Discuss an interesting or difficult case you encountered this past week. How did you use evidence to support your actions .

I had this week very interesting pediatric case. A patient brought by parents. The patient was 9 years old presented with c/o of rashes on the upper and lower back, front side upper and lower stomach. The patient had a medical history of acute kidney injury. Denies any fever, vomiting, diarrhea. Per mother, patient rashes started 3 days ago with a small patch on the back of right shoulder and now spread more on the back and front side. Patient c/o of inching. My preceptors told me to think about the differential diagnosis. I thought it is eczema or psoriasis. But my preceptor told me it is pityriasis rosea. And he prescribes topical steroids’ hydrocortisone 0.5% bid.

It starts with the herald patch on the trunk or neck and follows by multiple small erythematous scaly lesions on the trunk or neck and it is appearing like Christmas tree. And it is flare up usually by sore throat, fever, GI disturbance, arthralgia. And it is a benign papulosquamous disorder, mostly it is seen in clinical. Some patients present with severe pruritus. Pityriasis rosea is present in with lesions and lesions are Vesicular, Purpuric, Urticarial, Lichenoid lesions, Erythema multiforme, Follicular, and Giant. And lesions are presented in Inverse, Acral, Unilateral, Limb-girdle, Oral mucosa, or Blaschkoid pattern. Pityriasis rosea is easily treatable. It is self-limiting, it can be improved in 2-8 weeks. But some patients need antihistamine, emollients, topical steroids to control itching. Even it is treated with Macrolides, antiviral, antibiotic, phototherapy (Mahajan, K., Relhan, V., Relhan, A. K., & Garg, V. K. 2016).

Reference

Mahajan, K., Relhan, V., Relhan, A. K., & Garg, V. K. (2016). Pityriasis Rosea: An Update on Etiopathogenesis and Management of Difficult Aspects. Indian journal of dermatology, 61(4), 375-84.