A Case of Pediatric Rash

A 7-year-old Black girl presented to the emergency department with a 4-day history of pruritic rash on her back and abdomen. She was otherwise healthy and fully vaccinated for her age. There was no history of new environmental exposures. Examination was notable for a flesh-colored ovoid patch at the level of her right scapula and a diffuse flesh-colored papular rash on her back in the shape of an inverted “V.” (Figure 1). Pityriasis rosea. The patient’s rash with a herald patch and papular rash in a “Christmas tree” pattern is consistent with pityriasis rosea. Pityriasis rosea is an acute, self-limited exanthem, thought to be viral in nature that occurs most commonly in older children and young adults.1Goldstein A.O. Goldstein B.G. Pityriasis Rosea.https://www.uptodate.com/contents/pityriasis-rosea?search=pityriasis+rosea&source=search_result&selectedTitle=1∼28&usage_type=default&display_rank=1#H3Date accessed: September 15, 2022Google Scholar Although pityriasis rosea is classically described as a papulosquamous, erythematous rash localized to the trunk and proximal extremities,2Schadt C. Pityriasis rosea.JAMA Dermatol. 2018; 154: 1496Crossref PubMed Scopus (5) Google Scholar presentations may vary among dark-skinned individuals. Dark-skinned individuals with pityriasis rosea may present with a nonerythematous, purely papular rash with facial and scalp involvement.3Amer A. Fischer H. Li X. The natural history of pityriasis rosea in black American children: how correct is the “classic” description?.Arch Pediatr Adolesc Med. 2007; 161: 503-506Crossref PubMed Scopus (33) Google Scholar,4Jacyk W.K. Pityriasis rosea in Nigerians.Int J Dermatol. 1980; 19: 397-399Crossref PubMed Scopus (49) Google Scholar,5Ahmed M.A. Pityriasis rosea in the Sudan.Int J Dermatol. 1986; 25: 184-185Crossref Scopus (27) Google Scholar Eruptions tend to be more pruritic, and hyperpigmentation may occur after the rash resolves.3Amer A. Fischer H. Li X. The natural history of pityriasis rosea in black American children: how correct is the “classic” description?.Arch Pediatr Adolesc Med. 2007; 161: 503-506Crossref PubMed Scopus (33) Google Scholar