The characteristic feature of PLEVA is the rapid evolution of 2- to 3-mm-diameter
erythematous macules into
papules with a fine micaceous scale. The thicker the scale, the more frequently it breaks free at the edges while staying attached in the middle. The central punctum of the
papule frequently develops into a vesiculopustular structure, experiences hemorrhagic
necrosis, ulcerates, and is covered in reddish-brown crusts. There may be postinflammatory hyper- and
hypopigmentation as well as varioliform scars.
Pruritus and burning are among the symptoms. Although diffuse and widespread patterns can also occur, the trunk, extremities, and flexural areas are the most common sites for PLEVA to occur. Lesions can occur at any stage of development, making the eruption polymorphous. Subsequent crops of lesions can persist for weeks, months, or even years. The rapid progression of necrotic
papules to large coalescent ulcers with necrotic crusts, hemorrhagic bullae, and pustules distinguishes Febrile ulceronecrotic Mucha–Habermann disease from PLEVA. Both a secondary infection of the
ulcers and a large, painful
necrosis of the skin are possible. The mucosa of the mouth and genitalia may also be impacted.
Atrophic scars and
hypopigmentation are common after ulcer healing. PLC presents with a far slower clinical course than both febrile ulceronecrotic Mucha–Habermann disease and PLEVA. Similar to PLC, the lesion begins as an
erythematous papule that turns reddish-brown and is easily detached to reveal a shiny, pinkish-brown surface. The lesion also has a centrally adherent micaceous scale. In contrast to PLEVA and febrile ulceronecrotic Mucha–Habermann disease, the papule in question regresses and flattens on its own over a few weeks. Frequently, a hyper- or
hypopigmented macule is left behind. == Diagnosis ==