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Chapter 43. Erythema Annulare Centrifugum and Other Figurate Erythemas

Walter H.C. Burgdorf

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Erythema Annulare Centrifugum at a Glance
  • Clinical pattern of annular expanding erythematous rings, which enlarge rapidly, fade, and then disappear, as new lesions appear.
  • Diagnosis of erythema annulare centrifugum is one of the exclusions.
  • Superficial and deep variants can be separated clinically and histologically. Deep form is usually lupus tumidus or erythema migrans.

The figurate erythemas include a variety of eruptions characterized by annular and polycyclic lesions. Classification of this group has always been controversial; the literature abounds with contradictions, uncertainties, and a bewildering array of synonyms. Darier in 1916 was the first to use the term erythema annulare centrifugum1 (EAC), although similar lesions had been described previously under other names. Table 43-1 lists the figurate erythemas and the differential diagnoses to consider.

Table 43-1 Migratory Erythemas
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Table 43-1 Migratory Erythemas

Disorder

Key Features

Erythema annulare centrifugum (EAC)

Slowly migrating lesions; often idiopathic.

This chapter

Erythema gyratum repens

Rapidly moving; usually cancer marker.

153

Erythema chronicum migrans

Annular lesions originating from tick bite; skin sign of Lyme borreliosis.

187

Lupus erythematosus

Most deep EAC is lupus tumidus. Annular lesions common in neonatal and subacute cutaneous LE; Ro/La antibodies should be sought; overlaps with Sjögren syndrome (especially in Asians).

155

Urticaria

Giant urticaria is often annular and migratory; patients have ordinary urticaria elsewhere and more pruritus.

38

Pityriasis rosea

Individual lesions closely resemble superficial EAC but pattern and course different

42

Bullous pemphigoid

Early lesions often urticarial and may be annular.

56

Erythema multiforme

Target lesions, usually acral, often mucosal disease; some lesions annular.

39

Dermatophyte infections and tinea versicolor

Many fungal infections are annular (ringworm); the scale contains hyphae or spores.

188

Psoriasis

Pustular and occasionally ordinary psoriasis may have annular lesions.

18

Erythema marginatum

Transient, rapidly spreading annular erythema; specific for rheumatic fever.

160

Necrolytic migratory erythema

Marker for glucagonoma; erosive perioral and acral lesions, but truncal lesions may be polycyclic.

153

Carrier state chronic granulomatous disease

Female carriers may have annular lupus erythematosus-like rash.

143

Hereditary lactate dehydrogenase M-subunit deficiency

Rare genodermatosis with annular erythematous and scaly lesions.

This chapter

Familial annular erythema

Extremely rare.

This chapter

Annular erythema of infancy

Many different disorders; must rule out neonatal lupus erythematosus.

This chapter

EAC is an uncommon disorder. No epidemiologic data are available. There are only three large series in the literature: (1) 66 cases identified clinically,2 (2) 73 first diagnosed histologically,3 and (3) 90 carrying either a clinical or histological diagnosis.4 EAC appears to have no predilection for either sex or for any age group.

Both the annularity and the peripheral spread of EAC have attracted speculation as to a possible mechanism. Most hypotheses have centered on interactions among inflammatory cells, their mediators, and ground substance as foreign antigens diffuse through the skin.5,6

While many possible triggers have been suggested, all are common ...

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