Pediatric emergency medicine trisk 1367 1367
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active infections. Referral to a dermatologist is recommended to institute
longer-term treatment as needed.
Pityriasis lichenoides
Pityriasis lichenoides is a lymphocytic inflammatory skin condition that
classically has been divided into the acute (pityriasis lichenoides et
varioliformis acuta or PLEVA) form and the chronic (pityriasis lichenoides
chronica or PLC) form. This distinction may be artificial as there are often
overlapping features of both in an individual patient so the term pityriasis
lichenoides (PL) is generally preferred. There is a rare and severe form
known as febrile ulceronecrotic Mucha–Habermann (FUMH) syndrome.
Patients present with persistent crops of skin lesions that vary in
appearance from crusted vesicles and papules ( Fig. 70.9 ) to scaly patches
and small plaques that may be hypopigmented in some cases ( Fig. 70.10 ).
These lesions are most often asymptomatic. There is often a predilection for
sun-protected areas, and in summertime, areas exposed to sunlight often
show fewer skin lesions. In FUMH syndrome, these lesions are often
accompanied by fever and larger, often painful, ulcerated papules and
plaques.
At times, the condition may be initially misdiagnosed as varicella, but PL
patients are generally afebrile (except in FUMH), and the lesions of PL
persist for months to years. At other times, the condition may resemble PR
but PL will persist for months to years, differentiating it from PR. Infants
who develop crusted papular eruptions that resemble PL should also be
evaluated for the possibility of LCH.
