Marked lesions, such as hair loss, scaly skin, and visible papulovesicle
of the affected area, appeared on day 10 postinfection and reached highest degree on day 14.
Eczema is a chronic relapsing inflammatory skin disease characterised clinically by pruritus, erythema, scaly and clustered papulovesicles
induced by various endogenous or exogenous factors.
It may be urticarial lesions, eczema and erythema multiforme-like eruptions (with or without mucosal or perineal involvement), purpura and recurrent anaphylaxis.5-9 The skin lesions develop 3-10 days before menstruation and persist up to 1-2 days after the end of the menstrual cycle, with recurrent cyclic aggravation, closely related to the serum progesterone concentration.5 Our patient also had the same cyclical pattern of skin lesions that appeared 3-4 days before menstrual cycle, presented with sheet of papulovesicles
and pustules involving face, body folds and extremities associated with fever.
It is histopathologically characterized by dilated lymphatic vessels in the papillary dermis that elevate the epidermis above that of the surrounding skin, leading to the characteristic "frogspawn" grouped vesicles or papulovesicles
seen clinically [2, 3].
The pruritic rash usually consists of acute-onset monomorphous, flat-topped or dome-shaped red-brown papules and papulovesicles
, one to 10 mm in size, located symmetrically on the face (FIGURE 6), the extensor surfaces of the arms and legs, and, less commonly, the buttocks.
Most commonly, the physical examination findings were vesicles or papulovesicles
(52%), but crusting (33%), pustules (6%), and erosions (23%) also occurred.
The intensity of the response may vary, ranging from a slightly irritable red erythema to wheals with papules or papulovesicles
matched with intense itch arising between 3 and 6 h after exposure, with a peak after 12 to 24 h.
The lesion characteristically progresses rapidly from small indurate papulovesicles
to necrotic ulcers with surrounding erythematic and a central black Escher.
PLEVA tends to present more acutely with papulovesicles
that may develop necrotic, ulcerative, or haemorrhagic changes.