Crusty papules could have viral origin

THE RASH was mildly itchy but had broken down to form dark crusts in areas. He had not been picking at it. There was no response to strong steroid creams.

This is pityriasis lichenoides acuta, sometimes known as PLEVA. It is possibly viral in origin and begins as papules or papulovesicles which break down to form crusts. There are several flushes of lesions in different stages of development. Central trunk lesions resolve more quickly but resolution can take 12 months or longer.

The condition can be treated with narrow-band ultraviolet light therapy and drugs such as erythromycin 400mg bd can be used for their

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