Otolaryngology Book

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Erythema Annulare Centrifugum

Aka: Erythema Annulare Centrifugum, Darier's Erythema Annulare Centrifugum
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  1. 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 coliUrinary Tract Infection
        3. Tuberculosis
      6. Thyroid disease
        1. Hyperthyroidism
        2. Hashimoto's Thyroiditis
        3. Grave's 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
  2. Symptoms
    1. Pruritus may be present depending on type
    2. No constitutional symptoms
  3. 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
  4. Differential Diagnosis
    1. See Annular Lesion
    2. Tinea Corporis
  5. Labs: Biopsy
    1. Perivascular dermal Lymphocyte infiltrates
      1. Organized in coat-sleeve appearance
    2. Papillary edema
    3. Spongiosis
    4. Parakeratosis
  6. Management
    1. High potency Corticosteroids (variable efficacy)
  7. 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
  8. References
    1. White (1994) Regional Dermatology, Mosby-Wolfe, p. 264
    2. Hsu (2001) Am Fam Physician 64(2):289-96

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