Differential Diagnosis for Ring-Enhanced Plaques with Central Ulcer and Blistering
Single Most Likely Diagnosis
- Eczema herpeticum: This condition is a spread of the herpes simplex virus within the skin, often presenting with ring-enhanced plaques, central ulceration, and blistering, particularly in individuals with atopic dermatitis. The clinical presentation and history of eczema make it a strong candidate.
Other Likely Diagnoses
- Impetigo: A highly contagious skin infection that can cause blistering and ulceration, often with a golden crust. While it doesn't always present with ring-enhanced plaques, its contagious nature and the presence of blistering make it a consideration.
- Dermatophyte infections (ringworm): These fungal infections can cause ring-shaped lesions with central clearing and sometimes blistering, especially in the case of inflammatory ringworm.
- Autoimmune bullous dermatoses (e.g., pemphigus, pemphigoid): These conditions can present with blistering skin lesions and, in some cases, may have a ring-like appearance or central ulceration.
Do Not Miss Diagnoses
- Necrotizing fasciitis: Although rare and not typically presenting with ring-enhanced plaques initially, this condition can rapidly progress and cause severe damage. Early signs might include painful swelling, redness, and blistering, making it crucial not to miss due to its high mortality rate.
- Malignant lesions (e.g., basal cell carcinoma, squamous cell carcinoma): While less common, certain skin cancers can present with ulceration and, in rare instances, might mimic the described appearance. Given the potential for serious outcomes, these should not be overlooked.
Rare Diagnoses
- Leprosy (Hansen's disease): Can cause a variety of skin lesions, including those with central ulceration and potentially blistering, though ring-enhanced plaques are less typical.
- Granuloma inguinale (donovanosis): A sexually transmitted infection that can cause ulcerative lesions, which might occasionally appear with a raised border, resembling a ring-enhanced plaque.
- Cutaneous leishmaniasis: This parasitic infection can cause skin lesions with central ulceration, though the presence of ring-enhanced plaques and blistering would be less common.