A 16-year-old young man presented with intensely itchy erythematous
dermatitis on the body for 1 week and vesicular lesions on the palms and soles for 4 to 5 days. Lesions on the palms and soles were accompanied by severe burning and
itching. The patient gave a history of
sore throat and
fever, 1 week prior to the onset of lesions. A general physical examination was normal, and cutaneous examination revealed multiple, well-defined erythematous scaly plaques with collaret scaling on the trunk and extremities (Figure 1). Vesicular lesions were seen on the palms and soles (Figure 2). The differential diagnoses we considered were
pityriasis rosea and
secondary syphilis. The possibility of dermatophytid, vesicular
pityriasis rosea, and
pompholyx was limited to the palms and sole lesions. Complete blood cell count was within normal limits. Results from
antistreptolysin O titer,
potassium hydroxide mount, and
venereal disease research laboratory were negative. Skin biopsies were taken from the back and left palm. The biopsy specimen from the back revealed focal spongiosis, lymphocyte exocytosis, vacuolar changes in the basal layer, and perivascular lymphocytic infiltrate in the dermis (Figure 3). The biopsy obtained from the vesicular lesion on the left palm revealed an intraepidermal vesicle with no evidence of acantolytic process (Figure 4). A diagnosis of
pityriasis rosea was made and the patient was started on
clarithromycin 500 mg once a day for 7 days, along with
antihistamines and
emollients. The lesions faded dramatically in a very short period, and there was significant involution of almost all of the lesions after 7 days of
clarithromycin. During the 6 months of follow-up, no recurrence was observed.