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

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

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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