C. Pityriasis lichenoides et varioliformis acuta (PLEVA)
Of course it is the one with the long name… This is a severe and threatening variant of PLEVA known as Febrile Ulceronecrotic Mucha-Habermann disease (FUMHD). Though the pathogenesis is poorly understood, it is thought to be due to an aberrant t-cell immune response. Diagnosis is confirmed by skin biopsy. The prevalence is unknown; only 42 cases have been reported in the medical literature. Associated symptoms include high fevers, diarrhea, myalgias, arthritis, CNS symptoms, megaloblastic anemia, interstitial pneumonitis, lymphocytic myocarditis and sepsis. No consensus treatment exists. Case reports describe treatments with systemic steroids, methotrexate, dapsone, cyclosporine, psoralen and ultraviolet A (PUVA), ultraviolet B (UVB), acyclovir, immunoglobulins, and 4,4-diaminodiphenylsulphone (DDS). The other options can also make you look very sick, but do not have the ulcerative appearance as seen in the image.
Sotirious E., Patsatsi A., Tsorova C., LazaridouE., Sotiriadis D. Febrile ulceronecrotic mucha-Haberman disease: a case report and review of the literature. Acta Derm Venerology, 2008.
Treat, JR. Pityriasis lichenoides et varioliformisacuta (PLEVA). UpToDate. July 12, 2019. Accessed June 14, 2020.
Febrile ulceronecrotic mucha-Haberman disease Febrile Ulceronecrotic Mucha-Haberman Disease. Genetic and Rare Disease Information Center website. September 15, 2015. Accessed June 14, 2020.