768ityriasis lichenoides et varioliformis acuta (PLEVA) is a cutaneous disorder of unknown etiology and characterized by a generalized eruption of acute onset, consisting of papular lesions that undergo central vesiculation which may ulcerate and resolve with hemorrhagic crusts.1,2 Although descriptions of this disorder had been made many times previously, term "PLEVA" was first described in 1925 by Habermann. 3 PLEVA occurs predominantly in the second or third decades of life and it is uncommon in childhood. There is a male predominance. 4 The disease starts on the trunk with erythematous papules that develop crusts, vesicles, pustules or erosions, then spontaneously regresses within a few weeks.
3,4Varioliform scars and postinflammatory hyper-or hypopigmentation may result.3 The eruption may be asymptomatic or sometimes accompanied by itching, fever and malaise. 1 There are three major pathogenic theories of PLEVA: an inflammatory reaction triggered by infectious agents; an inflammatory response secondary to a T-cell dyscrasia and an immune complex-mediated hypersensitivity vasculitis.3 A number of physicians suspect an infectious etiology such as Epstein-Barr virus, Toxoplasma gondii and Human immunodeficiency virus since the disease appears rapidly and favors younger patients.2,3 Several reports have demonstrated clonal T-cell receptor rearrangements from patient specimens, suggesting that PLEVA is a lymphoproliferative disorder involving T-cell subtypes, despite its clinically benign course and the absence of morphologically atypical cells in the skin lesions. 4 PLEVA is the prototypic disease featuring lymphocytic vasculitis, except that fibrin deposition is not seen. Lymphoid atypia is not a standard feature of PLEVA. All cases of PLEVA show interface dermatitis. There is exocytosis, parakeratosis and extravasation of erythrocytes. Epidermal damage range from intercellular and extracellular edema, to extensive keratinocyte necrosis, vesicles, pustules and ulcers. Immunohistochemical stainings are mostly positive for CD8 and negative for CD4 and CD30. A An na ah h t ta ar r K Ke e l li i m me e l le er r: