Unique clinical presentations of pityriasis rosea: aphthous ulcers, vesicles and inverse distribution of lesions.

Pityriasis Rosea (PR) is a common skin disorderencountered in daily practice. Although its etiologyhas not been established, there has been widespreadresearch into possibilities. The lack of its characteristicmanifestations, specifically the herald patch andtruncal involvement, can lead to pitfalls in diagnosis.Whereas other conditions in the differential diagnosisshould be considered, PR can at times also manifest inan atypical manner. We wish to illustrate three casesof PR including those that presented with aphthousulcers, vesicles, and an inverse pattern.

En coup de sabre.

En coup de sabre (ECDS) is a rare form of localized scleroderma that typically manifests in children and women. It presents as a fibrous pansclerotic plaque extending in a bandlike distribution on the frontoparietal scalp with surrounding scarring alopecia. Many patients have comorbid central nervous system involvement in addition to the cutaneous findings. En coup de sabre is a rare entity that should be delineated from Parry-Romberg syndrome, as both entities share some common features and may coexist. Corticosteroids remain the treatment of choice, but other modalities such as methotrexate, excimer laser, and grafting have been used with varying success. We report a case of an elderly woman who presented with an asymptomatic alopecic plaque consistent with ECDS.

Inflammatory linear verrucous epidermal nevus responsive to 308-nm excimer laser treatment.

Inflammatory linear verrucous epidermal nevus (ILVEN) is a rare cutaneous disease that presents as linear psoriasiform plaques with associated prominent pruritus. The lesions commonly pre-sent on the legs with onset during childhood. Inflammatory linear verrucous epidermal nevus typically is refractory to treatment. Therapies range from topical treatments to lasers and surgical options. It is clinically and histopathologically similar to psoriasis, suggesting it may respond to established psoriasis treatments such as the excimer laser. We report the case of an otherwise healthy 20-year-old woman with dry, pruritic, red lesions on the right leg that had been present since infancy. Biopsy revealed psoriasiform hyperplasia with a verruciform surface. Multiple topical treatments including ablative CO2 laser therapy showed no remarkable improvement. The patient was then treated with a UV 308-nm excimer laser and showed noticeable clinical improvement. Because of its clinical and histopathological similarities to psoriasis, we hypothesized that the excimer laser may be useful in the treatment of these lesions.