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Charles E. Crutchfield III M.D.

An 14-month-old girl presents with circular red plaques on her arms and legs. They have been present for approximately three months. They do not have any scale. They donít seem to change in appearance. The mother says they donít seem to bother her very much, and she does not scratch at them. Daycare is concerned that she has ringworm.

What is your diagnosis?

Ringworm

Diagnosis: Annular Erythema of Infancy

Discussion: This is an odd and somewhat rare figurate erythema reported in children. It is usually asymptomatic, without an overlying scale. The condition usually is constant and unchanging and can last several weeks to several months. There was an earlier report of a transient and repeating rash, but it is my belief that this report probably represented a true urticarial variant.

There is a related condition, (or even considered to be a variant of annular erythema of infancy by some) called “neutrophilic figurate erythema of infancy.” Dermatopathologic evaluation demonstrates a strong neutrophilic presence and karyorrhexis in these cases.

Because the patient was unbothered by the eruption, I did not perform a biopsy. I informed the parents that it was not ringworm (no significant scale (only mild xerosis) nor pruritus at all). I reassured the parents that the condition was called ‘annular erythema of infancy,' and that it was a benign disease, and was not caused by any other health condition, and should resolve on its own over a few months. I told the parents if the condition changed or became symptomatic to please bring her back in. The mother returned to my clinic six months later for a completely different skin concern of her own. At that visit the mother reported that her daughters rash had completely cleared 4 months after the daughter’s last visit.

References:

Annular erythema of infancy: A diagnostic challenge

Annular erythema of infancy


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