Indian Journal of Paediatric Dermatology

LETTER TO EDITOR
Year
: 2020  |  Volume : 21  |  Issue : 1  |  Page : 76--77

Migratory unilateral laterothoracic exanthem in a child


Yashdeep Singh Pathania, Saurabh Singh 
 Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Correspondence Address:
Dr Saurabh Singh
Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur - 342 005, Rajasthan
India




How to cite this article:
Pathania YS, Singh S. Migratory unilateral laterothoracic exanthem in a child.Indian J Paediatr Dermatol 2020;21:76-77


How to cite this URL:
Pathania YS, Singh S. Migratory unilateral laterothoracic exanthem in a child. Indian J Paediatr Dermatol [serial online] 2020 [cited 2020 Sep 24 ];21:76-77
Available from: http://www.ijpd.in/text.asp?2020/21/1/76/273833


Full Text



An 8-year-old boy presented with a 2-month history of mildly itchy rash over left side of the chest and abdomen with a history of rhinitis, lasting for 3 days without fever. On examination, there were grouped erythematous to skin-colored papules over the left side of chest and abdomen [Figure 1]. Mucosa was free and there was no lymphadenopathy. Routine blood investigations were within normal limits although HSV-1 serology was positive (both IgM and IgG). Skin biopsy was noncontributory and showed mild perivascular lymphomononuclear infiltrate.{Figure 1}

Lesions first appeared over the left side of the chest and abdomen with complete disappearance of lesions after 3 weeks of topical emollients and oral antihistamine. Subsequently, after a week, similar eruption appeared over right flank [Figure 2], followed by migration of similar lesions over left lumbar area followed by disappearance in a week interval. Migration and reduction of lesions continued to occur during above treatment. Herpes simplex virus-1 serology was 7.3 IU/ml after a month. The patient was lesion free after almost 2 months with no sequelae.{Figure 2}

Unilateral laterothoracic exanthem is a distinctive skin eruption that typically starts unilaterally in or around the axilla.[1] A viral etiology is suspected but not proven.[2],[3] The eruption usually resolves in 4–6 weeks without sequelae.[4] The disorder is most prevalent in Caucasian children aged 1–5 years.[4] The male-to-female ratio is approximately 1:2.[4] The condition occurs more frequently in winter and spring.[4] A postzygotic mutation at an early stage of embryogenesis, which renders the keratinocytes of one side of the body more reactive to infective agents, may explain the unilateral predominance of the eruption.[3]

Our case had unusual migratory evolution of the exanthem, although HSV-1 serology was positive, and the eruption was probably idiopathic in view of lack of a classic viral prodrome and symptomatology.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Brunner MJ, Rubin L, dunlap F. A new papular erythema of childhood. Arch Dermatol 1962;85:539-40.
2Nahm WK, Paiva C, Golomb C, Badiavas E, Laws R. Asymmetric periflexural exanthem of childhood: A case involving a 4-month-old infant. Pediatr Dermatol 2002;19:461-2.
3Niedermeier A, Pfützner W, Ruzicka T, Thomas P, Happle R. Superimposed lateralized exanthem of childhood: Report of a case related to adenovirus infection. Clin Exp Dermatol 2014;39:351-3.
4Gragasin FS, Metelitsa AI. Unilateral laterothoracic exanthem. CMAJ 2012;184:322.