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

Migratory unilateral laterothoracic exanthem in a child


Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Date of Submission14-Mar-2019
Date of Decision14-Apr-2019
Date of Acceptance27-Nov-2019
Date of Web Publication24-Dec-2019

Correspondence Address:
Dr Saurabh Singh
Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur - 342 005, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_33_19

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How to cite this article:
Pathania YS, Singh S. Migratory unilateral laterothoracic exanthem in a child. Indian J Paediatr Dermatol 2020;21:76-7

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 Oct 25];21:76-7. Available from: https://www.ijpd.in/text.asp?2020/21/1/76/273833



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: Grouped erythematous to skin-colored tiny papules over the left side of the chest and abdomen in a vertical centrifugal configuration with central exfoliation

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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: Grouped erythematous to skin-colored tiny papules over the right flank

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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 Top

1.
Brunner MJ, Rubin L, dunlap F. A new papular erythema of childhood. Arch Dermatol 1962;85:539-40.  Back to cited text no. 1
    
2.
Nahm 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.  Back to cited text no. 2
    
3.
Niedermeier 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.  Back to cited text no. 3
    
4.
Gragasin FS, Metelitsa AI. Unilateral laterothoracic exanthem. CMAJ 2012;184:322.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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