Siobhan is a 44-year-old who presents with itchy annular plaques on the abdomen, chest, neck, shoulders and back.

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Siobhan is a 44-year-old who presents with itchy annular plaques on the abdomen, chest, neck, shoulders and back (pictured).

These began several months ago as erythematous plaques on the abdomen, gradually increasing in number and expanding from the centre. Oral antihistamines, topical steroids and topical antifungals have had no effect.

There is no clear contact precipitant and no recent medication use. Siobhan is usually well but has a strong family history of type 2 diabetes and, on recent routine blood testing, was found to have a newly elevated HbA1c of 7.4%.

Pathology was otherwise normal.