A previously healthy 42-year-old man presented with a 20-day history of an expanding, asymptomatic rash on his trunk. The initial lesion had been a red spot on the patient’s left side. 10 days after that spot had first appeared, smaller lesions had developed elsewhere. The patient reported no viral prodrome. The skin examination — including the initial lesion that had appeared — is shown. What is the diagnosis?
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Family Medicine notes
A previously healthy 42-year-old man presented with a 20-day history of an expanding, asymptomatic rash on his trunk. The initial lesion had been a red spot on the patient’s left side. 10 days after that spot had first appeared, smaller lesions had developed…
ANSWER: ✅ Pityriasis rosea (P.rosea)
On the basis of the finding of a “herald” patch in the patient’s midaxillary line on the left side, a diagnosis of pityriasis rosea was made. Pityriasis rosea is a self-limiting disorder that typically affects children, adolescents, and young adults. The cause of pityriasis rosea remains unclear. It may be related to viral reactivation of human herpes virus 6 or 7.
© NEJM image challenge
On the basis of the finding of a “herald” patch in the patient’s midaxillary line on the left side, a diagnosis of pityriasis rosea was made. Pityriasis rosea is a self-limiting disorder that typically affects children, adolescents, and young adults. The cause of pityriasis rosea remains unclear. It may be related to viral reactivation of human herpes virus 6 or 7.
© NEJM image challenge
The New England Journal of Medicine
September 4, 2025 | NEJM
Image Challenge from the New England Journal of Medicine — September 4, 2025
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❤️ PREVENT score for ASCVD assessment
https://professional.heart.org/en/guidelines-and-statements/prevent-calculator
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https://professional.heart.org/en/guidelines-and-statements/prevent-calculator
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professional.heart.org
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