ERYTHEMA ANNULARE CENTRIFUGUM

By Gary M. White, MD

Erythema annulare centrifugum


Erythema annulare centrifugum (EAC) is a distinct cutaneous eruption--probably allergic in nature-- characterized by spreading annular lesions with a trailing scale.

Clinical

The morphology is distinct from tinea corporis which classically has a scaly leading edge. EAC lasts an average of nine months but may resolve in four to six weeks or be present for 34 years. Two clinical subtypes are recognized, a superficial gyrate erythema (red and scaly) and a deep gyrate erythema (red arcs, no scale).

Association with Malignancy

Lymphoproliferative and solid tumors have been linked to the development of EAC, although this is rare [Am J Clin Dermatol 2012;13: 239]. The EAC may precede, be concurrent with or appear after the diagnosis of the malignancy. Rarely, it may herald a recurrence.

Workup

Most patients, especially women, should have either a biopsy or an ANA, Ro/La drawn to exclude subacute cutaneous lupus erythematosus. Other workup includes a search for any antigenic stimulus, such as tinea pedis, Candida infection, a new drug, blue cheese ingestion (contains penicillin), Streptococcal infection, thyroid disease, dental infection, viral infection (e.g., EBV), or malignancy. Molluscum contagiosum has been reported to induce EAC [JAMA Derm 2015;151;1385].

Differential Diagnosis

See annular, red, scaly lesions.

Treatment

Potent topical steroids should be tried but they may not be effective. In rare, severe cases, IM triamcinolone has been used. If an antigen is suspected, it may be removed, although often, the EAC does not respond. Some patients have had their EAC resolve with treatment of thyroid disease.

Oral fluconazole was an effective treatment in five children with EAC [PD 2016;33;501] suggesting that overgrowth of candida may be causative in a significant percentage of patients.

Additional Pictures

Deep Type, No Scale. Notice the progression in these three photos of the same patient.
Erythema annulare centrifugum Erythema annulare centrifugum Erythema annulare centrifugum

More EAD of the trunk.
Erythema annulare centrifugum Erythema annulare centrifugum Erythema annulare centrifugum Erythema annulare centrifugum

EAC of the arm.
Erythema annulare centrifugum Erythema annulare centrifugum

EAC to new bath oils
Erythema annulare centrifugum Erythema annulare centrifugum

EAC in an older gentlemen that in areas resembled erythema gyratum repens.
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