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Das E.a.c. ist im Gewebsbild durch Histo-Eosinophilie mit “essaimage”, Odem mit Bindegewebsverquellung und Gefaswandalteration als ein allergisches Geschehen gekennzeichnet. Durch das Ausschwarmen der oxyphilen Lipoideiweisgranula zum Zwecke der Allergenverarbeitung kommt es im Gewebe zu Umsetzungen und Ausfallungen von Lipoiden. Daneben treten infolge der histotoxischen Hypoxydose Fettablagerungen im Bereich der geschadigten Gefase in Erscheinung.

A clinical trial of the long acting antihistamic agent “Chlorpheniramine Nyscaps” was estimated on 37 cases of pruritic skin diseases, consisting of 10 cases of urticaria chronica, 2 of urticaria acuta, 3 of pruritus cutaneus universalis, 1 of erythema annulare centrifugum, 1 of erythrodermia, and 19 of eczema and/or dermatitis. 1. The daily dosage was 8∼16 mg, administrated orally once a day. 2. The duration of therapy was from 3 days to 7 days. 3. The result of clinical effect was evaluated as follows: it was markedly effective in 11 cases, and moderately in 17 cases, (consisting of 7 cases of urticaria chronica, 2 of urticaria acuta, 2 of pruritus cutaneus universalis, 1 of erythema annulare centribugum, 1 of erythrodermia and 14 of eczema and dermatitis). 4. The urinary and liver function tests were carried out in 7 cases given 16 mg of Chlorpheniramine Nyscaps daily for 14 days and no abnormal sign was observed. 5. Side effect was observed only in 2 cases. It was drowsiness in both cases. We believe clinical administration of this drug will be favorably beneficial to treatment of pruritic skin diseases.

The study was carried out to know the pattern of dermatoses among admitted patients in skin inpatient department from March 2009 to February 2010 in Dhaka Medical College Hospital. A total of 244 patients (124 female & 120 male) were admitted during this study period. Exfoliative dermatitis 52(21.31%) were the most commonest dermatoses, followed by Psoriasis vulgaris 28(11.47%), Pemphigus vulgaris 20(8.19%), Stevens Johnson Syndrome 20(8.19%), Bullous pemphigoid 16(6.55%), Erythema multiforme 16(6.55%), Systemic lupus erythematosus 12(4.91%), Scrofuloderma 12(4.91%), Scleroderma 12(4.91%), Darier's disease 8(3.27%), Vasculitis 8(3.27%), Psoriatic arthopathy 8(3.27%), Pemphigus vegetans 4(1.63%), Lupus vulgaris 4(1.63%), Tuberculosis verrucosa cutis 4(1.63%,), Herpes zoster 4(1.63%), Erythema annulare centrifugum 4(1.63%), Chronic bullous disease of childhood 4(1.63%), Xanthoma tuberosum 4(1.63%). Mycosis fungoides 3(1.22%), Sezary syndrome 1(0.40%). Key words: Pattern of dermatoses; prevalence. DOI: 10.3329/jdmc.v19i1.6251 J Dhaka Med. Coll. 2010; 19(1) : 43-46.

Berichtet wurde uber ein E.a.c. als Leitsymptom einer im Verlauf von etwas uber 2 Monate letal endenden akuten Leukose bei einem 10 1/2 jahrigen Kind. Besprechung der in der Literatur niedergelegten Befunde mit einigen Bemerkungen zur Pathogenese und Atiologie.

Hammar, H. (Department of Dermatology, Karolinska Sjukhuset, Stockholm, Sweden). Erythema annulare centrifugum coincident with Epstein-Barr virus infection in an infant. Acta Paediatr Scand63: 788, 1974.—Persistent annular erythemas include various more or less distinctly defined clinical entities mostly found in adults but are sometimes seen in infants. Erythema annulare centrifugum is distinguished as one group among these dermatoses. The pathogenesis of the annular erythemas is not clearly understood. A two-week-old girl who developed recurrent erythema annulare centrifugum during her first 6 months of life is described. Significant changes in the titres of anti-Epstein-Barr virus antibodies were coincident with the clinical course. The general health of the girl was not affected and there were no signs of infectious mononucleosis either in the girl or in her mother. The eruption left an apparently normal skin except for one lesion with atrophy and telangiectases one year after its first appearance. The coincistence of the significant rise and fall of anti-Epstein-Barr antibody titres with the clinical appearance of erythema annulare centrifugum strongly suggests a pathogenetic effect of the virus on the skin eruption.

SUMMARY The case history of a patient who presented with erythema annulare centrifugum and white banding of the toe nails is recorded. On investigation for an underlying malignancy the patient was found to have an opacity in the lower lobe of the right lung. Subsequently lobectomy was performed and histology of the operative specimen revealed a malignant carcinoid tumour of the bronchus.

I wish to present a case of the subacute type of disseminated lupus erythematosus, the eruption of which had a striking clinical resemblance to erythema annulare centrifugum. Report of Case A 59-year-old Negro woman entered the clinic complaining of a mildly pruritic eruption on the upper extremities of two years' duration and of a persistent dull pain in both knees for the past four years. Except for the aforementioned complaints the patient always felt well and her appetite was good. The eruption was symmetrical and was limited to the upper extremities. It consisted of complete and partial rings which varied in size from that of a split pea to that of a 25-cent piece. They were nonscaly, firm, pinkish thread-like lesions, which enveloped partially depigmented skin and, at times

Increasing use has been made of intralesional injections for the treatment of a number of chronic dermatologic disorders. The dermatoses reported to respond to the local injection of steroids include alopecia areata, alopecia totalis, alopecia universalis, circumscribed neurodermatitis, psoriasis, atopic dermatitis, lichen planus, keloid, nummular eczema, granuloma annulare, erythema annulare centrifugum, dermatitis herpetiformis, pemphigus, and discoid lupus erythematosus. 1-5 In addition to the intralesional injection of lesions such as those listed above, the dermatologist makes use of intracutaneous or subcutaneous injections routinely for the administration of many drugs, infiltration of lesions with local anesthetics prior to biopsy or excision, intradermal testing in allergic conditions, etc. This extensive employment of injections creates several important health problems, as well as many minor ones. Requirements for syringes used may be listed as follows: (1) sterility (especially concerning serum hepatitis), 6,7 (2) freedom from contamination, 8,9,11 (3) freedom from leakage and contact with surroundings

For the past year we have studied a young woman with a unique triad of findings: enormous breast hypertrophy, generalized melanoderma, and, finally, thousands of pruritic polycylic bands undergoing continuous migration over the skin surface. We have encountered nothing of this kind in our clinical experience or in the literature. Intensive investigative studies disclosed the presence of an autoallergic state. The patient proved to have specific circulating autoantibodies to her own cystic breast tissue. In addition, her serum showed a strongly positive L.E. phenomenon. Accordingly it is our wish to record and to attempt to interpret these clinical observations and laboratory studies. Report of a Case The patient, a 26-year-old white woman, was first seen by us in October, 1958.*At that time she presented the three problems (Figs. 1, 2, 3) of breast enlargement, melanoderma, and gyrate migratory bands. Although she had had purpura and an attack of poison

ERYTHEMA annulare centrifugum, a rare dermatosis, usually occurs in otherwise healthy persons: however, some cases have been reported in which it was associated with internal disease. Because of the possibility of discovering a clue to its etiology, such cases are of especial interest. I wish to record one that I observed for a short time. REPORT OF A CASE Mrs. J. S., a 60-year-old white housewife, a native of the United States, had a total hysterectomy and salpingectomy in 1941. The uterus contained fibroids and a hypertrophic endometrium; there were subserous cysts of the Fallopian tubes, and an ovarian fibroid. No sign of carcinoma was found. Late in 1950 the patient began to suffer from painful swellings of the legs, malaise, and anorexia, with diffuse aching pains followed by swelling of the abdomen. A series of deep x-ray treatments relieved her; the abdominal swelling and edema of

The fluorescent antibody technique was used to investigate the possible role of autoimmune factors in certain dermatoses. Serum, sections of cutaneous lesions, and specimens of uninvolved skin were studied. Control procedures, sera, and tissues were involved in the investigation. Specific antigen-antibody reaction was not detected in the skin of patients who had one of the following conditions: psoriasis, erythema multiforme bullosum, pemphigus vulgaris, and dermatitis herpetiformis. Antibodies for calf thymus nucleohistone extract (NHE) were detected in serum of two patients who had both psoriasis and arthropathy and another patient who had had severe cutaneous manifestations of psoriasis for 17 years. The significance of the presence of the antibody was postulated. Non-species-specific antinuclear antibodies were detected in sera of patients who had discoid lupus erythematosus. Specific yellow-green fluorescence was observed when the immune substance reacted with human epidermal cell nuclei and calf thymus nucleohistone extract. The conceivable importance of autoimmune factors in the pathogenesis of discoid lupus erythematosus was discussed. Antinuclear antibody was demonstrated in the serum of patients who had scleroderma. Tissue specificity was not noted with the technique employed. The results of this study further support the concept that an autoimmune reaction may be a factor in the development of enlarging annular lesions (erythema annulare centrifugum). A correlation could not be made between the presence of serum antinuclear antibodies, as determined by the fluorescent antibody technique, and abnormal serum protein fractions detected by electrophoresis.

IN A PREVIOUS article it was stated that some cases of erythema annulare centrifugum are dermatophytids.1This was based on the fact that several cases of this disease were found to fulfill the minimal basic criteria for the diagnosis of a dermatophytid. In addition, in two of these cases, erythema annulare centrifugum was reproduced and abolished by the experimental production and eradication of tinea pedis. In 1930, Epstein and Grunmandel2presented a definitive work on the local immunoallergic changes occurring in tinea circinata. In both experimental and spontaneous human tinea circinata, they produced a cruciform superinfection through the center of the annular lesions and demonstrated by this method that local immunity occurred not only in the center of the resolving infection, but also in a zone around the fungous focus. These changes were demonstrable only during a specific phase of the disease. It is likely that this corresponds

To the Editor.— Although much attention has been directed to the possibility of a causal relationship between dermatosis and the existence of an internal malignant tumor, comparatively little is known of any possible association between skin lesions and the existence of a benign tumor. We have observed a case of erythema annulare centrifugum that cleared after the removal of a benign ovarian cystadenoma. Report of a Case.— The patient was a 52-year-old woman, who denied having had any previous skin diseases. In 1952, a cyst was removed from her right ovary. In July 1972, she was admitted to the hospital with many pruritic, annular lesions. The lesions had affected the left buttock initially and then had spread to the torso and extremities a few weeks later. The eruption consisted of an annular erythema, with a raised border and a central clear area, and of small, reddish, edematous plaques with

A case is presented embodying many interesting aspects of cancer and associated host resistance. Skin testing showed the patient to be reactive to his own tumor tissue extracts, and pathologic studies showed the presence of tumor cells in the annular dermatitis. Temporary involution of the annular erythema followed removal and roentgen treatment of the original tumor and involved axillary nodes. Recurrence of the dermatitis preceded gross clinical reappearance of the malignancy; however, the erythema disappeared again as the patient's health began to fail generally 3 weeks before death.

Epitheliomata (Basal and Squamous) in Epidermolysis Bullosa (Dystrophic Type) . Presented byDr. Beatrice M. Kesten. Lichen Planopilaris—Pringle. Presented byDr. Alexander W. Young Jr. Linear Scleroderma. Presented byDr. Leo Schweich. Amyloidosis of the Tongue. Presented byDr. Royal M. Montgomery. Acrocyanosis (?): Generalized Angiectasis. Presented byDr. Gerald F. MachacekandDr. Helen O. Curth, Mycosis Fungoides. Presented byDr. George C. Andrews. Sarcoidosis, Apparently Limited to the Parotid Gland. Presented byDr. Leslie P. Barker. Familial Benign Chronic Pemphigus. Presented byDr. Gerald F. Machacek. Tuberculosis Cutis. Presented byDr. Daniel Hyman. Case for Diagnosis: Erythema Annulare Centrifugum as an Id Reaction to Fungus Infection? Presented byDr. J. Lowry Miller. Vogt-Koyanagi Syndrome. Presented byDr. Carl T. Nelson. Seborrheic Dermatitis; Nummular Eczema; Nontropical Sprue. Presented byDr. Paul Gross. Recurrent Necrobiosis Lipoidica Diabeticorum in and Around Skin Grafts. Presented byDr. Charles F. PostforDr. J.

Annular or circinate lesions are found in a number of dermatoses, but there is a condition that was first described by Darier1which has been given the appropriate name of erythema annulare centrifugum and which is believed to be an entity by those observers who have had the opportunity to study a case and to compare it in all of its details with other conditions of the skin that present annular and circinate lesions. A careful perusal of the accumulated literature on erythema annulare centrifugum convinces one that the majority of cases described as examples of this condition are cases of circinate urticaria or gyrate toxicoderma, probably closely allied to erythema multiforme or erysipeloid. If one has carefully studied a true example of erythema annulare centrifugum, certain features, which will be described later, serve to identify this condition, for the present at least, as a morphologic

Psoriasis is a disease that at times can take on unusual clinical forms. This is the report of a patient with a rare variant of annular pustular psoriasis in which the lesions have the configuration of erythema annulare centrifugum and resemble subcorneal pustular dermatosis. This rare variant is characterized by rapid evolution, mild toxicity, and rapid response to therapy. Classical lesions of psoriasis can be lacking, and the diagnosis may rest on the clinical course and histologic findings.

A case of erythema gyratum repens is reported. Autopsy revealed an undifferentiated metastatic malignancy of the brain, mediastinum, and cauda equina. This is the first case of erythema gyratum repens in which there was erythema annulare centrifugum, vesicular erythema annulare centrifugum, and urticaria.

Three cases are presented in which erythema annulare centrifugum developed as the result of treatment of chronic discoid lupus erythematosus with antimalarials. The possibility that the eruption represented a known variant of lupus erythematosus was excluded by its prompt regression on discontinuing the offending drug, namely, hydroxychloroquine sulfate in two cases and chloroquine sulfate in one. Systemic corticosteroids given simultaneously in two cases failed to suppress the erythema annulare centrifugum. There did not appear to be any mathematical relationship between dosage of the antimalarial and the development of the eruption.

Dermatophytid is the name given the group of skin diseases resulting from allergic reactions to fungous infection of the skin—so-called dermatophytosis. The following minimal criteria must be fulfilled in order to establish the diagnosis of dermatophytid: Focus of dermatophytosis Positive skin test to trichophytin Precipitation of dermatophytid due to blood-borne fungi or fungous products released by a. Activation of dermatophytosis b. Overtreatment of the dermatophytosis Absence of fungi in the dermatophytid lesions Clearing of dermatophytid after the dermatophytosis has been eradicated Various investigators have proposed that the following are types of dermatophytids: Disseminated papular lesions 1 Vesicular lesions of the hands 2 Erysipelas-like dermatitis of the lower extremities (may eventuate in chronic lymphedema) 3 Migrating thrombophlebitis and thromboangiitis obliterans 4 Urticaria (often associated with asthma and vasomotor rhinitis) 5 Miscellaneous group (erythema multiforme, erythema nodosum, exfoliative dermatitis, lesions simulating pityriasis rosea, and erythema annulare centrifugum) 6

Peterkin 1 in 1945 published a report concerning a patient with erythema annulare centrifugum treated by the oral administration of sulfathiazole. The author characterized the improvement in his patient as "dramatic." A 28 year old man had noted this condition for one month prior to the institution of sulfathiazole therapy. Within three days only pigmentation persisted. The patient was discharged from the hospital after one week, apparently cured. Unfortunately, Peterkin was unable to follow this patient, and so the ultimate result is not known. Obviously, the results obtained in 1 case do not establish the efficacy of any therapeutic agent. This fact is especially to be kept in mind in the case of a capricious disease such as erythema annulare centrifugum. Therefore, the case here reported is presented as another instance in which this dermatosis responded to treatment with sulfonamide compounds. REPORT OF A CASE C. M., a 13 year

COLCOTT FOX, 1 in 1891, under the title of erythema gyratum perstans, described an infrequent disorder of the skin of which the essential characteristic was persistent annular erythema. In 1908, Wende 2 assembled several cases and published, under the title of erythema figuratum perstans, a complete and detailed account of an entity characterized by persistent erythematous lesions with annular, circinate, and gyrate forms. Between 1891 and 1916, many writers described cases under different titles of which the essentiality was persistent annular erythema similar to, if not the same as, Wende's disease. In 1916, Darier 3 described a persistent annular erythema under the title of erythema annulare centrifugum and maintained that it was a distinct entity, different from Wende's erythema figuratum perstans in that erythema annulare centrifugum was a "dry" disease, whereas Wende's erythema figuratum perstans showed evidence of vesiculation. Darier's title has become the more popular one for

Study of a patient with recurrent erythema annulare centrifugum of eight years' duration revealed it to be due to hypersensitivity to Penicillium mold of blue cheese. Oral test administration of blue cheese produced a rapid flare and extension of the lesions with a concomitant specific degranulation and decrease in the circulating basophil leukocytes. Complete avoidance of blue cheese has resulted in clinical clearing.