PLEVA

PLEVA, or pityriasis lichenoides et varioliformis acuta, is a rare inflammatory skin condition that lies within the pityriasis lichenoides spectrum. It typically presents with sudden crops of red to brown papules that can become vesicular or crusted and are often varioliform (pox-like). Lesions most commonly appear on the trunk and proximal limbs and may be itchy or tender. The course is variable, with episodes occurring over weeks to months and possible relapses over years.

The cause of PLEVA is not well understood. It is considered an inflammatory or immune-mediated process, and various infectious triggers have been proposed, though no single causative agent has been established. The condition most often affects children and young adults, but it can occur at other ages.

Diagnosis is based on clinical features supported by skin biopsy. Histopathology typically shows a dense lymphocytic infiltrate in the dermis with focal keratinocyte necrosis, red blood cell extravasation, and mild epidermal changes; these findings help distinguish PLEVA from other vesicular or nodular diseases but can overlap with related conditions. Laboratory tests are not specific for PLEVA and are used to rule out other diseases.

Treatment aims to control symptoms and limit relapses. First-line options include phototherapy (narrowband UVB or UVA1) and anti-inflammatory antibiotics such as erythromycin or doxycycline. Topical corticosteroids may provide relief for localized lesions. Refractory cases may require systemic therapies, including methotrexate, cyclosporine, or acitretin. Most patients experience improvement over time, although relapses are common; the prognosis is generally favorable with appropriate management.