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Images in Clinical Practices

Indian Pediatrics 2003; 40:266-267

Pityriasis Lichenoides Et Varioliformis Acuta


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]

 

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