In adults, the most common etiology of annular lesions is tinea, a superficial fungal infection of keratinized tissue. While tinea may be readily identifiable, a wide variety of clinical entities mimic these infections, leading to confusion and, often, misdiagnosis.
Key morphological characteristics of annular lesions can improve diagnostic accuracy, leading to correct initial treatment. See Table 1. This review also may be helpful especially in cases of suspected tinea that are refractory to treatment. Asymmetric, well-demarcated, erythematous lesion with or without central clearing. Often associated with a scaly, palpable edge. KOH microscopy positive. Non-scaly, erythematous to violaceus colored papules or plaques with a thin, smooth border.
Favors the dorsal aspects of the extremities. Topical, intralesional, or oral corticosteroids. Can begin with a herald patch, followed by a diffuse eruption involving the trunk and proximal extremities. Lesions are oval-shaped, scaly, skin- to salmon-colored papules or plaques. Oral corticosteroids if significant pruritus is present.
Erythematous annular or polycyclic plaques with a trailing scale inside an erythematous border. Favors the trunk and proximal extremities. Large, evolving erythematous plaque without scale. Well-circumscribed, non-scaly edematous papules or plaques with blanched centers, surrounded by a red flare. First- or second-generation antihistamines. Small, violaceous, polygonal-shaped papules and plaques with a diffuse network of white streaking.
Topical or intralesional corticosteroids; oral corticosteroids if severe. Erythematous, serpiginous tracts associated with intense pruritus. Annular, skin- to brown-colored plaque with a raised, ridge-like border. Topical 5-fluorouracil with or without topical retinoids; cryosurgery. Well-circumscribed, erythematous dry plaques with silvery scale.
Well-demarcated, erythematous or hyperpigmented scaly or crusty coin-shaped plaques. Red to pink plaques with raised borders and central clearing. Occurs following sun exposure. Favors the face, upper trunk, and backs of arms. Multiple firm, red to purple to brown colored papules, nodules, or plaques. Favor the face, neck, and areas of trauma. Can have annular lesions. Intralesional triamcinolone. Oral corticosteroids for systemic disease.
Sharply demarcated red to pink to brown patches or thin plaques with greasy scale. Edematous plaques with three distinct zones. Tuberculoid — erythematous plaques with raised, sharply defined borders and atrophic center. Characteristically anesthetic. Lepromatous — numerous, poorly defined, hypopigmented macules that are symmetrically distributed. Superficial mycotic infections are those limited to keratinized environments such as the skin, hair, and nails.
Notoriously, these infections are caused by dermatophytes, a collective term that describes three genera — Microsporum , Trichophyton , and Epidermophyton. Tinea infections are caused by close contact with infected persons, animals, or, occasionally, soil, and are spread to multiple body areas via autoinoculation when an infected region is scratched.
Tinea can be diagnosed confidently when characteristic lesions described below are observed. When available, the diagnosis can be confirmed by observing branching hyphae under the microscope using a potassium hydroxide KOH preparation.
Tinea corporis and tinea cruris, the most common subtypes of dermatophytosis, are discussed briefly in this report. Tinea corporis is a superficial dermatophyte infection of the body, not involving the scalp, face, hands, feet, or groin. Lesions are similar to those of tinea corporis, characterized by an asymmetric, well-defined, mildly erythematous patch with associated scale. The advancing border is raised and may contain vesicles, pustules, or papules.
For localized tinea corporis or cruris, pedis, and faciei, topical antifungals, such as imidazoles clotrimazole, miconazole, ketoconazole, econazole, oxiconazole, sulconazole or allylamines naftifine, terbinafine , should be used once to twice daily for two to six weeks, including two weeks following clearance. Granuloma annulare GA is a relatively common, self-limiting disorder of the dermis that affects women twice as often as men.
Granuloma annulare can be diagnosed clinically by its unique distribution and morphology. Asymptomatic lesions with smooth, non-scaly contours are differentiated easily from the pruritic, scaly, and rough lesions of tinea.
Biopsy with histopathologic correlation can be used to confirm or establish the diagnosis when not clinically obvious.
Reassurance and observation is appropriate, as GA is benign and self-limiting. If left alone, one half of cases will resolve within two years. Pityriasis rosea is a common eruption primarily seen in adolescents and young adults. Lesions are mildly pruritic and oriented along cleavage lines.
A small subset of patients will experience a prodrome of headache, fever, and generalized malaise days to weeks prior to the initial outbreak. When the rash is localized to the trunk, axillae, or groin, it commonly is mistaken for tinea. Tinea rarely is as widespread, and its lesions generally exude more significant central clearing. The classic presentation often is alarming to patients, prompting medical evaluation.
However, treatment generally is not required, as the eruption spontaneously remits in three to eight weeks. Erythema annulare centrifugum EAC belongs to a group of disorders characterized by raised, erythematous lesions that form annular, polycyclic, or arcuate arrangements.
See Figure 2. Lesions have a predilection for the trunk and proximal extremities, sparing the hands, feet, face, and mucosa. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content. To learn more about Healthwise, visit Healthwise. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.
Updated visitor guidelines. You are here Home » Pityriasis Rosea. Top of the page. Topic Overview What is pityriasis rosea? What causes pityriasis rosea? The rash does not appear to spread from person to person. What are the symptoms? Pityriasis rosea causes a rash. The rash often begins with a single, round or oval, pink patch that is scaly with a raised border herald patch. The size of the patch ranges from 2 cm 0. The larger patches are more common.
See a picture of a herald patch. Days to weeks later, salmon-colored, 1 cm 0. Patches sometimes spread to the neck but rarely to the face. Patches on the back are often vertical and angled to form a "Christmas tree" or "fir tree" appearance. Mild itching is a problem for about half of the people who get the rash. The rash usually lasts 6 to 8 weeks, but it can last up to several months.
The lesions are not as distinct; instead, they are more generalized over the area. The rash can be more papular, or bumpy, in young children, pregnant women and on darker skin tones. In infants, vesicles and wheals have been known to appear.
Even oral lesions can occur, and in some cases, the rash covers the entire body. This is an atypical pityriasis rosea rash on the upper back. Normally there are fewer lesions that are more spread out over the trunk, but these papular lesions cover a lot of the area and are very close together.
An atypical rash is often misdiagnosed as ringworm, psoriasis , or eczema. If the rash can't be accurately diagnosed solely on appearance, a KOH potassium hydroxide test will be done. Although pityriasis rosea appears mostly on the trunk, it's not uncommon for it to spread around the body, including the arms, neck and even scalp. The rash rarely spreads to the face. It's unknown whether pityriasis rosea is contagious and there is no cure.
In many cases, a dermatologist will prescribe an oral antihistamine or topical steroids to help with itching. Few studies have investigated treatment options, but there are few theories that may shorten the rash's course, including concentrated doses of erythromycin an antibiotic used to treat acne , sun exposure, and UVB therapy.
Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Pityriasis rosea and pityriasis rosea-like eruptions: How to distinguish them? Annular lesions: Diagnosis and treatment. Am Fam Physician. Vanravenstein K, Edlund BJ. Diagnosis and management of pityriasis rosea.
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