A Previously unreported variant of a common papulosquamous disorder – bullous pityriasis rosea with a relapsing and remitting course

Introduction: Pityriasis rosea is a acute self-limiting papulosquamous dermatosis localized in trunk and extremities, seen more frequently in adolescents and young adults. Atypical variants are rare accounting to approximately 20 % of all cases. Atypical presentations in PR can lead to difficulty in diagnosis. Here I present a previously unreported rare atypical case of Bullous pityriasis rosea in a 7 year old child.

Materials and method:

Case report-

A 7 year old male child presented with 3-4 cm in size erosions with overlying minute pustules and vesicles in the upper and lower extremities.  History of bullous lesions which progressed to the current erosions present for the past seven days. History of similar lesions which remitted and relapsed, on its own even without any treatment, since childhood, was told by the parent. Based on the clinical findings and presentations, differential diagnosis included chronic bullous impetigo, bullous mastocytosis, and chronic bullous disorder of childhood. Skin biopsy was done.  Histopathology showed features consistent with pityriasis rosea.

Discussion: PR presenting in bullous form is by itself an atypical presentation. On top of that the disease having a remitting and relapsing course is even rarer. Though PR is a common self-limiting disease, recognition of disease variants with respect to morphology, location and evolution of lesions may avoid unnecessary procedures and drug ingestion.