Case history

Case history

A 20-year-old woman with fair skin presents with intensely itchy small papules on the V-shaped neck area and dorsal aspects of her arms. The lesions occurred on the third day of her spring break vacation by the sea. She spent most of her time on the beach, in the shade. She remembers having had the same problems last year.

Other presentations

This skin condition most commonly presents as the papular type, although other subtypes occur.[1][2][3] The papular variant has pinpoint size lesions (1-3 mm in diameter) is also quite common, hemorrhagic manifestations occur less frequently.[1][2][3] The subtype of the second most common, plaque type, of PLE is erythema exudativum multiforme, which forms figurate, cockaded lesions.[4] The ictus or insect bite-like variant belongs to the papular-vesicular group of PLE.[5][6] It is characterized by a central vesicle surrounded by multiple urticarial papules. The vesiculobullous type is a rare variant that appears as a mix of papules and bullae.[7]

Although PLE appears in distinct (polymorphous) variants and differs between people, in each patient the clinical picture is monomorphous: that is, restricted to one of the variants.[1][6]

PLE only affects sun-exposed areas; dissemination occurs very rarely.[8] Predilection sites (in decreasing frequency) are the throat, V-shaped neck area, extensor surfaces of the arms, hands, legs, and face.[9][10][11]​ In children, the face is more frequently affected.[1] Juvenile spring eruption (JSE) is characterized by a papulovesicular rash affecting young males and is suggested to be a subtype of PLE.[12][13]​ 

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