Pityriasis Lichenoides et Varioliformis Acuta: Diagnostic Enigma Unveiled with Clinicopathologic Insights into a Rare Dermatologic Entity

Pityriasis Lichenoides et varioliformis acuta (PLEVA) is a rare, idiopathic, inflammatory dermatosis representing the acute end of the pityriasis lichenoides spectrum. It usually affects children and young adults, whereas occurrence in older individuals is distinctly uncommon. We report a 53-year-old male laborer who presented with multiple, discrete, erythematous, itchy papuloplaque lesions over the back and neck for 8 days. There were no systemic symptoms. Clinical differentials included pityriasis rosea and PLEVA. Histopathological examination of a punch biopsy revealed mild acanthosis, focal spongiosis, basal layer vacuolar degeneration, lymphocytic exocytosis, red blood cell extravasation, and a dense superficial perivascular lichenoid lymphocytic infiltrate, confirming the diagnosis of PLEVA. The patient responded well to a short course of systemic and topical therapy, with complete resolution of lesions within 6 weeks and no recurrence on follow-up. This case highlights that PLEVA can present even in older adults, an age group where it is exceptionally uncommon. Recognition of its variable clinical spectrum and careful histopathological evaluation are essential to distinguish it from other papulosquamous disorders. Reporting such atypical presentations expands current understanding of disease demographics and reinforces the need to consider PLEVA in the differential diagnosis of acute eruptive dermatoses across all age groups.