Pityriasis Rosea with Erythema Multiforme – Like Lesions: An Observational Analysis
Our last case was a 24-year-old man who presented with a generalized eruption over his trunk for 2 weeks. He did not give history of any lesion preceding the rash. He complained of itching in the lesions that was discomforting but not severe enough to hamper routine activities and sleep. Physical examination revealed numerous erythematous plaques on his trunk and the upper limbs. Few of the lesions were typical papulosquamous lesion of PR and showed peripheral collarette of scales while few showed an iris like appearance suggestive of the EM variant of PR []. Most of the lesions were oriented along the lines of skin cleavage. All blood investigations were within normal limits and VDRL and HSV serology were nonreactive. He was prescribed topical betamethasone cream and oral levocetrizine 5 mg once daily for 4 weeks after which the lesions healed without any sequelae.\nThese five patients presented to our outpatients department in the last 2 years. Age range at presentation was 15-22 years, and the male:female ratio was 3:2. Three of them had history of a herald patch preceding the eruption. Majority of the patients (4/5) reported mild to severe itching in the lesions. One patient also had multiple smaller lesions suggestive of papular PR along with the EM-like lesions. Blood tests including VDRL of all the patients were unremarkable.\nIn all the five patients two 4mm punch biopsies were done, one from a typical papulosquamouslesion of PR and the other from an EM-like lesion. The papulosquamous lesion revealed focal parakeratosis, prominent spongiosis, and perivascular lymphocytic infiltrate in the upper dermis. Extravasation of RBCs and exocytosis of lymphocytes into the epidermis was also seen []. The EM-like lesions showed focal thinning of the epidermis and significant spongiosis. The superficial dermis showed perivascular lymphocytic infiltrate. However, no characteristic features of EM such as vacuolar degeneration of the basal layer or satellite cell necrosis could be appreciated in any of the fivebiopsies [].