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January 2001
Case Submitted by Stephen Schleicher, MD
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CASE:
A 42-year-old man has had an extensive rash for three or
four weeks. The dermatitis began as a solitary patch on his
left upper arm, and several days later similar lesions appeared
on his back and chest. He has no symptoms aside from occasional
mild itching and is not taking any oral medications. Cutaneous
examination reveals multiple, discrete, round-to-oval erythematous
scaling patches on the extremities and trunk. The face, palms,
and soles are not affected.
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The patient has pityriasis rosea, a common,
acute, self-limited papulosquamous skin disorder typified by
round-to-ovid lesions encircled by a fine collarette of scale.
The eruption is usually confined to the upper extremities and
trunk, and a Christmas-tree distribution on the back is classic.
Also classic is the appearance of a so-called herald patch a
few days before the onset of the full-blown exanthem. The cause
of pityriasis rosea is unknown, but a viral origin has been
postulated. Mild cases do not require any treatment; however,
oral or topical steroids may be warranted to shorten the course
of extensive disease. |
Dr. Schleicher is director of the DermDx Centers for Dermatology
of Northeastern Pennsylvania and a clinical instructor of dermatology
at Graduate Hospital's City Line Campus in Philadelphia, kings
College in Wilkes-Barre, and Beaver College in Glenside, Pennsylvania.
He is also a member of the EMERGENCY MEDICINE editorial board.
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