Prolonged remission of pediatric pityriasis lichenoides et varioliformis acuta after systemic corticosteroid therapy: a case report and scoping review

Abstract Background Pityriasis lichenoides is a rare inflammatory dermatosis characterized by a heterogeneous clinical course and poorly standardized treatment strategies. Approximately 20% of cases occur during childhood, yet evidence regarding systemic corticosteroid therapy remains limited. Methods We report the case of a 2-year-old boy with pityriasis lichenoides et varioliformis acuta (PLEVA) treated with systemic corticosteroids. A scoping review of the literature was also performed to summarize current therapeutic approaches in pediatric PLEVA. Results The child developed PLEVA after an episode of acute gastroenteritis. Initial treatment with acyclovir and azithromycin resulted in minimal clinical benefit. A subsequent severe relapse with intense pruritus and secondary impetiginisation required hospitalization. Systemic corticosteroid therapy administered with gradual tapering produced rapid and marked clinical improvement, followed by complete remission after 4 weeks. A later flare associated with febrile pharyngotonsillitis responded promptly to another short steroid course. No additional relapses occurred during 15 months of follow-up. Conclusions Although current evidence does not support systemic corticosteroids as standard therapy for PLEVA, selected clinical experiences suggest that carefully tapered regimens may contribute to rapid disease control and sustained remission. Larger prospective studies are needed to better define their efficacy and safety profile.