A 5-year-old child presents with an acute onset of numerous flesh-colored to pink papules on the face, trunk, and extremities, each surrounded by a pale halo. The child had a low-grade fever and malaise for 3 days before the rash appeared. The lesions are asymptomatic. What is the most likely diagnosis?

• A Pityriasis lichenoides et varioliformis acuta (PLEVA) ✓
• B Mucha-Habermann disease
• C Guttate psoriasis
• D Pityriasis rosea

Explanation

PLEVA (Mucha-Habermann disease) presents with acute onset of crops of red-brown papules that vesiculate, hemorrhage, and necrose, leaving varioliform scars. The lesions may have a pale halo and are often preceded by mild systemic symptoms. Guttate psoriasis shows salmon-colored papules with silvery scale. Pityriasis rosea follows a herald patch and Christmas tree distribution.

Reference: Andrews' Diseases of the Skin: Clinical Dermatology, 13th ed.

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