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Therapeutic Approach

Pityriasis lichenoides et varioliformis acuta (PLEVA) is an uncommon, idiopathic, inflammatory skin disease characterized by recurrent crops of erythematous, scaly papules, vesicles or hemorrhagic crusted ulcers, most commonly on the trunk and extremities. Lesions typically regress within a few weeks, resulting in a postinflammatory hypopigmentation, hyperpigmentation, and varioliform scar. Patients with PLEVA are often asymptomatic but can be pruritic. Systemic symptoms may be seen in the rare, more severe variant, febrile ulceronecrotic Mucha–Habermann disease (FUMHD).

There are no standard treatment guidelines for PLEVA. Treatment consideration is generally based on the severity of the disease and the treatment adverse effect profiles. In the authors experience, initial treatment includes mid- to high-potency topical steroids combined with either oral tetracycline class antibiotics or narrowband UVB phototherapy, with refractory cases treated with low dose oral weekly methotrexate. Combination treatment regimens are acceptable. Relapse is not uncommon. See Table 10-1.

Table 10-1PLEVA Treatment Table

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