Pityriasis lichenoides et varioliformis acuta

QUESTION 6

A 12-year-old boy presents to the pediatric dermatology office as a referral for the abrupt onset of widespread erythematous crusted papules. His mother states that he has had vesicles off and on since 7 years old without a definitive diagnosis being given. The skin changes come up in April and usually resolves by September. The lesions are intensely pruritic. He has been seen by his pediatrician and treated with desoximetasone 0.05% cream without resolution of his symptoms. On physical examination, there are widespread erythematous and heme-crusted papules some with superficial ulceration. Some of these are varioliform and in various stages of healing (6a, b).