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11-Year-Old Girl with Sparse, Itchy Eruption

Can you diagnose this case?

David L. Kaplan 2014 Series Editor @ University of Missouri – Kansas City School of Medicine

Signs and Symptoms

An 11-year-old female presented for evaluation of a slightly itchy and sparsely distributed eruption that was slowly spreading on her arms, trunk, and legs over the last 6 months. She is otherwise healthy.

What is responsible for this rash?

Choose one to reveal diagnosis and discussion

Scabies
Psoriasis
Pityriasis rosea
Pityriasis lichenoides et varioliformis acuta
Follicular eczema

Answer: Pityriasis lichenoides et varioliformis acuta

See the full case at Consultant360

A biopsy confirmed the clinical diagnosis of pityriasis lichenoides et varioliformis acutal (PLEVA). Most patients present during the first 3 decades of life. Studies of children have shown a variable age of onset between 3 to 15 years, with a mean age of 9.3 years.

This benign condition usually runs a self-limited course over several months. No randomized trials have been reported though anecdotal reports suggest courses of either erythromycin- or tetracycline-based antibiotics can be successful.

Differential diagnosis: Scabies would be expected to be more widespread and more pruritic. Psoriasis and pityriasis rosea would be scalier. Follicular eczema would show more prominent follicular accentuation than seen here and would be more pruritic.

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