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.
Which of the following statements is consistent with the diagnosis?
The correct answer is:
The lesions will resolve with no intervention.
Characterize the presentation of pityriasis rosea.
A "herald patch" precedes the rash in 50% of cases.
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.
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.