Discussion
PLEVA is an acute polymorphic eruption of erythematous macules quickly evolving into papules with a fine micaceous scale eventually progressing to vesicles, pustules, hemorrhagic and necrotic crusts lasting from weeks to months. Lesions heal with varioliform scars, postinflammatory hyper and hypopigmentation. 3
The histopathology of PLEVA is characterized by spongiosis, parakeratosis, acanthosis, intraepidermal vesicles, necrosis, wedge-shaped dermal lymphohistiocytic inflammatory infiltrate and erythrocyte extravasations 1 as observed in our case.
Dermoscopy and histopathological correlation was described by Ankad and Beergouder in which an amorphous brownish structure corresponds to basophilic material in the epidermis and wedge‑shaped lymphocytic infiltration in the dermis. Red dots and hemorrhages represent extravasations of red blood cells in the papillary dermis and dilatation of blood vessels. Whitish‑structureless and crusted areas are due to hyperkeratosis, acanthosis, and epidermal erosion.2
Dermoscopic features as mentioned in literature consists of three concentrical zones of central browish clod, intermediate ring of white scale and peripheral vascular ring. 2 However,in our case in majority of lesions we observed a typical target pattern of central crust, middle vascular zone and peripheral whitish scales which has not been reported in literature so far.
The differential diagnosis for PLEVA includes lymphomatoid papulosis, arthropod bite reactions, varicella, Gianotti-Crosti syndrome, erythema multiforme, pityriasis rosea, guttate psoriasis and secondary syphilis.3 Various treatment modalities include doxycycline,eythromycin, acyclovir, dapsone, methotrexate, psoralen plus ultraviolet A, infliximab and etanercept .Systemic corticosteroids have role in severe cases of PLEVA .4