Abstracts

Bressler GS, Jones RE Jr: Erythema annulare centrifugum. J Am Acad Dermatol 1981 May; 4(5): 597-602.

If one reviews the literature on the subject of erythema annulare centrifugum, it becomes quite obvious there is considerable confusion about the clinical presentation and histopathologic findings. This confusion is exemplified by the various quotes from dermatologic texts and scientific publications. Darier, who originally described the disease, described an annular, indurated, erythematous lesion without a scale that histologically was characterized by a superficial and deep lymphohistiocytic infiltrate and normal epidermis. Ackerman suggested that there are two types of gyrate erythema, a superficial type showing a scale, and the deep type as described by Darier. After reviewing the literature and studying patients with gyrate erythemas, it seems that there are two distinct types best termed the superficial and deep forms of gyrate erythema. Dermatologists use the term erythema annulare centrifugum to denote both of these forms. Perhaps that term should be discarded.

Minni J et al. A novel therapeutic approach to erythema annulare centrifugum. J Am Acad Dermatol 2006; 54 (3): S143-5.

A 57-year-old white man presented with a 1-year history of pruritic, generalized, polycyclic plaques located predominantly on the trunk and extremities. The patient had received a previous diagnosis of psoriasis which had responded only to multiple courses of systemic prednisone, with recurrent clinical relapse upon withdrawal of the steroid. The patient was treated with 25 mg twice weekly Etanercept. This patient’s impressive response to Etanercept, relapse after cessation, and his subsequent clearance after readministration add credence to the beneficial role of etanercept in this case. We suggest that the pathogenesis of EAC is TH1-mediated with elevated levels of tumor necrosis factor a and associated proinflammatory cytokines, and, therefore, responsive to antietumor necrosis factor a therapy.

Muret MG et al. Annually recurring erythema annulare centrifugum: A distinct entity? J Acad Dermatol 2006; 54: 1091-5.

Four patients presenting a peculiar clinical variant of erythema annulare centrifugum are reported. The lesions were clinically and histopathologically indistinguishable from classic superficial erythema annulare centrifugum but constant annual and seasonal recurrences for many years or decades were observed. No clear precipitating factor could be identified. No associated symptoms were present and the eruption regressed spontaneously after a variable period of days to months. Annually recurring erythema annulare centrifugum seems to represent a rare distinct clinical entity that has received little attention in literature. Clinicopathologic features of this peculiar clinical disorder and the differential diagnosis with other recurrent seasonal eruptions are reviewed.

Neuman R, Schmidt JB, Niebauer G. Subacute lupus erythematosus-like gyrate erythema. Report of a case associated with breast cancer. Dermatological 1986; 171(3): 146-9.

We present a case of an annular skin lesion in association with a breast cancer. For differential diagnosis we had to consider subacute cutaneous lupus erythematosus and the group of gyrate erythemas. Lupus band test and immune serology were negative. The parallel course of the erythema and the internal malignancy were striking.

Rodriguez De Paterna L, Arnaiz F, Estenoz J, Ortuno B, Lanzos E. Study of serum tumor markers CEA, CA 15.3 and CA 27.29 as diagnostic parameters in patients with breast carcinoma. Int J Biol Markers 1995; Jan-Mar;10(1):24-9.

Serum levels of CEA, CA 15.3 and CA 27.29 were measured during the follow-up of 499 breast cancer patients. Studies included three different groups of women: 82 blood donors free of disease, 42 patients with non-malignant breast diseases and 499 breast cancer patients. After the determination of cut-off values, serum levels of tumor markers did not show significant elevations in benign breast diseases. On the basis of our results CA 15.3 (sensitivity = 57%; accuracy = 87%) was the most effective marker, CA 27.29 (sensitivity = 62%; accuracy = 83%) was the most sensitive and CEA (sensitivity = 45%; accuracy = 81%) was the least sensitive and effective marker. The combined use of markers was evaluated by step-wise logistic regression analysis. The regression coefficients showed that CA 15.3 (coeff. = 2.97) and CA 27.29 (coeff. = 1.46) were suitable for the detection of possible metastases during follow-up. Finally, we studied the relationship between pT, pN, pM and circulating levels of CA 15.3 and CA 27.29.

White JW. Gyrate Erythema. Dermatol Clin 1985 Jan; 3(1): 129-39.

The gyrate erythemas consist of a nonspecific group (often called erythema annulare centrifugum) for which the cause is usually unknown, and three specific types (erythema marginatum rheumaticum, erythema chronicum migrans [Lyme disease], and erythema gyratum repens). The first specific type, erythema marginatum rheumaticum, has become extremely rare with the decline of its associated disease, rheumatic fever. The second specific type, erythema chronicum migrans, is caused by a spirochete transmitted by the I. ricinus complex of ticks. The third specific type, erythema gyratum repens, is uncommon, morphologically distinctive, and an indicator of serious disease, usually internal malignancy, in almost every instance.

Weyers W et al. Erythema annulare centrifugum: Results of a clinicopathologic study of 73 patients. Am J Dermatopathol 2003; 25: 451-462.

Erythema annulare centrifugum is classified generally into a superficial and a deep type. Whether those types are variants of the same process or unrelated to one another, and whether they represent non-specific patterns or specific clinico-pathologic entities, is controversial. To answer those questions, we analyzed 82 biopsy specimens from 73 patients with a clinical and histopathologic diagnosis of erythema annulare centrifugum, gyrate erythema, or figurate erythema regarding a variety of clinical and histopathologic findings. We found substantial differences between cases with a wholly superficial type and cases with a superficial and deep infiltrate. Clinically, a collarette of scales was seen only in the superficial type. Histopathologically, some findings were much more common in the superficial type (eg, spongiosis, parakeratosis, crusts, edema of the papillary dermis, epidermal hyperplasia) and others in the deep type (eg, sleeve-like arrangement of the infiltrate, melanophages, subtle vacuolar changes at the dermo-epidermal junction, individual necrotic keratinocytes). Whereas cases of the superficial type could be distinguished from differential diagnoses by a variety of clinical and histopathologic findings, most cases of the deep type showed subtle signs of lupus erythematosus. Neither type was associated consistently with any other systemic disease. Because the superficial and the deep type of erythema annulare centrifugum seem to be unrelated to one another, they should not be referred to by the same name.

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