Persistent Acral Pityriasis Rosea in a Pediatric Patient: A Rare Clinical Variant

Pityriasis rosea (PR) is a self-limited papulosquamous skin condition most commonly observed in children and young adults. Atypical variants of PR have been increasingly recognized, particularly those with unusual morphology, distribution, or disease course. Acral involvement is rare and may pose diagnostic challenges, especially in pediatric patients. We report the case of a 15-year-old previously healthy Saudi male patient who presented with a persistent erythematous and scaly eruption lasting for more than three months. The eruption involved the trunk and extremities and showed prominent acral involvement affecting both the palms and soles. The patient denied pruritus, pain, recent infections, medication use, or similar previous episodes. Physical examination revealed multiple erythematous scaly plaques and patches without mucosal, nail, or lymph node involvement. Histopathological examination of a punch biopsy demonstrated findings consistent with PR in the appropriate clinical context. The patient was managed with narrowband ultraviolet B phototherapy, topical betamethasone combined with calcipotriol, urea 10% cream, and vitamin D supplementation. This case highlights a rare presentation of persistent acral PR in a pediatric patient, emphasizing the importance of recognizing atypical and prolonged presentations to avoid misdiagnosis.