From the Research
The management for ring-enhanced plaques with central ulceration typically involves a combination of topical corticosteroids and antimicrobial therapy, with a focus on reducing inflammation and preventing secondary infection, as supported by the most recent evidence 1. The approach to managing ring-enhanced plaques with central ulceration should prioritize reducing inflammation around the lesion and preventing secondary infection in the ulcerated area.
- Start with a medium to high-potency topical corticosteroid such as triamcinolone 0.1% or clobetasol 0.05% applied twice daily to reduce inflammation around the lesion.
- Concurrently, apply mupirocin 2% ointment or silver sulfadiazine 1% cream to the ulcerated area three times daily to prevent secondary infection.
- The affected area should be gently cleansed with saline solution before each application.
- Occlusive dressings may be beneficial to enhance medication absorption and protect the ulceration. This regimen should continue for 7-14 days, with reassessment after one week. If the lesion shows signs of infection (increased erythema, purulence, warmth), oral antibiotics such as cephalexin 500mg four times daily or doxycycline 100mg twice daily for 7-10 days may be necessary, as indicated by studies on similar conditions 2, 3, 4, 5. It's crucial to address both the inflammatory component of the ring-enhanced plaque and the potential for infection in the ulcerated center, as these lesions often represent a localized inflammatory dermatosis with compromised skin barrier function that increases susceptibility to bacterial colonization. Given the variability in the etiology of ring-enhancing lesions, including infections, tumors, demyelinating diseases, treatment-related conditions, and hematoma 1, a comprehensive diagnostic approach may be necessary to guide management. However, the primary focus should remain on reducing inflammation and preventing infection to improve outcomes in terms of morbidity, mortality, and quality of life.