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Question

my son has an annular rash which appeared on interior upper arms first, appearing to transfer to the torso next morning. He had similar appearance on his interior thighs, just above the knee, which, within 6 hours covered the entire thigh. I now see obvious rings on his ankles and heels and at the base of his thumbs. No seeping, crustiness, flaking or itch at this point. I've ruled out ringworm due to the extremely irregular shape of the rings and the rapid advancement. No other symptoms

Submitted: 161 days and 16 hours ago.
Category: Pediatrics
Value: $15
Status: CLOSED
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Optional Information

Gender: Male
Age: 10

Already Tried:
when I first thought of ringworm I used Lotrimin. I've dealt with ringworm before. I have 6 kids. It's not that. No itch. No exposure to new foods or laundry supplies. As stated, from first appearance it spread very rapidly. He was stung by a bee 1 week prior. 2 days of moderate swelling. I'm a P.A. and have always been able to diagnose my children before. The rings are dark on the feet and ankles. Not raised. Irregular shape. Flesh colored inside. Look like kidneys or "Africa".

Posted by Dr David 161 days and 16 hours ago.

Info Request

Hello and thank you for your post. I am sorry to hear that your son is having this problem. Please understand that diagnosing rashes remotely is a bit difficult.

First a few questions if you don't mind: how old is he? Is he otherwise healthy? Does he have any other symptoms? Are you in an area with a lot of Lyme disease? Is he taking any medications? Does the rash look remotely like this? Please let me know and I will get back to you. Thank you, XX XXXXX
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Posted by Dr David 161 days and 16 hours ago.

Info Request

Whoops, sorry I see his age listed now and the fact that he has no other symptoms. Since you are a PA, what do you think about erythema multiforme (the photo I sent earlier)? Thanks, XX XXXXX

161 days and 16 hours ago.

Reply

the rash in the picture is much darker than my son's. His is light pink and more scattered. In looking again at the one's on his ankle, they are definite circles. I am at a loss. I co-worker suggested Fifth's, but face and cheeks are not affected. As stated earlier, he has no fever, no itching, about 50% of the rash is slightly raised the rest is simply the discoloration. He's been around no-one contagious that we know of. I leaned toward the ringworm, as we have two outdoor cats that he won't leave alone. They show no symptoms and my son's rash is not behaving like ringworm. It happened so fast that I immediately thought of an allergic reaction, but there was no itching. It seemed to move too fast to be fungal, which left viral, but I can't place it. The rings on the feet and ankle seem familiar, though, as if I've seen them before. I've been researching ALL day.

Posted by Dr David 161 days and 16 hours ago.

Answer

Thanks for the further information. I will include another photo to see if that is more what it looks like (the pattern is more important than the color). Based on what you have described, erythema multiforme would be highest on my list. Let me know what you think about this. I meant to say that granuloma annulare can be annular but doesn't usually come on this sudden in my experience (and isn't usually widespread).

Please let me know your opinion. Thanks, XX XXXXX
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161 days and 16 hours ago.

Reply

in reading on minor erythema multiforme, it is stated that Herpes Zoster can be a cause. Is it possible that this outbreak could be due to my son's exposure to someone with an active outbreak of shingles. BTW - even this picture is much more aggrevated than my son's case, however it does look similar enough to be a plausible possibility.

Jeri

Accepted Answer

Thanks for the further information. Obviously the pictures available from the internet are going to be more extreme for effect. I suppose that this could be from exposure to shingles but one would expect that he would have had some manifestation of the zoster itself. Most times we aren't sure what causes the EM anyhow.

Rest assured that it is not dangerous. Clearly if he develops mucus membrane involvment to suggest Stevens-Johnson syndrome, he needs to be seen right away. Otherwise benadryl or simple observation should be sufficient. In rare cases, systemic steroids may be tried (with mixed results).

I hope this is helpful. Please let me know if I can help in any other way. I hope he is doing better soon. Thanks, XX XXXXX

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Expert: Dr David
Pos. Feedback: 100.0 %
Accepts: 808
Answered: 9/1/2009

Board Certified Pediatrician

Board-certified pediatrician at children's hospital, former chief resident, multiple publications

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