Asymptomatic Circular Erythematous Lesions on Chest

Case at a Glance

A 26-year-old male presented with multiple asymptomatic circular erythematous lesions on his chest, discovered incidentally by his partner. The lesions were characterized by dark red centers with surrounding erythematous rings, measuring approximately 5mm in diameter.

Patient's Story

The patient's fiancée noticed unusual skin lesions on his chest during routine daily activities. The patient reported no associated symptoms including pain, pruritus, or systemic complaints. He denied recent medication use, both prescription and over-the-counter. The lesions appeared suddenly without any preceding trauma or known exposures.

Initial Assessment

Physical examination revealed multiple well-demarcated circular lesions on the anterior chest. Each lesion consisted of a dark red to purpuric central area approximately the size of a pencil eraser (5mm), surrounded by a complete erythematous ring. The lesions were flat, non-palpable, and showed no central punctum or evidence of arthropod bite. The patient appeared systemically well with no fever or other constitutional symptoms.

The Diagnostic Journey

The unusual morphology of the lesions prompted careful consideration of the differential diagnosis. The distinctive target-like appearance with central dark areas and peripheral erythematous rings was noted as atypical for common dermatologic conditions. Initial clinical assessment ruled out obvious infectious causes, drug reactions (given negative medication history), and arthropod bites (absence of central punctum).

Final Diagnosis

The diagnosis remained uncertain at initial presentation due to the unusual morphologic features of the lesions, which did not fit typical patterns of common dermatologic conditions.

Treatment Plan

Given the asymptomatic nature and stable appearance of the lesions, a conservative approach with close monitoring was initially recommended. Dermatologic consultation was advised for definitive diagnosis and management if the lesions persisted or evolved.

Outcome and Follow-up

The patient was counseled to monitor for any changes in lesion appearance, development of new lesions, or onset of systemic symptoms. Instructions were provided to seek immediate medical attention if constitutional symptoms developed, with routine dermatologic follow-up planned for persistent lesions.