PLEVA: the great masquerader

Abd Rahman, Mohd Aizuddin and Jamani, Nurjasmine Aida and Zainun, Norsafina (2023) PLEVA: the great masquerader. Medicine and Health, 18 (Suppl. 7). p. 126. ISSN 1823-2140 E-ISSN 2289-5728

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Abstract

Introduction: The rare benign dermatosis Pityriasis lichenoides et varioliformis acuta (PLEVA) is mostly found in children and young adults. It has uncertain etiopathogenesis. The largest series of children with pityriasis lichenoides had a median PLEVA onset of 60 months, with a slight male predominance. The hallmark signs of the disease are the presence of acute inflammatory papules and papulovesicles with hemorrhagic or necrotic crusts on the trunk and flexural areas. Recurrence and remittance complicate rash diagnoses, especially in primary care. PLEVA mimics lymphomatoid papulosis, varicella, pityriasis rosea, guttate psoriasis, and secondary syphilis. PLEVA rarely causes febrile ulceronecrotic MuchaHabermann syndrome (FUMHD), which can be fatal. Case report: A 21-year-old man with vitiligo and metabolic syndrome had a one-month vesicular eruption, recurrent erythematous macules, and crusted patches on the trunk, extremities, and scalp. He received systemic and local antibiotics at multiple clinics without improvement. Upon assessment, he appeared well with stable vital signs. There were generalised brownish scales, with patches seen mainly on the trunk and all flexural areas, mixed with newer erythematous macules, papules, and dried-up blisters with necrotic and a few hemorrhagic at the centre of the crust on the skin, especially at the limbs. After a provisional diagnosis of PLEVA, he was referred to a dermatologist for a skin biopsy. Histopathological examination (HPE) of lichenoid dermatitis confirmed PLEVA. The lesions resolved after two months of treatment with oral and topical corticosteroids administered in tapering doses. Conclusion: The lack of consensus on PLEVA’s classification, etiopathogenesis, diagnosis, and treatment makes it a medical challenge. Clinical suspicion and histopathology confirm the diagnosis.

Item Type:	Article (other)
Uncontrolled Keywords:	Lichenoid dermatitis; pityriasis lichenoides et varioliformis acuta; primary care
Subjects:	R Medicine > R Medicine (General) R Medicine > RL Dermatology
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine Kulliyyah of Medicine > Department of Family Medicine (Effective: 1st January 2011)
Depositing User:	DR MOHD AIZUDDIN ABD RAHMAN
Date Deposited:	26 Dec 2023 14:56
Last Modified:	19 Feb 2024 15:36
URI:	http://irep.iium.edu.my/id/eprint/109203

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