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42-Year-Old Male with Circular, Scaling Lesion on Trunk

Can you diagnose this case?

David L. Kaplan 2014 Series Editor @ University of Missouri – Kansas City School of Medicine

Signs and Symptoms

An asymptomatic, circular, scaling lesion on the trunk of a 42-year-old man consistently reappears after clearing. The lesion initially erupted 3 months earlier; since then, it has arisen, lasted a few weeks, and disappeared several times. The patient has no other complaints; he takes no medications.

What does your differential diagnosis include?

Choose one to reveal diagnosis and discussion

Tinea corporis
Tinea versicolor
Granuloma annulare
Erythema annulare centrifugum
Lupus erythematosus

Answer: Erythema annulare centrifugum

See the full case at Consultant360

The presentation strongly suggested erythema annulare centrifugum, a reactive process to an underlying disease that is often undiagnosed. Tinea corporis, tinea versicolor, and granuloma annulare lesions do not wax and wane as did this patient’s eruption. The rash of lupus erythematosus also tends to persist and typically arises on sun-exposed skin. Perform a potassium hydroxide examination, for a dermatophyte infection, which is the most common underlying disorder; this patient had tinea pedis. Further workup is needed only if the patient has symptoms other than the rash. Treatment of the tinea pedis resulted in resolution of the infection and the erythema annulare centrifugum as well.

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