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Annually recurring erythema annulare centrifugum (AR-EAC) is a rare variant, characterized by typical annular plaques recurring in the same period of the year. We describe 5 new cases and present a review of the literature. Patients were 3 females and 2 males with an age range of 25–55 years. Multiple annular plaques were located at the thighs in 4 patients and the neck in one patient. In 1 patient, a single lesion was present. Plaques were recurring in summer in 3 cases; in 1 case, in spring; and another patient, in winter since 3–4 years. Lesions were self-healing in few days or weeks. Histologically, the epidermis presented mild acanthosis with patchy spongiosis, slight parakeratosis, and mild exocytosis. There was a perivascular lympho-histiocytic infiltrate of variable intensity in the superficial dermis, with occasional eosinophils. In 1 case, the inflammatory infiltrate reached the deep dermis. Mucin deposition was absent. Phenotyping studies in 1 case revealed a predominance of T cells, with a small B-cell component. Moreover, a moderate number of CD123+ plasmacytoid dendritic cells and CD1a+ dendritic cells were noted. Fourteen cases of AR-EAC have been published previously. Collectively, patients’ age ranged from 16 to 83 years, with a mean age of 47 years and a disease duration of 1–30 years. Lesions affected more frequently extremities and recurred most commonly in summer. Patients were all in good general health. Topical corticosteroids were the mainstay of treatment. AR-EAC is a benign disorder, the nature of which remains enigmatic.

Erythema annulare centrifugum (EAC) is a rare erythema characterized by erythematous and urticarial papules or annular plaques that enlarges centrifugally. The lesions usually involve the thighs and the legs. Several disorders are occasionally associated with EAC, infections, including mycoses, bacteria, or viruses and drugs have also been regarded as possible causes of this eruption. We present a 42-year-old dark-skinned woman affected by recurrent EAC that appeared secondary to influenza type A (H1N1). Histopathology showed a superficial form of EAC. In our case, a previous cytomegalovirus and Epstein-Barr virus (EBV) infection were identified and no underlying other diseases were found. Clarithromycin with calcipotriol betamethasone treatment was temporarily efficacious. In the last 3 years, the lesions started to appear every 2 weeks and tended to regress with local treatment after a variable period. We believe that the latent cytomegalovirus and the reactivity induced by EBV combined with influenza can determine, in our case, a cell mediate cutaneous immune response, which leads to the peculiar inflammatory disease known as EAC.

To summarize the differential diagnosis and describe a clinical approach for the evaluation of target and targetoid lesions in hospitalized patients. Important diagnostic considerations for target and targetoid lesions in an inpatient setting include erythema multiforme, Stevens-Johnson syndrome/toxic epidermal necrolysis, mycoplasma-associated rash and mucositis, fixed drug eruption, urticaria multiforme, subacute cutaneous lupus erythematosus, and Rowell syndrome. Less frequent diagnoses may include erythema migrans, arthropod bite, erythema gyratum repens, erythema annulare centrifugum, tinea concentricum, tinea corporis, Granuloma annulare, elastolytic giant cell granuloma, cutaneous T cell lymphoma, linear IgA syndrome, pigmented purpuric dermatosis of Majocchi, hobnail hemangioma, and acute hemorrhagic edema of infancy. Morphology can be a key in initially discriminating among these entities. Classic target lesions should be distinguished from targetoid, gyrate, and annular lesions. The differential diagnosis of target and targetoid lesions in hospitalized patients is broad; however, attention to additional morphologic features, location, concomitant symptoms, mucosal involvement, histopathology, location, and progression can aid in diagnosis. Clinical evaluation should also consider patient demographics and associated systemic symptoms to elucidate the correct diagnosis.

Erythema annulare centrifugum is one of the figurate erythemas which clinically presents by annular, polycylic, erythematous plaques which is characterized by scaling behind the progressing edge. It is considered to be a hypersensitivity reaction to an antigen. Various etiological factors like cutaneous or systemic infections, drugs, malignancy, pregnancy are considered. Hereby we report a case of erythema annulare centrifugum which was treated for long period of time considering to be a dermatophytosis. This report highlights the need to be vigilant for diagnosing this condition in patients presenting with erythematous annular plaques. Keywords: Annular plaques, Erythema Annulare Centrifugum, Dermatophytosis, Histopathology.

With the expansion of the COVID‐19 vaccination drive, an increasing number of adverse effects are surfacing. A 74‐year‐old woman presented with multiple erythematous and itchy patches on several sites. She had no relevant medical history, apart from the first AZD1222 vaccination 1 month previously. Microscopically, epidermal changes, including mild spongiosis and parakeratosis, were observed. Tight perivascular lymphocytic infiltration (coat‐sleeve pattern) was also observed in the dermis. The final diagnosis was erythema annulare centrifugum (EAC) induced by SARS‐CoV‐2 vaccination. Based on this report, dermatologists should be aware of the possibility of EAC from the AZD1222 vaccination.

Erythema annulare centrifugum (EAC) is a figurate erythema presenting with annular, erythematous plaques with a trailing scale. It is considered a hypersensitivity reaction to a variety of antigens and is associated with multiple underlying causes including malignancy. Malignancy-associated EAC is termed paraneoplastic erythema annulare centrifugum eruption (PEACE). Although a specific etiology has yet to be elucidated, this form of EAC is likely to occur due to cytokine and/or antigen stimulation from an underlying malignancy. PEACE is primarily associated with lymphoproliferative disorders and rarely solid tumors. Our report discusses a case of PEACE associated with metastatic colorectal adenocarcinoma. On presentation to our clinic, the patient had developed a migratory annular eruption over a year. His review of symptoms was positive for signs of underlying malignancy, including weight loss and recent lower vertebral fracture. A biopsy of his annular lesion revealed a non-specific pityriasiform dermatitis. A vertebral biopsy uncovered a diagnosis of metastatic colorectal cancer. At that time, clinicopathologic correlation allowed us to reach the diagnosis of PEACE.

Erythema annulare centrifugum (EAC) is a rare skin disease that is thought to be caused by interactions between inflammatory cells, mediators, and foreign antigen substances. It typically starts as erythematous macules or urticarial papules that enlarge peripherally to form an arcuate or polycyclic plaque. Symptomatic relief is the main therapy for this disease because no effective treatment is yet available. We report the case of a 50-year-old male with reddish pruritic patches on both arms, around the thighs, on the abdomen, and on the buttocks. The complaint started 3 years prior to treatment and often recurred. Fungal examination was negative, and histopathological examination supported a diagnosis of EAC. The patient was prescribed a topical corticosteroid, topical antifungal, and antihistamine. Although the lesion only showed minimal improvement, the patient experienced significant reduction in pruritus with no occurrence of new lesions. Despite being a rare disease, EAC must be considered when encountering an annular erythematous plaque.

Erythema annulare centrifugum (EAC) is a reactive phenomenon of the skin that has been reported to occur in association with numerous conditions, including infections.1 It commonly presents with annular, erythematous plaques with a fine desquamation in the inner portion of the advancing edge.2 In the last year, a wide spectrum of cutaneous manifestations has been associated with SARS-CoV-2 infection, including acral areas of erythema with vesicles or pustules, other vesicular eruptions, urticarial lesions, maculopapular eruptions and livedo or necrosis.3,4.

Syphilis, sexually transmitted disease which is caused by spirochete bacterium, Treponema pallidum. It presents with a spectrum of lesions and the signs and symptoms of syphilis vary depending on which of the four stages it presents. One needs a high level of clinical suspicion and keen history taking are required to identify the underlying syphilis, which is very commonly masked as some other cutaneous condition. Many different skin diseases may have lesions with a annular maculo-papular erythematous morphology and scaling, e.g., pityriasis rosea of Gibert, actinic porokeratosis, erythema annulare centrifugum, granuloma annulare, subacute or discoid lupus erythematosus and certain annular variants of psoriasis. 1 Some of these also have palmo-plantar involvement where these need to be differentiated from from the rash of secondary syphilis. The present article addresses a case of solely palmoplantar hyperpigmented lesion without any clinical evidence of secondary syphilis. Keywords: Hyperpigmentation, Secondary Syphilis, Treponema Pallidum.

Mycosis fungoides, the most common cutaneous T-cell lymphoma, is known to exhibit varied clinical presentations and mimic many other dermatoses. This morphological heterogeneity can often lead to initial misdiagnoses resulting in significant delays from symptom onset to diagnosis. We report a case of mycosis fungoides imitating clinical and histopathological features of erythema annulare centrifugum.

Herpetiformis dermatitis is the best characterized extraintestinal manifestation of celiac disease (CD). However, other chronic heterogeneous skin lesions have been associated with CD and should be considered in the differential diagnosis.

The authors describe the case of a 63-year-old female patient with a history of left mastectomy due to breast adenocarcinoma at the age of 45 years and a neuroendocrine tumour of the terminal ileum diagnosed 3 months before the appearance of diffuse skin lesions. Her medical history also included

Several skin diseases can present with annular lesions, including granuloma annulare, urticaria, tinea, erythema chronicum migrans, and lupus erythematosus. In addition, there are rare annular diseases whose nosographic identity is accepted including erythema annulare centrifugum (EAC) and erythema gyratum repens. In this chapter, rare variants of annular erythema whose nosographic positioning is still debated are discussed. They are annually recurring EAC, neutrophilic figurate erythema, palpable migratory arciform erythema, eosinophilic annular erythema, and annular lichenoid dermatitis of youth.

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.

Erythema annulare centrifugum (EAC) is an unusual skin condition appearing as recurrent erythematous annular eruptions associated with autoimmune disorders, infections, and various neoplastic conditions. We present a very rarely reported association of EAC with Hashimoto thyroiditis (HT) in a young male. A 26-year-old male recently diagnosed as case of HT presented in the dermatology clinic with nine-month history of non-itchy persistent annular lesions on the body. The morphology and biopsy of lesions confirmed the diagnosis of EAC. HT is a part of the spectrum of autoimmune thyroid diseases with its own specific cutaneous manifestations. Our case also depicts the impact of antigen-antibody related immunological reaction, which might be involved in the development of both HT and EAC, and it could be the stages of the same pathological condition of two different clinical presentations.

Erythema annulare centrifugum is a dermatosis of unknown aetiology which usually follows a self-limiting course. Nevertheless, some cases tend to chronicity, especially when a culprit stimulus is not found, and can be challenging to treat. A 24-year-old male presented with a 3-year history of persistent plaques with polycyclic outlines and an infiltrated rim on the forearms, buttocks and thighs. After histopathological correlation, a diagnosis of erythema annulare centrifugum was therein made. Secondary causes were ruled out. Treatment with topical and systemic steroids provided no benefit, and the patient was reluctant to further systemic oral immunosuppression. Photochemotherapy was then attempted. A marked improved was observed since the first session, and the patient was clear by the 7th treatment. No adverse events were noted. The patient is still in remission at the 3rd month of follow-up. To our knowledge, we report the first case of an erythema annulare centrifugum successfully treated with photochemotherapy. Our case highlights the potential of this time-honoured therapeutic modality to address chronic and debilitating cases of this figurate dermatosis.

Summary A 44-year-old woman with seronegative polyarthritis presented with a 2-year history of a solitary, bluish-red, oedematous, nonscaly, annular and partially reticulated macule on her right thigh. Histopathological findings revealed perivascular and periadnexal lymphocytic infiltrate in the dermis. Alcian blue and colloidal iron stains highlighted mucinous deposit in the upper and mid dermis. Direct immunofluorescence showed a linear deposit of IgG and C3 along the basement membrane zone. Antinuclear antibody was positive at a titre of 1 : 80, with homogenous and speckled patterns. Except for its unusual localization and lack of photosensitivity, our case had the clinical and histopathological features of lupus erythematosus tumidus. These characteristics were also reminiscent of reticular erythematous mucinosis and erythema annulare centrifugum, both of which are considered to be associated with cutaneous lupus erythematosus (CLE). Hydroxychloroquine 200 mg daily led to improvement of the skin lesion. The unusual clinical presentation of our case emphasizes the heterogeneity of clinical manifestations of CLE.

Neutrophilic figurate erythema (NFE) has been rarely reported. This study aimed to identify the clinical and pathological features of NFE. We retrospectively reviewed the information from diagnostic cases from 2000 to 2013. The diagnosis of NFE includes clinically annular rash, histopathologically predominant neutrophilic perivascular and interstitial infiltrate in the dermis without evidence of vasculitis, and exclusion of other known specific entities. Fifteen cases of NFE were identified, including 11 women and 4 men. The age distribution was 18-66 years (average 41). The major characteristic patterns in NFE were blistering annular erythema (5/15 patients), purpuric annular erythema with vesicles (4/15 patients), and multiple annular rash with central ring-shaped scales (4/15 patients). There was no specific predicted location and no association with a major systemic disease. Papillary dermal edema and mild-to-moderate leukocytoclasis in the upper dermis are the main histopathological features. Ten of the 15 patients had recurrent episodes. Two patients who had single episode were associated with drug reaction. Antineutrophil therapy was required to control the symptoms in 3 patients. NFE has a similar clinical course as erythema annulare centrifugum but has distinct features that can be recognized clinically. The pathologists should be aware of the entity when making the diagnosis of neutrophil-mediated inflammatory disorders. The treatment regimen for neutrophilic dermatoses may be needed to manage the skin lesions.

Informed consent: Written informed consent for the paper to be published (including images, case history and data) was obtained from the patient/guardian for publication of this paper, including accompanying images.

Erythema annulare centrifigum emphasizing the role of beta cell of head of pancreas in its plausible causation is describe, the features of which conformed to non-insulin dependent diabetes mellitus type 2.

A switch from cell-mediated to humoral immunity (helper T 1 [Th1] to helper T 2 [Th2] shift) during gestation plays a key role in placental immune tolerance. As a result, skin diseases that are Th2 mediated often worsen, whereas skin diseases that are Th1 mediated often improve during gestation. Also, due to fluctuations in glandular activity, skin diseases involving sebaceous and eccrine glands may flare, whereas those involving apocrine glands may improve during pregnancy. Despite these trends, inflammatory and glandular skin diseases do not always follow the predicted pattern, and courses are often diverse. We review the gestational course of inflammatory skin diseases, such as atopic dermatitis (atopic eruption of pregnancy), psoriasis, impetigo herpetiformis, urticaria, erythema annulare centrifugum, pityriasis rosea, sarcoidosis, Sweet syndrome, and erythema nodosum, as well as glandular skin diseases, including acne vulgaris, acne rosacea, perioral dermatitis, hidradenitis suppurativa, Fox-Fordyce disease, hyperhidrosis, and miliaria. For each of these diseases, we discuss the pathogenesis, clinical presentation, and management with special consideration for maternal and fetal safety.

Key Clinical Message Annular urticarial lesions in a child must establish a main differential diagnosis with urticaria multiforme, common urticaria, acute hemorrhagic edema of infancy, erythema marginatum, erythema annulare centrifugum, annular erythema in childhood, erythema multiforme, Sweet's syndrome, Schönlein‐Henoch purpura, erythematosus lupus, several systemic vasculitis, and serum sickness.

We present the case of a 29-year-old woman who initially presented to her GP with a short history of non-pruritic annular skin lesions with central clearing. A month later, she developed signs and symptoms of bone marrow failure with bruising, epistaxis and fatigue. After urgent review of a blood film, she was diagnosed with acute promyelocytic leukaemia (APML), which is a haematological emergency. Treatment with all-trans retinoic acid (ATRA) was commenced immediately and she was subsequently treated with arsenic trioxide (ATO). The annular rash was subsequently diagnosed as paraneoplastic erythema annulare centrifugum (PEACE), which resolved with treatment. This case demonstrates the importance of the urgent diagnosis of APML and highlights PEACE as a rash that clinicians should be aware of, as it can be the initial manifestation of a number of both haematological and non-haematological malignancies.

Palpable migratory arciform erythema is an entity of unknown etiology, with few published cases in the literature. The clinical and histopathological features of this disease are difficult to be distinguished from those of Jessner’s lymphocytic infiltration of the skin, lupus erythematous tumidus and the deep erythema annulare centrifugum. We describe here the first two Brazilian cases of palpable migratory arciform erythema. The patients presented with infiltrated annular plaques and erythematous arcs without scales. These showed centrifugal growth before disappearing without scarring or residual lesions after a few days. They had a chronic course with repeated episodes for years. In addition, these cases provide evidence of a drug-induced etiology.

Sipuleucel-T is a cellular immunotherapy approved for the treatment of metastatic castration-resistant prostate cancer. We report a patient developing an immune related adverse effect from sipuleucel-T drug-induced erythema annulare centrifugum-like eruption. A brief review of the mechanism and implications of this eruption are also included.

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.

An 80-year-old man, with no known medical history or previous medication, presented with a 3-month history of asymptomatic erythematous scaly plaques over his arms, abdomen and legs. He denied any systemic complaints. Prior to our admission, the patient was diagnosed with superinfected eczema and

Erythema annulare centrifugum is a figurate erythema of unknown etiology. It has been associated with many different entities, including infections, food allergy, drug reactions and malignant neoplasms. Herein, we report a case of erythema annulare centrifugum as presenting sign of activation of breastcancer.

Mycosis fungoides (MF) is a common type of cutaneous non-Hodgkin mature T cell lymphoma (CTCL). The median age of diagnosis is in the mid-50s with an increased incidence seen in patients older than 70.1 Before the diagnosis of MF, patients may experience a premycotic phase, during which nonspecific scaly skin lesions are present. These may fluctuate and resemble more common skin conditions, such as eczema and psoriasis, rendering a definitive diagnosis difficult to establish. Further complicating matters, MF may present with a variety of morphologically distinct cutaneous lesions. In addition to the classic form of MF, there are 3 other common variants: folliculotropic, pagetoid reticuloid, and granulomatous cutis laxa. More rare subtypes include, among others, hypopigmented/hyperpigmented, erythrodermic, poikilodermic, pigmented purpuralike, bullous/dyshidrotic, papular, and the invisible subtypes.2 These cutaneous lesions may be pruritic and have a profound impact on a patient's quality of life.3 Because of the nonspecific and variable course of presentation, the diagnosis of MF usually takes many years.1 We present a case of MF in a young adult Asian male with an atypical presentation.