Pediatric Erythema Annulare Centrifugum Treated with Oral Fluconazole: A Retrospective Series

Evaluation of Clinicopathological Features and Associated Conditions in Erythema Annulare Centrifugum: A Retrospective Observational Analysis of 63 Patients

INTRODUCTION

Erythema annulare centrifugum (EAC) is a rare reactive disease that typically presents as annular or polycyclic erythematous lesions. There are few studies about EAC in the literature; therefore, data on the pathogenesis of the disease are limited.

OBJECTIVES

We aimed to examine the demographic, clinical, pathological characteristics and associated conditions of the patients with EAC.

METHODS

We analyzed records of the patients with EAC who admitted to our clinic in the last four years retrospectively.

RESULTS

A total of 63 patients, 39 women and 24 men, were included in our study. The mean age of the patients was 47.8±11.2 years. The mean disease duration was 15.54±12 months. The trunk and thigh were the most commonly involved sites (49%, 33%). Associated conditions were identified in 52.3% of the patients. Infections (N = 16), malignancies (N = 6), rheumatic diseases (n=4) and drugs (n=4) were the most common precipitating factors respectively. The most common infections were superficial fungal infections and Helicobacter pylori infection. Histopathologically, 10 patients had deep type and 53 patients had superficial type EAC. We determined that the disease duration from the onset of the disease was longer (12.3 versus 16.2 months) and the number of attacks (1.2 versus 2.8 attacks) was higher in the superficial type when compared to the deep type (P = 0.042, P = 0.038).

CONCLUSIONS

In our study, infections, malignancies and rheumatic diseases were among the most common etiologic factors. We would also like to draw attention to Helicobacter pylori infection as a precipitating factor which may be a novel finding.

Annular and acral/facial dyskeratotic paraneoplastic disorders

Annular and acral/facial dyskeratotic paraneoplastic disorders are inflammatory dermatoses that occur in association with distant cancers but are not precursors, extensions, or metastases of them. There are four classical entities under this rubric: two gyrate entities, erythema annulare centrifugum and erythema gyratum repens, and two acral/facial dyskeratotic entities, acrokeratosis paraneoplastic (Bazex syndrome) and tripe palms. Each of these entities may also occur in association with another etiopathogenesis and may present either as a classical entity or as a barely recognizable disease. We discuss these entities, their associated causes, and their differential diagnoses in turn.

Figurate erythemas - update and diagnostic approach

Figurate erythemas (FE) represent an etiopathophysiologically heterogeneous group of diseases defined by their characteristic annular erythematous skin lesions. Diagnosis is made primarily by clinical examination together with histological findings; often it is a diagnosis made by exclusion. While some authors discuss FE as clinical reaction pattern rather than distinct clinical entities, others identify four classic FE: erythema annulare centrifugum, erythema gyratum repens, erythema migrans and erythema marginatum. The differential diagnoses of FE are numerous and often challenging. We therefore present a potential diagnostic algorithm for FE that discriminates the differentials according to their temporal evolution and the clinical/histological phenotype of the various subtypes. Since some FE may present with an underlying malignancy, diligent clinicians are needed when dealing with those entities.

An observational study of the efficacy of azithromycin in erythema annulare centrifugum

Erythema annulare centrifugum (EAC) is a form of figurate erythema consequent to a cutaneous hypersensitivity reaction to an underlying agent. In the present study, we aimed to assess the role of oral azithromycin in cases of idiopathic EAC. We performed an open trial of azithromycin in 10 patients with idiopathic EAC. Histopathological examination of biopsies was performed to exclude any alternative diagnosis and to assess the depth of the infiltrate. Patients were administered oral azithromycin 250 mg once daily until clinical resolution of the disease, and followed up regularly to monitor for possible relapse. Histopathological examination of the 10 biopsies revealed superficial pattern in 3, deep pattern in 2 and mixed pattern in the remaining 5. Of the 10 patients, 8 responded to azithromycin 250 mg, with no relapse during follow-up. Oral azithromycin might be a promising therapy in cases of idiopathic EAC. Cases with a superficial pattern respond earlier than cases with a deep pattern.