A 23-year-old white female presents with a rash over her entire trunk. She states it started with one lesion on her lower abdomen and has now spread throughout her abdomen and back. It is mildly pruritic. She has been applying cortisone cream without resolution.

The rash consists of oval-shaped tan plaques with fine crinkly-surface appearance. Thin scale is present on the periphery of several lesions. Lesions align with the skin folds in a “Christmas tree” pattern (Langer’s lines), making the diagnosis of pityriasis rosea.

The initial lesion, which is usually larger, often precedes the eruption by 1 to 2 weeks (“herald patch”). Treatment is supportive; almost all cases resolve without scarring in about 6 weeks. A serologic test for syphilis should be done if lesions do not appear typical or are present on the palms or soles, as secondary syphilis is an important differential diagnosis not to miss. (192-1)


Claire O’Connell, MPH, PA-C, teaches in the PA Program at the New Jersey Medical School and Rutgers University, Piscataway, N.J.


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