Erythema Annulare Centrifugum

Aka: Erythema Annulare Centrifugum, Darier's Erythema Annulare Centrifugum

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II. Pathophysiology: Hypersensitivity Reaction

  1. Often idiopathic
  2. Pregnancy
  3. Dental Infection
  4. Insect Bites (Arthropod Bites)
  5. Foods
    1. Blue cheese ingestion (Penicillin reaction)
    2. Tomato ingestion
  6. Medication Reaction
    1. Ampicillin
    2. Thiacetazone
    3. Aldactone
    4. Spironolactone
    5. Hydrochlorothiazide
    6. Gold Sodium thiomalate
    7. Piroxicam
    8. Hydroxychloroquine sulfate
    9. Cimetidine
    10. Finasteride
    11. Amitriptyline
  7. Dermatophytes
    1. Tinea Pedis
  8. Bacterial Infection
    1. Streptococcal infection
    2. Escherichia coli Urinary Tract Infection
    3. Tuberculosis
  9. Thyroid disease
    1. Hyperthyroidism
    2. Hashimoto's Thyroiditis
    3. Grave's Disease
  10. Viral Infection
    1. Epstein-Barr Virus
    2. Molluscum Contagiosum
  11. Malignancy
    1. Large Cell Lymphoma
    2. Hodgkin's Disease
    3. Acute Myeloid Leukemia
    4. Malignant Histiocytosis X
    5. Prostate Cancer
    6. Carcinoid

III. Symptoms

  1. Pruritus may be present depending on type
  2. No constitutional symptoms

IV. Signs

  1. Type I: Superficial Gyrate Erythema
    1. Annular Lesion with trailing scale within borders
    2. Pruritic
  2. Type II: Deep Gyrate Erythema
    1. Annular red lesion without scale
    2. Not pruritic
  3. Characteristics
    1. Red Plaque with central clearing
  4. Distribution
    1. Trunk
    2. Buttocks
    3. Thighs and legs
  5. Spared areas
    1. Does not affect Hands and Feet
    2. Does not affect Face

V. Differential Diagnosis

  1. See Annular Lesion
  2. Tinea Corporis

VI. Labs: Skin Biopsy

  1. Perivascular dermal Lymphocyte infiltrates
    1. Organized in coat-sleeve appearance
  2. Papillary edema
  3. Spongiosis
  4. Parakeratosis

VII. Labs: Evaluation for secondary cause

  1. KOH of lesion
  2. Antinuclear Antibody (ANA)
  3. Tuberculin skit test (TST or PPD)
  4. Complete Blood Count (CBC)
  5. Liver Function Tests
  6. Urine Pregnancy Test

VIII. Imaging: Evaluation for secondary cause

  1. Chest XRay

IX. Management

  1. High potency Corticosteroids (variable efficacy)

X. Course

  1. Lesions persist on average 9 months
    1. May resolve as early as 4 to 6 weeks
    2. May persist as long as 34 years as in one patient

XI. References

  1. White (1994) Regional Dermatology, Mosby-Wolfe, p. 264
  2. Hsu (2001) Am Fam Physician 64(2):289-96 [PubMed]

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