Last reviewed: 21 Nov 2024
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 subacute recurrent skin eruption
Full details
Other diagnostic factors
- 2-week timing between herald patch and new lesions
- female sex
- prodromal symptoms
- pigmentary alteration (severe cases/dark skin color)
Full details
Risk factors
- age 10 to 35 years
- female sex
Full details
Diagnostic tests
Tests to consider
- skin biopsy
- antistreptolysin O titers
- potassium hydroxide (KOH) prep microscopy or fungal culture
- rapid plasma reagin/Venereal Disease Research Laboratory
Full details
Treatment algorithm
ACUTE
mild to moderate symptoms
severe or refractory disease
refractory to all other treatments
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.
Differentials
- Secondary syphilis
- Guttate psoriasis
- Tinea corporis
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