Time progression of EAC over several weeks.

ERYTHEMA ANNULARE CENTRIFUGUM

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

• It is commonly confused with tinea.
• Reported triggers include infections, drugs, Crohn’s disease, pregnancy, autoimmune endocrinopathies, and occasionally, neoplasms (PEACE).
• The term PEACE stands for paraneoplastic erythema annulare centrifugum eruption--i.e. EAC associated with malignancy.
• The peak incidence for EAC is the fifth decade of life, however EAC can appear throughout all age groups, with no known gender predilection.

Clinical

Annular, red rings with a trailing scale are classic of the superficial type. This morphology is distinct from tinea corporis which classically has a scaly leading edge. The other clinical subtype of EAC is the deep gyrate erythema type with red arcs and no scale.

EAC lasts an average of nine months but may resolve in four to six weeks or be present for 34 years.

Association with Malignancy

Lymphoproliferative and solid tumors have been linked to the development of EAC, although this is rare. 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.

Treatment Overview

• Topical Steroids
• Oral fluconazole
• Topical roflumilast BID

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 suggesting that overgrowth of candida may be causative in a significant percentage of patients. With that in mind, for women with EAC of the thighs, a course of fluconazole to treat any candida may be tried.

Roflumilast

There are several reports of EAC clearing with roflumilast 0.3% cream BID.

Additional Pictures

Annular rings with the classic trailing scale. NOT tinea.

RegionalDerm

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