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Erythema Annulare CentrifugumAka: Darier's Erythema Annulare Centrifugum

Pathophysiology
1. Idiopathic
2. Possible Hypersensitivity Reaction
  1. Pregnancy
  2. Dental infection
  3. Medication Reaction
    1. Blue cheese ingestion (Penicillin reaction)
    2. Ampicillin
    3. Thiacetazone
    4. Aldactone
    5. Hydrochlorothiazide
    6. Gold sodium thiomalate
    7. Piroxicam
    8. Hydroxychloroquine sulfate
    9. Cimetidine
  4. Dermatophytes
    1. Tinea Pedis
  5. Bacterial Infection
    1. Streptococcal infection
    2. Escherichia coli Urinary Tract Infection
    3. Tuberculosis
  6. Thyroid disease
  7. Viral infection
    1. Epstein-Barr Virus
    2. Molluscum Contagiosum
  8. Malignancy
    1. Large Cell Lymphoma
    2. Hodgkin's Disease
    3. Acute Myeloid Leukemia
    4. Malignant Histiocytosis X
    5. Prostate Cancer
    6. Carcinoid
Symptoms
1. Pruritus may be present depending on type
2. No constitutional symptoms
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. Distribution
  1. Trunk
  2. Buttocks
  3. Thighs and legs
4. Spared areas
  1. Does not affect Hands and Feet
  2. Does not affect Face
Differential Diagnosis
1. See Annular Lesion
2. Tinea Corporis
Labs: Biopsy
1. Perivascular dermal Lymphocyte infiltrates
  1. Organized in coat-sleeve appearance
2. Papillary edema
3. Spongiosis
4. Parakeratosis
Management
1. High potency Corticosteroids (variable efficacy)
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
References
1. White (1994) Regional Dermatology, Mosby-Wolfe, p. 264
2. Hsu (2001) Am Fam Physician 64(2):289

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 5/16/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.