REPORT OF A CASE
A62-year-old woman presented for evaluation of recurrent itchy lesions distributed over her upper and lower extremities including her hands and feet. She reported that the rash had been present for several months, but that she had a similar rash one year before. At her previous evaluation one year before, she reported the lesions had also occurred on the hands and feet but were accompanied by lesions in the mouth. At that time, she was diagnosed with Hand, Foot, and Mouth disease via biopsy and positive coxsackie titers. After treatment with clobetasol 0.05% cream, the lesions resolved, until this current episode.
Physical examination at the time of her current outbreak revealed multiple erythematous and hyperpigmented scaling, 1-3 cm papules and plaques on both palms and forearms, some with a collarette of the scale and others with necrotic changes and excoriations. Also, there were several similar hyperpigmented papules on the dorsal feet and ankles. Oral lesions were absent. Two 4 mm punch biopsy specimens were obtained from the left palm and right wrist.
Histopathologic examination revealed parakeratosis and a brisk lichenoid inflammation with scattered dyskeratotic keratinocytes and erythrocyte extravasation. These histologic findings were consistent with pityriasis lichenoides et varioliformis acuta (PLEVA).
The patient tested negatively for syphilis and antinuclear antibody laboratory results were within normal limits.