16-Year-Old with Multiple Pink, Scaly Skin Eruptions - Patient Case
This dermatology case comes from our Med-Challenger PEDS, part of Med-Challenger's library of board exam review and CME question banks.
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Try this case and test your knowledge of pediatric dermatology.
A 16-year-old girl presents to you with multiple pink, scaly skin eruptions on her upper torso (see Figure).
She states that she had a 2-cm eruption on her chest 1 week before. Other than the presence of the eruptions, her only complaint is mild itching.
Question:
Which of the following statements is consistent with the diagnosis?
Answer Options:
The eruptions never follow dermatomal lines.
Treatment should include antifungal medication.
The lesions will resolve with no intervention.
The patient is sexually active.
The correct answer is:
The lesions will resolve with no intervention.
Educational Objective:
Characterize the presentation of pityriasis rosea.
Key Point:
A "herald patch" precedes the rash in 50% of cases.
Explanation:
Pityriasis rosea is a mild skin eruption found mostly in children and young adults. A "herald patch" precedes the rash in 50% of cases. The eruption is usually asymptomatic, other than mild itching; oral lesions may be present, but they are very rare. No treatment is necessary for this condition because it will resolve in 8 to 12 weeks on its own. The differential diagnosis should include tinea corporis, drug eruption, and secondary syphilis.
Aspects of the pityriasis rosea rash may or may not have a dermatomal appearance, but, unlike herpes, will be bilateral and painless (other than pruritus). Herpes zoster virus infection typically presents with a unilateral dermatomal distribution that is severely painful. Though the herald patch may be mistaken for tinea corporis, the lesion is unresponsive to antifungal medication.
References:
Chuh A, Zawar V, Law M, Sciallis G3. Gianotti-Crosti syndrome, pityriasis rosea, asymmetrical periflexural exanthem, unilateral mediothoracic exanthem, eruptive pseudoangiomatosis, and papular-purpuric gloves and socks syndrome: a brief review and arguments for diagnostic criteria. Infect Dis Rep. 2012;4(1):e12.
Kliegman RM, et al. Diseases of the epidermis. In: Nelson Textbook of Pediatrics. 21st ed., 2020.