Pityriasis Rosea with Erythema Multiforme – Like Lesions: An Observational Analysis
A 15-year-old boy presented with a cutaneous eruption of 2 weeks duration. He gave history of appearance of a single erythematous scaly plaque on the left side of the abdomen initially. Within 7-10 days, he developed multiple erythematous slightly scaly papules and plaques over the trunk and both upper limbs, and few over both the thighs. Along with these lesions, he also noticed numerous erythematous plaques with depressed centers and peripheral elevated rings. All the lesions were arranged in a Christmas tree pattern. They were largely asymptomatic. He denied any history of painful fluid-filled lesions on the skin or mucosae, sexual contact or drug intake before the eruption. Physical examination revealed a herald patch measuring 2.5 × 1.5 cm over the abdomen and several smaller erythematous papules and plaques ranging from 0.2-1.5 cm in size, located on the trunk, both upper limbs, and proximal lower limbs. Numerous lesions were targetoid in appearance and were intermixed with typical looking PR lesions []. An active search was made for lesions suggestive of herpes simplex or dermatophytic infection but no such lesions were found. Examination also did not reveal any palpable lymph nodes, oral lesions or other significant pathology. A full blood count and blood chemistry profile yielded normal results. Antistreptolysin O (ASLO), C-reactive protein, venereal disease research laboratory (VDRL), Immunoglobulin M (IgM) for herpes simplex virus1 (HSV1) and HSV2 and throat swab were all normal. He was diagnosed as PR with EM-like lesions. He responded well to a 2 week course of 2.5% hydrocortisone cream and emollients.