Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Quiz
2020:86:1;98-100
doi: 10.4103/ijdvl.IJDVL_346_17
PMID: 29974887

Annular scaly plaques in a girl

Pooja Parulkar, Swagata Arvind Tambe, Chitra Shivanand Nayak
 Department of Dermatology, Topiwala National Medical College, BYL Nair Hospital, Mumbai, Maharashtra, India

Correspondence Address:
Swagata Arvind Tambe
19/558, Udyan Society, Nehru Nagar, Kurla East, Mumbai - 400 024, Maharashtra
India
Published: 29-Jun-2018
How to cite this article:
Parulkar P, Tambe SA, Nayak CS. Annular scaly plaques in a girl. Indian J Dermatol Venereol Leprol 2020;86:98-100
Copyright: (C)2020 Indian Journal of Dermatology, Venereology, and Leprology

A 13-year-old female, born of nonconsanguineous marriage presented with complaints of sudden onset of multiple red raised circular lesions on the trunk of 8 days duration associated with mild itching. There was no history of preceding upper respiratory tract infection, febrile illness or drug intake.

Cutaneous examination revealed multiple erythematous annular scaly plaques with central hyperpigmentation, and raised margins on the upper back [Figure - 1], upper chest [Figure - 2] and trunk [Figure - 3]. A single large plaque was also present on the right side of the neck extending to the shoulder. There was no evidence of regional or generalized lymphadenopathy.

Figure 1: Multiple erythematous annular scaly plaques with central hyperpigmentation and raised margins on upper back
Figure 2: Erythematous annular scaly plaques on shoulders and chest
Figure 3: Erythematous annular scaly plaques on the trunk

Skin biopsy showed parakeratotic stratum corneum overlying severely spongiotic epidermis with upper dermal edema and superficial perivascular mixed inflammatory infiltrate consisting of mononuclear cells and neutrophils with extravasated red blood cells in the dermis [Figure - 4] and [Figure - 5].

Figure 4: Parakeratosis, spongiosis with upper dermal edema and superficial perivascular mixed inflammatory infiltrate in the dermis (H and E, ×100)
Figure 5: Marked spongiosis, dermal edema and dilated blood vessels in dermis with extravasated red blood cells (H and E, ×400)

Laboratory investigations including enzyme-linked immunosorbent assay for human immunodeficiency virus (HIV) and Venereal Disease Research Laboratory test did not reveal any abnormality.

Answer

Pityriasis rosea.

Pityriasis rosea is an acute, common, self-limiting, papulosquamous disorder localized to the trunk and extremities of children and young adults. It is characterized by the initial eruption of a herald patch (mother patch), which is followed by generalized scaly oval eruptions typically on the trunk and proximal extremities along the Langer's lines of cleavage, giving the characteristic “Christmas tree appearance”. Approximately 20% of patients with pityriasis rosea may present with atypical clinical presentations.[1],[2] Atypical features include atypical morphology of rash, size of lesions, number of lesions, distribution, mucosal involvement, symmetry, disease duration and severity of symptoms. Indian children are more likely to present with atypical pityriasis rosea than Indian adults, atopic background being possibly facilitative.[3] Although no etiology has been proven, viral agents, especially human herpes virus 6 and 7, autoimmunity, several drugs and psychogenic status have been proposed as possible etiological factors.[1],[2],[4]

Atypical variants can be differentiated by size (pityriasis rosea gigantea of Darier, papular pityriasis rosea), distribution (cephalic pityriasis rosea, inverse pityriasis rosea, unilateralis pityriasis rosea, localized pityriasis rosea and pityriasis circinata et marginata of Vidal), sites involved (face, scalp, hands and feet, fingers, toes, eyelids, penis and oral cavity), severity (pityriasis rosea irritata with severe itch, pain and a burning sensation), course of the lesions (relapse, recurrent pityriasis rosea, annual relapse) and morphology (generalized papular, vesicular, purpuric or hemorrhagic,[5] urticarial, pustular and erythema multiforme like pityriasis rosea).[1],[4],[6]

There have been several case reports in the literature describing the clinical features of variants of pityriasis rosea but plaques with prominent scaling and large annular morphology is not a commonly reported variant.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References
1.
Chuh A, Zawar V, Lee A. Atypical presentations of pityriasis rosea: Case presentations. J Eur Acad Dermatol Venereol 2005;19:120-6.
[Google Scholar]
2.
González LM, Allen R, Janniger CK, Schwartz RA. Pityriasis rosea: An important papulosquamous disorder. Int J Dermatol 2005;44:757-64.
[Google Scholar]
3.
Zawar V, Chuh A. Follicular pityriasis rosea. A case report and a new classification of clinical variants of the disease. J Dermatol Case Rep 2012;6:36-9.
[Google Scholar]
4.
Miranda SB, Lupi O, Lucas E. Vesicular pityriasis rosea: Response to erythromycin treatment. J Eur Acad Dermatol Venereol 2004;18:622-5.
[Google Scholar]
5.
Bhalla N, Tambe S, Zawar V, Joshi R, Jerajani H. Localized purpuric lesions in a case of classical pityriasis rosea. Indian J Dermatol Venereol Leprol 2014;80:551-3.
[Google Scholar]
6.
Balci DD, Hakverdi S. Vesicular pityriasis rosea: An atypical presentation. Dermatol Online J 2008;14:6.
[Google Scholar]

Fulltext Views
755

PDF downloads
356
Show Sections