The rash is characterized as an intensely pruritic eruption of erythematous patches that. Sep 01, 2018 the skin lesions present as erythematous annular plaques with or without scales. If the expansion of the rash is not uniform it may become arciform arclike or polycyclic two or more connected rings. Examination of the right lateral ankle revealed a 2. This article highlights the differential diagnosis of conditions that can mimic tinea. Although plaques represent the most common presentation of annular lesions, lesions may also be macular, nodular, or composed of grouped papules, vesicles, or pustules.
On the lower abdomen the patient presented several extensive, larger than 5 cm diameter, annular patches with an elevated, erythematous border fig. A hyperkeratotic ridge marked the leading edge of the lesion, and the center of the. An unusual skin manifestation of sjs was originally described in japanese children and has been coined annular erythema of sjs. A 7dayold premature female infant presented with rapidly progressive, erythematous, annular skin lesions from the 5th day of life. Polycyclic lesion on the thigh of a child with a tinea capitis infection. The condition leads to erythema tous, annular patches on the trunk or extremities. A 17yearold male complains of itching, burning, and stinging of his feet. Tinea corporis refers to a dermatophytosis or superficial fungal infection of the skin, other than on the hands, feet, scalp, face or groin. Greater detail on many of the disorders discussed below is available elsewhere in uptodate. A yearold boy without significant past medical history presented to the outpatient dermatology clinic for evaluation of a rash. Scaly skin conditions skin diseases that have excessive scale or flaking papulosquamous disorders are due to epidermal inflammation or proliferation. Granuloma annulare classically presents with 1 or more indurated, erythematous or violaceous annular plaques on the extremities. While there are many dermatoses that have an annular appearance, the term annular erythema is sometimes reserved for a group of.
Erythematous scaly patches and plaques on the trunk and extremities hassab elnaby h, md, elkhalawany m, md department of dermatology, alazhar university, cairo, egypt correspondence. Annular erythematous erosive patches over trunk and limbs. The skin lesions started initially as erythematous patches over the perigastrostomy area, and. Physical examination reveals erythematous annular patches with distinct borders, central clearing, and fine scales. Annular erythema primary care dermatology society uk. Annular skin lesions commonly plague many primary care patients, but not all that is round is fungus. Erythema chronicum migrans is a skin finding at early stages of borreliosis, and erythema marginatum is the rapidly disappearing erythematous rash of acute rheumatic fever. Arcuate, annular, and polycyclic inflammatory and infectious lesions. Scleroderma is an autoimmune skin disease that can be localized or generalized. Tinea corporisa dermatophyte infection manifests on the trunk and extremities excluding the hair, nails, palms, soles, and groin and often mimics benign inflammatory skin conditions, such as granuloma annulare. Tinea corporis typically presents as an annular erythematous plaque with a raised leading edge and scale. Physical examination revealed multiple annular, erythematous patches and plaques scattered on the upper and lower extremities and trunk. In case 2, a 47yearold nonhispanic white woman presents to the. A 69yearold woman requests a second opinion because of a persistent skin condition.
Jan 01, 2012 tinea corporis is a common and wellknown dermatophyte inflection of the glabrous skin. Tinea corporis pityriasis rosea herald patch granuloma annulare urticaria xerotic eczema erythema. Tinea corporis is a dermatophyte infection that can occur on any cutaneous surface other than the hands, feet, scalp, or groin. As these patches enlarge, hyperkeratotic follicular papules begin to appear on the dorsal aspect of the trunk and upper and lower extremities and eventually coalesce with an erythematous perifollicular halo. A few 1cm pink scaly patches were present on the back bottom, and few 2 to 3mm pink scaly papules were noted on the extensor aspects of the elbows and forearms. It causes itchy raised patches of skin that can have sharply defined borders. While there are many dermatoses that have an annular appearance, the term annular erythema is sometimes reserved for a group of uncommon skin conditions that include erythema chronicum migrans, erythema annulare centrifugum eac, enapositive annular erythemas, and erythema gyratum repens. Erythema migrans, the characteristic rash of lyme disease. While it is generally characterized by a localized annular erythematous patch with a scaling border, tinea corporis occasionally appears generalized, covering a large area on the skin. The outer perimeter of the circular rash may be darker red in color than the center, giving the rash a ringlike appearance, according to medlineplus 3. The localized form, known as morphea, begins as erythematous patches that evolve into dusky, hypopigmented, indurated plaques with violaceous borders, usually on the trunk.
Annular erythematous patches with atrophic hypopigmented centre distributed over the forehead and cheek. One or more large erythematous patches may appear anywhere on the. Differential diagnosis of annular lesions american. It appears to be highly associated with the presence of antiro antibodies. Scaly annular and concentric plaques mdedge dermatology. Annular secondary syphilis is one of the uncommon forms, which often occurs in children and darkskinned people 2. Arcuate, annular, and polycyclic inflammatory and infectious. Sep 25, 2018 in case 1, a 24yearold woman presents to the clinic with a 4month history of an erythematous annular lesion on the dorsal arm. After an acute phase, nummmular or discoid eczema may progress towards a less vesicular and more scaly stage, often with central clearing, and peripheral extension, causing ringshaped or annular lesions. Potassium hydroxide examination and bacterial culture of the lesions. The patches were depigmented compared with the nonaffected skin. Generalized annular skin lesions photo quiz american. Annular erythema of infancy has clinical morphology of eac but occurs in infancy.
The advancing border was slightly elevated, erythematous, scaly, and superficially eroded, while centrally the skin was hyperpigmented. Cutaneous tcell lymphoma copied with kind permission from dermatoweb. Dec 18, 2018 this skin rash is caused by a fungal infection and can appear anywhere on the body. Annular lesions in dermatology narayanasetty nk, pai vv. The term annular comes from annulus latin which means ringed. Physical exam revealed generalized, confluent, erythematous, annular patches with central hypopigmentation and peripheral scale sparing the mucous membranes and palmoplantar surfaces. Nummular patches may accompany the more typical dry, erythematous scaling patches of atopic dermatitis. A yearold boy presents with red, annular rash on torso. Differential diagnosis of annular lesions american family. The skin lesions present as erythematous annular plaques with or without scales.
Annular erythema is a descriptive term that refers to a number of chronic annular and erythematous skin eruptions. Diagnosis is confirmed with koh preparation or fungal culture. Her eruption had been present for months and was resistant to a variety of topical medications, including. She was diagnosed provisionally as a case of neonatal lupus erythematosus and was investigated accordingly. Clinically and histologically, these lesions may be indistinguishable from annular scle.
Annular skin lesions appear as circular or ovoid macules or patches with an erythematous periphery and a central clearing. Annular erythematous erosive patches over the pubic, groin and perineal area. Annular erythema is not a diagnostic term but rather a description of a spreading erythematous eruption with an annular ringshaped appearance. Other descriptive terms used to classify these types of lesions include. Tinea presents as a pruritic, annular, erythematous patch or plaque that grows centrifugally figure 1. Annular ringshaped polycyclic two or more connected rings arciform arc like introduction the images below provide a quick diagnostic guide to the conditions in this group.
No joint swelling or tenderness was noted on examination. True ovalround patches and plaques are excluded from our. Tinea corporis is a dermatophyte infection that can occur on any cutaneous surface. The uncommon types of syphilides include nodular, psoriasislike, pustular, annular, eczematous, oral mucous patches, hair loss and nail changes 1. Necrolytic migratory erythema presenting with annular erosive. Jul 15, 2001 differential diagnosis of annular lesions. Aug 14, 2012 the patient also reported fevers, joint pain, and malaise. Hassab elnaby h, department of dermatology, alazhar university, cairo, egypt clinical findings a 42 yearold man presented with itchy skin le. Erythema annulare centrifugum eac is a chronic, reactive phenomenon of the skin presenting with arcuate or annular, erythematous patches or thin plaques that frequently exhibit scale along the inner portion of the advancing edge of lesions trailing scale picture 1ad. Tinea corporis is much more common than erythema annulare centrifugum. The clinical features and histopathological findings were suggestive of annular elastolytic giant cell granuloma.
In all cases both findings, clinical and histopathological should be considered when it comes to annular lesions which are frequently seen in daily routine. Annular skin lesions are characterized by a ringlike morphology. Apr 04, 2008 classically, patients present with a single erythematous patch. She was diagnosed provisionally as a case of neonatal lupus. Annular skin lesions differential diagnosis time of. The lesions were devoid of scale and exhibited central.
Erythematous scaly patches and plaques on the trunk and. Physical examination revealed widespread annular scaly lesions, some as large as 10 cm in diameter, on the trunk, buttocks, and limbs. Erythematous, annular, scaling patches on the skin. Recurrent annular erythematous scaly patches dermatology. Erythema annulare centrifugum is characterized by annular or arcuate, erythematous patches or plaques with central clearing and trailing scales behind the advancing margin on the trunk and. Slowly growing annular erythematous lesions on lightly. Annular elastolytic giant cell granuloma presented with. Lesions begin as erythematous patches that blister centrally, erode, crust over and heal with hyperpigmentation. The patient reported development of a red, annular rash on his. Dermatologic signs of systemic disease cleveland clinic. Treatment with 1% hydrocortisone lotion and emollients had resulted in only limited improvement of the skin lesions.
Pdf symmetrical erythematous annular and scaly patches. Physical examination revealed multiple 4 to 6cm pink, annular, scaly plaques with central clearing on the abdomen top and thighs. Annular skin lesions are figurate lesions characterized by a ringlike morphology. See detailed information below for a list of 10 causes of annular erythematous plaques, symptom checker, including diseases and drug side effect causes. Annular ringshaped polycyclic two or more connected rings arciform arc like. We list localised and generalised scaly skin disorders by their duration and body site. Symmetrical erythematous annular and scaly patches investigations revealed a hemoglobin hb value of 7.
Annular ringshaped polycyclic two or more connected. Skin manifestations of secondary syphilis occur in over 80% of cases. Erythematous lesions on the arm and chest page 2 of 4. Under woods light, the lesions appeared bright white. Common diseases that may present with annular lesions tinea corporis. Pdf annular, erythematous skin lesions in a neonate. Pityriasis rosea is more common in patients younger than 35 years and occurs along skin tension lines on the central trunk.
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