II. Pathophysiology: Hypersensitivity Reaction

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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Ontology: Erythema annulare centrifugum (C0263358)

Concepts Disease or Syndrome (T047)
ICD10 L53.1
SnomedCT 81542001, 399914006
Dutch erythema anulare centrifugum, Darier; erythema annulare centrifugum, erytheem; annulare centrifugum, Darier, erytheem; figuratum perstans, figuratum perstans; erytheem, Erythema annulare centrifugum
French Erythème annulaire centrifuge
German Erythema annulare centrifugum, Erythema anulare centrifugum
Italian Eritema anulare centrifugo
Portuguese Eritema anular centrífugo
Spanish Eritema anular centrífugo, eritema gyratum persistente, eritema anular centrífugo (trastorno), eritema anular centrífugo
Japanese 遠心性環状紅斑, エンシンセイカンジョウコウハン
Czech Erythema annulare centrifugum
Korean 중심 원심성 윤상 홍반
English annulare centrifugum erythema, erythema annulare centrifugum, erythema annulare centrifugum (diagnosis), Erythema annulare centrifugum, Erythema gyratum perstans, Erythema figuratum perstans, Erythema annulare centrifugum (disorder), erythema; annulare centrifugum, Darier, erythema; figuratum perstans, figuratum perstans; erythema, Darier; erythema annulare centrifugum
Hungarian Erythema annulare centrifugum