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37-Year-Old Pregnant Female with Pruritic Rash on Trunk

Can you diagnose this case?

David L. Kaplan, MD – 2015 Series Editor

Signs and Symptoms

This 37-year-old woman presented at week 29 of her third pregnancy with a slightly pruritic rash on her trunk and proximal extremities of 1 week’s duration. Her pregnancy had been uneventful. She denied any new exposures, recent illnesses, or new medications. The lesions appeared slightly erythematous and were oval shaped with minimal scale.

How would you diagnose this woman’s lesions?

Choose one to reveal diagnosis and discussion

Nummular eczema
Tinea corporis
Pityriasis rosea
Secondary syphilis
Pruritic urticarial papules and plaques of pregnancy (PUPPP)

Answer: Pityriasis rosea

See the full case at Consultant360

This patient has pityriasis rosea. This condition typically is seen after an upper respiratory tract infection, and while the patient denied any recent illnesses, she most likely was exposed to a precipitating pathogen. Fortunately, no warnings are necessary in pregnancy with this condition.

Nummular eczema typically would not be this widespread on the trunk, and usually is much itchier. Tinea corporis rarely is this extensive and is more pruritic and more scaly. Secondary syphilis is always a consideration, especially when the palms and soles are involved, which is not the case here. PUPPP is typically seen with a first pregnancy, tends to start and be concentrated on the abdomen, and is typically very pruritic.

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