This 38 year old male presented to me on Monday, November 24, 2008, with a chief complaint of an oval shaped rash on the inside of his right leg, just above the ankle. He discovered it on the evening of Sunday, November 23, 2008, because of symptoms of itching and pain. At the time of discovery it was the size of the dark red area in the photo below.  Since then the rash has expanded concentrically into an area that shows lesser degrees of inflammation and which measures 5 x 3.5 inches.  In the twelve hours preceding the first office visit the central area has become darker. The central part of the rash is warm to the touch. He experiences discomfort when walking. There are no other significant systemic signs or symptoms.

On Saturday, November 22, 2008, he spent some time in a neighborhood park and at a football game, but there is no history of insect bites.

Have you seen a rash like this before? If so, do you know what may have caused it? What kind of treatment would you recommend?

Rash above the ankle, on inside of right leg.

Rash above the ankle, on inside of right leg.

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