What Condition Accounts For This Eruption?

This 19-year-old young man presented for evaluation of a pruritic eruption over both elbows, occurring only in the summer months. He had noticed it last year, as well.

What condition accounts for this eruption?

A. Keratosis pilaris
B. Follicular eczema
C. Dermatitis herpetiformis
D. Summertime pityriasis
E. Polymorphous light eruption

Answer: D. Summertime Pityriasis

Summertime pityriasis is a well-described entity that has alternatively been referred to as frictional lichenoid eruption in children and summer lichenoid dermatitis of the elbows of children. It has been postulated that the condition results from frictional exposure on exposed skin, which occurs more commonly in the summer months.

Some authors have suggested that summertime pityriasis actually is either polymorphous light eruption or follicular eczema, although biopsy results and the clinical picture (eg, the location and appearance of the lesions) have not been particularly supportive of either diagnosis in this circumstance. Keratosis pilaris is generally asymptomatic and is typically located on the extensor surface of the upper arm. Dermatitis herpetiformis is unusual but possible in this age group, but it would not be expected to improve during the winter.

As a historical side note, summertime pityriasis also has the eponymous name of Sutton’s summer prurigo, named after dermatologist Richard Lightburn Sutton Jr, MD (1908-1990). Dr Sutton’s father, Richard Lightburn Sutton Sr, MD (1878-1952), also was a dermatologist and is credited with the first descriptions of aphthous ulcers (Sutton disease) and halo nevus or Sutton nevus (which he originally called leukoderma acquisitum centrifugum). The younger Dr Sutton lived about a mile away from my office. I never met him, but I cared for his widow. In one of the best compliments I have ever received, she said I reminded her of her husband.
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David L. Kaplan, MD, is a clinical assistant professor of dermatology at the University of Missouri–Kansas City School of Medicine in Kansas City, Missouri, and at the University of Kansas School of Medicine in Kansas City, Kansas. He practices adult and pediatric dermatology in Overland Park, Kansas.

This article originally appeared in Consultant. 2017:57(6):353-354.