Persistent Abdominal Red Rash: A 31-Year-Old's Diagnostic Dilemma

Abdominal erythema, diagnosis has been a persistent challenge?

Male, 31 years old.
Dear doctor, I am a 30-year-old male who smokes and has no significant medical history, except for a diagnosis of mild mitral valve prolapse in childhood.
Currently, I have a symptom: a ring-like erythema has appeared in my abdomen (specifically in the upper abdomen below the chest).
I am unsure what it is.
It has been present for over a month, sometimes appearing faint (light pink or light reddish-brown) and at other times more pronounced (reddish).
It is approximately the size of a coin (located around the stomach area), and the skin lesion is neither itchy nor painful.
There is no peeling or flaking, and the surface is not raised.
I have searched online and found that it resembles a granuloma or skin cancer, and it also looks like tinea.
I am quite worried.
I am currently studying in Australia and have seen two general practitioners, both of whom were unsure of the diagnosis but mentioned that since it is not painful or itchy, it may not require immediate attention.
The doctors suggested it could possibly be a superficial fungal infection and recommended using clotrimazole for three weeks, but there has been no improvement.
What should I do? I am very concerned about the persistent erythema for nearly two months and fear it may be something serious, such as cancer.

Lü, 30~39 year old female. Ask Date: 2018/02/20

Dr. Huang Xunying reply Family Medicine

Hello, based on your description, it does resemble a fungal infection.
However, if you have used medication and felt that the results were unsatisfactory, there may be other underlying causes.
I still recommend visiting a dermatologist for further evaluation, as some fungal infections can be more challenging to manage.
The dermatology department may perform a microscopic examination of the skin scrapings.
If you are concerned about a more serious condition, it typically does not present with fluctuating symptoms.
If you are worried, a biopsy may be necessary.
Thank you.

Reply Date: 2018/02/20

More Info

Based on your description, it sounds like you are experiencing a persistent abdominal rash that has raised concerns about its nature and potential implications. Given that you have already consulted with general practitioners in Australia who were unable to provide a definitive diagnosis, it is understandable that you are feeling anxious about the situation.
The characteristics of your rash—being ring-like, varying in color from pale pink to red, approximately the size of a coin, and lacking symptoms such as itching, pain, or peeling—suggest that it may not be an acute inflammatory process. However, the persistence of the rash over a month is noteworthy and warrants further investigation.

There are several potential causes for a persistent abdominal rash like yours. Some possibilities include:
1. Granuloma Annulare: This is a benign skin condition that often presents as ring-shaped lesions. It typically resolves on its own without treatment and is not associated with systemic disease.

2. Tinea Corporis (Ringworm): This is a fungal infection that can present as a red, ring-like rash. Although you have been using clotrimazole, which is effective for fungal infections, it may take time to see improvement, or the diagnosis may need to be reconsidered if there is no response.

3. Erythema Multiforme: This is a hypersensitivity reaction that can present with target-like lesions. It is usually self-limiting but can be triggered by infections or medications.

4. Psoriasis or Eczema: These chronic skin conditions can sometimes present with red patches that may not be itchy or painful. They often require specific treatments to manage.

5. Skin Cancer: While it is less likely given the characteristics you described, any persistent skin lesion that changes in appearance or persists over time should be evaluated for malignancy, especially if there is a family history of skin cancer or other risk factors.

Given your ongoing concerns and the lack of improvement with topical treatment, I recommend the following steps:
1. Seek a Dermatology Referral: A dermatologist can provide a more specialized evaluation of your rash. They may perform a skin biopsy to rule out conditions like skin cancer or other dermatological issues.

2. Consider a Broader Workup: If the dermatologist suspects an underlying systemic condition, they may recommend blood tests or imaging studies to rule out any internal issues.

3. Document Changes: Keep a record of any changes in the rash, including size, color, and any new symptoms. This information can be helpful for your healthcare provider.

4. Avoid Self-Diagnosis: While it is natural to research symptoms online, self-diagnosis can lead to unnecessary anxiety. Rely on professional medical advice for accurate diagnosis and treatment.

5. Follow Up on Treatment: If the clotrimazole treatment does not yield results, inform your healthcare provider. They may suggest alternative antifungal treatments or other therapies based on their assessment.

In summary, while it is understandable to be concerned about the possibility of a serious condition, many skin issues are benign and can be effectively managed with appropriate medical care. Seeking a specialist's opinion will provide you with clarity and peace of mind regarding your health.

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