Graphic number 2 shows several red-brown lesions on the front thorax and abdomen. The papules have an annular shape, are distributed individually, and vary significantly in size. Their size can be estimated between 1 and 10 mm. With those characteristics in mind, it is possible to include erythema multiforme, nummular eczema, and secondary syphilis in the differential diagnosis.
Although round lesions are usually associated with nummular eczema (Ely & Stone, 2010b), that condition needs to be excluded because the size of lesions is smaller than 1 cm (LeBlond, Brown, & DeGowin, 2009). Finally, erythema multiforme can be excluded because it does not usually appear on the chest or abdomen (LeBlond et al., 2009). Secondary syphilis is characterized by red-brown lesions (Ely & Stone, 2010b), and it usually manifests on the thorax and abdomen (LeBlond et al., 2009), so secondary syphilis is the most likely diagnosis in this case.
Graphic number 5 shows a skin condition in which the edematous lesions have irregular shapes. The lesions are pink and appear to have a scaly white and silvery surface. The size can be estimated between 5 and 10 mm. By observing the bodily hair and flat surface, it is possible to conclude they are most likely localized on the trunk. Because of the location and appearance of the lesions, it is possible to include pityriasis rosea, psoriasis, seborrheic dermatitis, and urticaria as possible diagnoses.
Although the silvery scales on the graphic are similar to the ones found in pityriasis rosea, it is possible to exclude that condition because it is characterized exclusively by oval lesions (Ely & Stone, 2010a). Psoriasis also does not have irregular patterns, so should be excluded from the diagnosis (LeBlond et al., 2009). Finally, seborrheic dermatitis most commonly occurs on the face, such as the scalp, eyebrows, or the nasolabial folds (LeBlond et al., 2009). That leaves urticaria as the most likely disorder because the graphic shows evanescent and edematous lesions with irregular patterns and high variability in size, which is characteristic for urticaria.
References
Ely, J. W., & Stone, M. S. (2010a). The generalized rash: Part I. Differential diagnosis. American Family Physician, 81(6), 726-734. Retrieved from http://www.aafp.org/afp/2010/0315/ p726.html
Ely, J. W., & Stone, M. S. (2010b). The generalized rash: Part II. Diagnostic approach. American Family Physician, 81(6), 735-739. Retrieved from http://www.aafp.org/afp/2010/0315/ p735.html
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2009). DeGowin's diagnostic examination (9th ed.). New York, NY: McGraw Hill Medical.
