This is the " Herald Lesion " of Pitryiasis Rosea and it often comes on the trunk after an upper resp. tract infection and is often mistaken and treated for a tinea infection ...after a week, the patient has no respite from the treatment ( oral and topical - antifungals ), but presents with the typical " Christmas tree " Pattern of Pitryiasis Rosea. These lesions are very itchy and only need symptomatic treatment with antihistamines and topical steroids ( in some cases ). And then there is "Reverse Pitryiasis Rosea" in which the lesions both herald and the ensuing florid lesions appear on the lower limb. I had come across a case of "reverse p rosea", recently (above image ), but it was after an attack of diarrhea ( suspected to be viral ). The patient presented with the herald lesion which looked like Tinea and then there was this florid lesion, which was accompanied by high fever and myalgia + arthrealgia..I tested for Dengue, Malaria, typhoid and Australia antigen - all negative. In addition LFTs, serum Creat and CBC was WNL and Urine microscopy and culture was negative. The only positive finding was a high ESR. Now ( 4 weeks on ), the lesions have completely resolved, but some itching persists.
