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