Endgames Spot Diagnosis

A striking annular rash in a young man

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j2914 (Published 05 July 2017) Cite this as: BMJ 2017;358:j2914
  1. Sze Ting Ivy Ngu, specialist registrar,
  2. David Bilsland, consultant dermatologist
  1. Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, UK
  1. Correspondence to ivy.ngu{at}nhs.net

A 34 year old man in Scotland described an expanding itchy rash on the right flank (fig 1) over a period of three months, despite using topical steroids, oral antifungals, and oral antihistamines. Borrelia serology performed four weeks after the start of the rash had been negative. He did not recall a history of an insect bite or foreign travel, but visits the Scottish highlands regularly. What is the most likely diagnosis?

Fig 1 Large annular rash on the right flank covering the posterior and lateral aspects, with an erythematous raised border and …

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