstract

Pityriasis lichenoides et varioliformis acuta is a disease that manifests as multiple, small, erythematous papules that may develop rapidly into vesicles, pustules, or papules. The etiology of this disease is unknown. Phototherapy is the most effective treatment.

Introduction

A 5-year-old boy presented with a 3-month history of an abrupt onset of a generalized asymptomatic red papular eruption predominantly involving the trunk and the proximal extremities. Other than the lesions, he is healthy. The eruption rapidly evolved into papulovesicles, subsequently evolving to papules with central necrosis and hemorrhagic crusts. There was no history of any constitutional symptoms such as fever preceded or accompanied by the eruption. There was no history of any drug intake prior to the eruption. There was no personal or family history of similar eruption. There was no personal and family history of any atopic diatheses. Topical steroids were prescribed by a general practitioner for this condition with little or no improvement.

Physical examination revealed a generalized symmetric eruption of multiple, discrete, reddish brown papules, each with central necrosis and hemorrhagic crusts (see Figure 1). The trunk, buttocks, and the proximal extremities were predominantly involved (see Figure 2). The child was afebrile and comfortable at the time of presentation. There was no mucosal involvement. A review of the systems and routine blood and urinalysis were unremarkable. A biopsy was not performed. His treatment consisted of topical steroids, oral antihistamines, and oral erythromycin. The patient returned 3 months later with complete resolution of the lesions and only minor scarring with some loss of skin markings and post-inflammatory hyperpigmentation.

Figure 1.

A generalized symmetric eruption of multiple, discrete, reddish brown papules, each with central necrosis and hemorrhagic crusts.

Figure 2.

The trunk, buttocks, and the proximal extremities were predominantly involved.

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