How I was diagnosed with pityriasis lichenoides: symptoms and signs

It took three months and three missed diagnoses from the moment my symptoms first appeared to the point when my “mysterious red spots” were biopsied and conclusively identified as pityriasis lichenoides et varioliformis acuta (PLEVA). Take a read below: Does any of this sound familiar?

I remember the exact day that my journey with pityriasis lichenoides began. In mid-December of 2012, I woke up, went to the bathroom to brush my teeth and noticed that I had broken out in a strange rash, apparently overnight — a few dozen red bumps dotted my lower torso, clustering around my navel and extending around my torso to my flanks. This is how you’d describe the event in more precise medical parlance: PLC and PLEVA usually “present with the sudden appearance of multiple red papules on the trunk, buttocks, and proximal extremities. It can, however, occur anywhere on the body.”

I didn’t feel itchy or otherwise unwell, so as a relatively healthy guy in my mid-twenties, I chalked it up to some kind of allergic reaction and continued about my day.

The next morning, I woke up and realized that the rash had spread; I could see the raised red spots on my arms and the tops of my legs. At breakfast, one of my friends noticed the spots and jokingly asked if I had contracted chicken pox (the thought had occurred to me, but I knew I had already had it as a child). This friend’s observation prompted me to visit an urgent care clinic, where a group of puzzled nurse practitioners pronounced the rash as a “viral exanthem,” or a reaction caused by my body fighting some kind of virus.

Misdiagnosis #1: Viral exanthem

Prescribed treatment: Wait it out

The nurses said that the rash would probably go away in a week or two, but Christmas came and went and the red spots were still present; the original spots had started to flake and fade into dull brown, but a new crop appeared to take their place. There were still no aggravating symptoms — no itchiness, no fatigue, just the spots.

At my parents’ suggestion, I visited my old pediatrician for a second opinion. After inquiring about systemic symptoms (still none — I felt healthy as ever), the good doctor said that he suspected folliculitis — often called the “hot tub disease,” it is the result of a bacterial or fungal infection that inflames the hair follicles. He prescribed a course of the antibiotic Augmentin.

Misdiagnosis #2: Folliculitis

Prescribed treatment: Augmentin

I completed the antibiotic course but there was zero improvement in the spots. At this point, more than a month had passed since the symptoms appeared. I got a referral to a dermatologist who took a quick look and immediately pronounced the spots to be allergic dermatitis. She advised me to change out my laundry detergent and soaps and prescribed triamcinolone steroid cream to reduce the inflammation. You guessed it: no effect.

Misdiagnosis #3: Allergic dermatitis

Prescribed treatment: Triamcinolone cream

After another month, I finally got a referral to an esteemed dermatologist in my area. He did a complete and careful examination and took a biopsy of one of the lesions; within a day, he had called me with a diagnosis of pityriasis lichenoides.

The moral of this story is simple: if mysterious red spots appear on your body and you can’t identify a proximate cause, get to a dermatologist and ask for a biopsy! Obtaining an accurate diagnosis is the first step to understanding pityriasis lichenoides and determining the steps to take in order to manage this condition.

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