Generalized annular skin lesions.

Volume 87, Number 7 www.aafp.org/afp American Family Physician 513 A 32-year-old woman presented with a pruritic skin rash that had appeared intermittently for two years. Initially, the rash involved multiple papules and small plaques on the face, neck, and trunk. The lesions progressed to large plaques with centrifugally spreading edges and central clearing. The patient did not have fever or joint pain, and was otherwise healthy. Sun exposure did not exacerbate the rash. Physical examination revealed erythematous, annular plaques on the face, neck, back, scalp, chest, abdomen, and buttocks (Figures 1 and 2). There was a fine scale, but no vesicles or pustules. The palms, soles, nails, and mucosa were not affected. Results of a potassium hydroxide preparation of a skin scraping were negative. A skin biopsy was performed. No hyphae or spores were detected on a periodic acid–Schiff stain.