Vesicular palmoplantar pityriasis rosea

Area of Science:

• Dermatology
• Infectious Diseases
• Clinical Case Study

Background:

• Pityriasis rosea (PR) is an acute, self-limiting skin condition typically presenting with a herald patch followed by generalized eruption of erythematous, scaly plaques.
• Atypical presentations of PR, including vesicular variants and palmoplantar involvement, can mimic other dermatoses, posing diagnostic challenges.

Observation:

• A 16-year-old male presented with a 1-week history of itchy erythematous dermatitis and a 4-5 day history of burning, itchy vesicular lesions on palms and soles.
• The patient reported a preceding sore throat and fever. Physical examination revealed characteristic PR plaques and distinct vesicular lesions on the palms and soles.
• Histopathological examination showed spongiosis and lymphocytic infiltrate consistent with PR, ruling out other conditions like syphilis or fungal infections.

Findings:

• The patient was diagnosed with pityriasis rosea and treated with a 7-day course of clarithromycin, antihistamines, and emollients.
• Rapid and dramatic resolution of both the generalized rash and the vesicular palm/sole lesions was observed within 7 days of clarithromycin treatment.
• No recurrence of pityriasis rosea was noted during a 6-month follow-up period.

Implications:

• This case suggests that atypical vesicular pityriasis rosea involving palms and soles can be effectively treated with oral antibiotics like clarithromycin.
• Early and accurate diagnosis of atypical PR is crucial for appropriate management and patient reassurance.
• Further research may explore the role of antibiotics in managing specific variants of pityriasis rosea.