EOSINOPHILIC ANNULAR ERYTHEMA

By Gary M. White, MD

Eosinophilic Annular Erythema EAC in an elderly woman.


Eosinophilic annular erythema (EAE) is a rare benign recurrent disease, originally described in children (where it has been called annular erythema of infancy), characterized by the recurrent appearance of persistent non-pruritic, urticarial annular lesions. The term EAE is often reserved for adults with this condition.

Histologically a perivascular infiltrate composed of lymphocytes and abundant eosinophils in the dermis is exhibited.

Clinical

Recurrent, erythematous, spreading, annular plaques, with disease-free periods, mainly affecting the trunk and extremities is characteristic. Lesions may be pruritic.

Differential Diagnosis

An antigen driving an allergic response should be excluded. Infection such as tinea parasites should be ruled out. Annular urticarial lesions include erythema annulare centrificum, lupus, urticaria, urticarial bullous pemphigoid and an annular form of Well's syndrome. Annular hives can usually easily be excluded as those lesions come and go within hours, in contrast to AE. Lupus has a very different appearance histologically and ANA is generally positive. Well's syndrome may look similarly histologically, but has flame figures, whereas EAE does not. Well's syndrome may leave pigmentation or even atrophy whereas EAE does not.

Treatment

The condition responds well to prednisone, but remits when the steroid is stopped. Hydroxychloroquine may be tried. Chloroquine 250 mg/day cleared one case after only 2 weeks.

References

A 15-year-old boy with a history of bronchial asthma presented with a recurrent eruption over four years of mildly pruritic erythematous plaques that enlarge, but clear in the center to form annular plaques, localized to the trunk and extremities. The lesions disappear spontaneously after a few weeks leaving no atrophy or scars. The patient also reported remission rapidly after taking oral steroids for his asthma, but recurrence on ceasing this medication Dermatology Online Journal

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