The distribution of the rash helps to distinguish the condition
The differential diagnosis for this type of exanthem includes drug eruptions, pityriasis rosea, miliaria, scarlet fever, papular acrodermatitis of childhood, and other viral rashes. The asymmetric distribution of APEC helps to distinguish the condition. Other possible asymmetric skin lesions, such as contact dermatitis, tinea corporis, or lichen striatus, can be differentiated by the characteristics of the cutaneous lesions. Contact dermatitis lesions are more vesicular, pruritic, and related to the contact area. Tinea corporis lesions tend to be smaller, circular, well-limited, and often have pustules. Lichen striatus starts as small pink-, red-, or flesh-colored spots that join together to form a dull red and slightly scaly linear band over the course of one or 2 weeks.12 Because APEC is self-limiting, a skin biopsy is usually not necessary.13
Lesions usually persist for one to 6 weeks and resolve with no sequelae. Only symptomatic treatment is required.9 Topical emollients, topical corticosteroids, or oral antihistamines can be used, if necessary.
Our patients. Both patients were treated with oral antihistamines and the rashes completely resolved within 2 to 3 weeks.
CORRESPONDENCE
Celia Horcajada-Reales, MD, Hospital Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007 Madrid, Spain; celiahr@hotmail.com.