Photo Quiz

Rash on the Ankle


Am Fam Physician. 2019 Dec 15;100(12):773-774.

A 65-year-old man presented with a rash on his right ankle that developed four days prior. The rash began as a single papule but progressively spread. The patient reported itching but no pain or tenderness. He applied bacitracin and triamcinolone to the rash without improvement. The patient had a history of basal cell carcinoma, actinic keratosis, and seborrheic keratosis. He had recently visited the North Carolina coast immediately after a hurricane impacted the area. On physical examination, he was in no acute distress, and his vital signs were normal. A vesicular rash extended approximately 3 cm × 1 cm anterior and slightly superior to the right medial malleolus in a serpentine pattern. A second, smaller lesion was located directly superior to the same malleolus (Figure 1).




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

Address correspondence to John E. Snellings, MD, FAAFP, at Reprints are not available from the authors.

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This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

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