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A. Epidemiologynavigator

  1. More common in the spring and fall
  2. Peak incidence age 10 to 35 years

B. Symptomsnavigator

  1. A single herald plaque lesion develops usually on the trunk
  2. Over next 1-2 weeks an exanthematous rash develops
  3. Lesions sometimes pruritic
  4. Rash resolves spontaneously in 6-12 weeks

C. Physical Examinationnavigator

  1. Herald patch appears as a bright red slightly raised plaque 2 to 5 cm in diameter
  2. Over next 1-2 weeks multiple smaller oval, erythematous, raised papules and plaques appear
  3. Rash seen on trunk and proximal portion of extremities but rarely the face
  4. The long axes of the lesions classically follow a "Christmas tree distribution"

D. Differential Diagnosisnavigator

  1. Drug Eruptions
  2. Secondary Syphillis
  3. Guttate Psoriasis
  4. Erythema Migrans

E. Treatmentnavigator

  1. Await spontaneous remission
  2. After 6 weeks, skin biopsy needed if no resolution to confirm diagnosis
  3. Calamine topically to lesions for puritis
  4. More severe puritis
    1. Diphenhydramine (Benadryl®) or hydroxyzine (Atarax®)
    2. UVB phototherapy

References navigator

  1. Fitzpatrick TB. 1997. Color Atlas and Synopsis of Clinical Dermatology. pg.104