Last reviewed: 17 Mar 2025
Last updated: 16 Aug 2022
Summary
Definition
History and exam
Key diagnostic factors
- herald patch
- pruritus
- age 10 to 35 years
- 2- to 12-week duration
- scale
- located on trunk and upper extremities
- fir-tree pattern distribution
- located on face, palms, soles, mucosa
- acute to sub-acute recurrent skin eruption
Other diagnostic factors
- 2-week timing between herald patch and new lesions
- female sex
- prodromal symptoms
- pigmentary alteration (severe cases/dark skin colour)
Diagnostic investigations
Investigations to consider
- skin biopsy
- antistreptolysin O titres
- potassium hydroxide (KOH) preparation microscopy or fungal culture
- rapid plasma reagin/Venereal Disease Research Laboratory
Treatment algorithm
Contributors
Authors
Daniela Kroshinsky, MD, MPH

Director of Inpatient Dermatology
Associate Professor of Dermatology
Massachusetts General Hospital
Harvard School of Medicine
Boston
MA
Disclosures
DK declares that she has no competing interests.
Acknowledgements
Dr Dean S. Morrell would like to gratefully acknowledge Dr Eve Lowenstein, Dr Ladan Shahabi, and Dr John English, previous reviewers of this topic.
Peer reviewers
Dean S. Morrell, MD
Clinical Professor
Department of Dermatology
University of North Carolina
Chapel Hill
NC
Disclosures
DSM declares that he has no competing interests.
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