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Description
A woman in her 20s presented with an erythematous, itchy, scaly rash on her trunk and extremities for 3 weeks duration. She was otherwise healthy and had no history of taking any medication. Disseminated erythematous papular eruptions with fine scales, occurring along the lines of cleavage of the trunk were observed on physical examination. Similar lesions were observed on the proximal extremities (figure 1). Several relatively larger, well-demarcated, 2–4 cm in diameter, erythematous, salmon-coloured plaques were also seen over the back, thighs (figure 2) and arms. The face, axillae and groin were spared. A venereal disease research laboratory test and viral markers (HCV, HBsAg and HIV-1 and 2) were non-reactive.
Erythematous scaly rash on the back.
Similar erythematous scaly rash on the back of the left thigh. Dermoscopy was performed from the region of skin in the black rectangle.
Dermoscopy of a plaque on the left thigh showed a fine collarette of scale attached to the periphery of the plaque (red arrow) with its free edge extending internally, and a central scale (yellow arrow) was noticed. Some peripheral dotted vessels with patchy distribution (black circle) and brown globules (white arrow) were present. A central yellowish with a peripheral erythematous background were also observed (figure 3). Based on clinic-dermatoscopic features, a diagnosis of pityriasis rosea (PR) was made.1–4 The patient was prescribed emollients and antihistamines (Tablet loratadine 10 mg once at night). The patient responded well to treatment, and by 6 weeks, the rash was completely resolved.
Dermoscopic features. Fine collarette of scales attached to the periphery of the plaque (red arrow), central scale (yellow arrow), peripheral dotted vessels with patchy distribution (black circle), brown globules (white arrow) and central yellow with peripheral reddish background.
Learning points
Pityriasis rosea (PR) is a self-limited cutaneous disease characterised by widely distributed erythematous scaly lesions with pruritus and no significant constitutional symptoms.
The dermoscopic findings in pityriasis rosea include peripheral collarette scale (35%–84%), central scale (35%), irregularly distributed scale (23%–35%), peripheral dotted vessels (65%) with patchy distribution (35%), brown globules (7%) and central yellow with peripheral red background (40%). Brown globules are a recently reported dermoscopic feature in PR, which was also seen in our case.
Therefore, dermoscopy (inflammoscopy: the dermoscopic features of cutaneous inflammatory disorders) may provide remarkable clues to diagnose pityriasis rosea. Dermoscopy is more useful in plaque lesions of pityriasis rosea, as compared with the papules, as in the later, scaling is absent or minimally seen in the centre.
Ethics statements
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Footnotes
Contributors The following authors were responsible for the drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: SV and NKK. The following authors gave final approval of the manuscript: SV and NKK.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.