Photo Quiz

Annular Scaly Plaques

 


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Am Fam Physician. 2016 May 15;93(10):865-866.

A 57-year-old woman presented with a largely asymptomatic rash on her feet that began six months earlier. She had infrequent mild pruritus but no other symptoms related to the rash. She had no systemic symptoms such as fever, chills, myalgias, or arthralgias. The rash did not improve after two months of treatment with terbinafine cream (Lamisil).

Physical examination demonstrated well-circumscribed, erythematous, annular plaques on the dorsa of her feet that were 3 to 4 cm in diameter (Figure 1). The plaques had no induration, but there was a trailing white scale. They were nontender to palpation, and the surrounding skin was unaffected. Findings from a potassium hydroxide preparation of the scale were negative.


Figure 1.

Question

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Erythema annulare centrifugum.

B. Granuloma annulare.

C. Psoriasis.

D. Tinea pedis.

Address correspondence to Elizabeth Seiverling, MD, at eseiverling@hmc.psu.edu. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

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1. Bolognia J, Jorizzo J, Schaffer JV, Callen JP, eds. Dermatology. 3rd ed. Philadelphia, Pa.: Elsevier Saunders; 2012....

2. Marks JG, Miller JJ, eds. Lookingbill and Marks' Principles of Dermatology. 5th ed. Philadelphia, Pa.: Elsevier Sanders; 2013.

3. Ziemer M, Eisendle K, Zelger B. New concepts on erythema annulare centrifugum: a clinical reaction pattern that does not represent a specific clinicopathological entity. Br J Dermatol. 2009;160(1):119–126.

4. Lebwohl M, ed. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. London, UK: Mosby; 2002.

5. Habif TP, ed. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 6th ed. St. Louis, Mo.: Elsevier; 2016.

6. Mease PJ, Gladman DD, Papp KA, et al. Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics. J Am Acad Dermatol. 2013;69(5):729–735.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

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