Clinical manifestations

1. The initial lesion, called the "herald patch", can appear anywhere on the body, and is 2-6 cm in size, and begins a few days to several weeks before the generalized eruption. The hands, face, and feet are usually spared.

2. The lesions are oval, and the long axes follow the lines of cleavage. Lesions are 2 cm or less, pink, tan, or light brown. The borders of the lesions have a loose rim of scales, peeling peripherally, called the "collarette." Pruritus is usually minimal.

C. Differential Diagnosis. Secondary syphilis (always check a VDRL for atypical rashes), drug eruptions, viral exanthems, acute papular psoriasis, tinea corporis.

D. Treatment. Topical antipruritic emollients (Caladryl) relieve itching. Ultraviolet therapy may be used within the first week. The disease usually resolves in 2-14 weeks and recurrences are unusual.

References: See page 195.

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