REPORT OF A CASE
A 26-year-old woman noted the abrupt onset of a skin eruption approximately 4 weeks before presentation. Lesions appeared on her waist and axillae and then spread to involve her chest, trunk, arms, and legs. After 3 weeks, her palms and soles became involved as did her face. Pruritus, absent at first, became problematic after several weeks. Constitutional symptoms included frequent headaches, malaise, and feeling feverish. She also experienced more than her usual number of aphthous ulcerations.Her physical examination revealed a thin, afebrile woman covered with innumerable, small, erythematous papules that had crusting and scaling. Many of the lesions also appeared vesicular and hemorrhagic. All cutaneous surfaces were involved (Figs 1 and 2). Several oral aphthous ulcerations were also noted. Her examination otherwise showed normal findings.A biopsy specimen was obtained (Fig 3).What is your diagnosis?
Pityriasis lichenoides et varioliformis acuta
Gross DJ, Metheny RS, Keeran MG. A Widespread Hemorrhagic and Crusted Eruption of Recent Onset. Arch Dermatol. 1993;129(3):365-366. doi:10.1001/archderm.1993.01680240107018