A 12-year-old boy presented with multiple
erythematous scaly plaques, distributed bilaterally over the chest,
back and proximal extremities for past more than two weeks (Fig. 1).
Most plaques were elliptical in shape while few were polymorphic, with
prominent erythema on the border, and dirty white scaling with
occasional hemorrhagic crusting in the centre (Fig. 2). Few
papular and pustular lesions abutting the plaques were also evident.
Itching was conspicuously absent. The course of eruption was
progressive, though indolent. He also had malaise, lethargy, headache
and fever. Blood counts disclosed a total leucocyte count of 17000/cu.mm.
with 80% polymorphonuclear leuco-cytes. Blood culture was negative and
cerebrospinal fluid examination was normal. Biopsy of a skin lesion
revealed a dense lymphocytic perivascular dermal infiltrate. The
patient was empirically started on ceftriaxone for 1 week and was
asymptomatic in two days, except for the cutaneous lesions, for which
topical mometasone furoate cream was applied and improvement was noted
over the next 2 weeks, except for post inflammatory hyperpigmentation.
 |
 |
|
Fig.1.Multiple erythematous, elliptical
to polymorphic plaques present bilaterally over the chest and
proximal upper extremities. |
Fig. 2. Close up view of left anterior
aspect of chest showing few polymorphic plaques, showing an
erythematous border, and dirty white scaling with occasional
hemorrhagic crusting in the centre. |
Pityriasis lichenoides et varioliformis acuta (PLEVA)
is considered to be a hypersensitivity reaction to infectious agents
that probably cause release of vasoactive substances, leading to
perivascular cutaneous inflammation. Lesions are polymorphic, may
occur in recurrent crops, and without treatment may last for months.
Presence of such an eruption should prompt search for an underlying
infection, treatment of which may lead to either spontaneous
resolution of the skin lesions, or may facilitate their rapid
remission by topical or systemic steroids.
Ram Gulati,
Gautam Bagga,*
Departments of Skin, STD & Leprosy
and Pediatrics,*
Mahatma Gandhi National Institute of Medical Sciences,
Sitapura Institutional Area, Jaipur.
E-mail: [email protected]
