Etiopathogenesis and Management of Difficult Aspects
I had this week
very interesting pediatric case. A patient brought by parents. The patient was
9 years old presented with c/o of rashes on the upper and lower back, front
side upper and lower stomach. The patient had a medical history of acute kidney
injury. Denies any fever, vomiting, diarrhea. Per mother, patient rashes
started 3 days ago with a small patch on the back of right shoulder and now
spread more on the back and front side. Patient c/o of inching. My preceptors
told me to think about the differential diagnosis. I thought it is eczema or
psoriasis. But my preceptor told me it is pityriasis rosea. And he prescribes
topical steroids' hydrocortisone 0.5% bid.
It starts with the herald patch
on the trunk or neck and follows by multiple small erythematous scaly lesions
on the trunk or neck and it is appearing like Christmas tree. And it is flare
up usually by sore throat, fever, GI disturbance, arthralgia. And it is a
benign papulosquamous disorder, mostly it is seen in clinical. Some patients
present with severe pruritus. Pityriasis rosea is present in with lesions and
lesions are Vesicular, Purpuric, Urticarial, Lichenoid lesions, Erythema
multiforme, Follicular, and Giant. And lesions are presented in Inverse, Acral,
Unilateral, Limb-girdle, Oral mucosa, or Blaschkoid pattern. Pityriasis rosea is easily treatable. It is
self-limiting, it can be improved in 2-8 weeks. But some patients need
antihistamine, emollients, topical steroids to control itching. Even it is
treated with Macrolides, antiviral, antibiotic, phototherapy (Mahajan, K.,
Relhan, V., Relhan, A. K., & Garg, V. K. 2016).
Reference
Mahajan, K.,
Relhan, V., Relhan, A. K., & Garg, V. K. (2016). Pityriasis Rosea: An
Update on Etiopathogenesis and Management of Difficult Aspects. Indian journal
of dermatology, 61(4), 375-84.
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