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Mature T-cell leukemias (MTCLs) are clonal proliferations of posttyhmic T cells that often exhibit systemic involvement including a variety of cutaneous manifestations.1 Because of the morphologic and phenotypic overlap, diagnosis of MTCLs requires comprehensive assessment of clinical presentation, immunophenotypic profiles, and serologic, cytogenetic, and molecular studies.2 T-cell prolymphocytic leukemia (T-PLL) accounts for only 2% of small lymphocytic leukemias in adults and classically manifests with striking leukocytosis, lymphadenopathy, and marked hepatosplenomegaly.1, 3 Unlike Sezary syndrome (SS), in which cutaneous presentation is a rule, only one-third of patients with T-PLL have cutaneous manifestations.4, 5, 6, 7 Cutaneous manifestations of T-PLL are heterogenous.5, 7, 8 We describe a patient who presented with erythematous patches and plaques, gyrate erythema, and bulky lymphadenopathy with an immunophenotype masquerading as SS. A diagnosis of T-PLL was confirmed using flow cytometry and cytogenetic analysis of the bone marrow aspirate demonstrating chromosome 14q32 rearrangement.

A 22-year-old female presented with generalised lichenification and severe pruritus, along with multiple annular papules and concentric plaques over trunk and extremities for the last 3 years. Her haematological investigations revealed leucocytosis with peripheral blood eosinophilia and raised serum IgE levels. Skin biopsy showed perivascular and interstitial infiltrate of eosinophils and lymphocytes in the dermis. Bone marrow examination showed myeloid hypercellularity with increased number of eosinophils, but no atypical cells. Cytogenetic studies did not reveal any chromosomal alterations. No systemic involvement was found on imaging. A diagnosis of idiopathic skin-limited hypereosinophilic syndrome was made. She was treated with tapering doses of oral prednisolone and weekly methotrexate with significant improvement in skin lesions and pruritus in 2 months, which was maintained at 7-month follow-up.

Gyrate erythema, which also is known as erythemaannulare centrifugum (EAC), is a reactive dermatitisthat is thought to occur in response to an underlyingtrigger. The superficial form is characterized bythe typical, centrifugally-expanding, annular,erythematous patches or plaques with a distincttrailing scale. The deep form also is a centrifugallyexpanding,erythematous plaque but with induratedborders and absence of scale. These cutaneousfindings are thought to be reactive, most often inresponse to infections or drugs and, less likely, tounderlying malignant conditions.

We report a case with an unusual manifestation of bullous pemphigoid (BP) in a 57-year-old woman. She presented with a one-month history of pruritus and multiple annular patches with central regression on her trunk and extremities and there were no signs of corresponding internal malignancy. Eosinophilic spongiosis was observed in histopathologic examination and direct immunofluorescence studies revealed a strong linear staining pattern of the basement membrane zone with C3 and IgG. This unusual case indicates that a lack of blisters does not necessarily exclude a diagnosis of BP, and supports previous reports suggesting gyrate erythema can be an initial manifestation of bullous disease.

Erythema annulare centrifugum (EAC) is an inflammatory skin condition, classified as a variant of figurate or gyrate erythema. It manifests with annular, erythematous macules, papules and plaques. The aetiopathogenesis of EAC is not fully understood; it is currently regarded as a hypersensitivity reaction to multiple factors, such as infections, medications, food components or even some pregnancy-related factors (1–3). However, EAC may also less commonly represent a paraneoplastic syndrome associated with occult malignancy. To the best of our knowledge the case described here is the first report of EAC associated with ovarian cancer.

The authors present the case of a 65-year-old gentleman with a 2.6-mm Breslow thickness melanoma on the lower limb. During his treatment, he underwent several operations including a partial foot amputation. At clinical review, he was noted to have developed an unusual rash. This rash, an annular and gyrate erythema, has never been described before in relation to melanoma, and is sometimes seen in the presence of paraneoplastic processes. Highlighting this new association may enable clinicians to understand and appreciate melanoma better in the future.

Erythema annulare centrifugum (EAC) is a gyrate erythema, which is typically characterized by annular, erythematous plaques with trailing scale. It is considered to be a reactive condition with a wide variety of inciting causes but unclear pathophysiology. The mean duration of the eruption is 11 months. We present a patient with a 50-year history of recurrent EAC with no known cause. Although it does follow a previously reported pattern of seasonal recurrence, this case represents the longest reported duration of EAC.

Alendronate is a bisphosphonate compound used to treat diseases of pathologic bone resorption. Cutaneous reactions to this medication are rare. We report the case of a superficial gyrate erythema that occurred as a reaction to weekly alendronate therapy used in the treatment of postmenopausal osteoporosis.

Summary A 70-year-old male presented with a diffuse gyrate erythema with clinical and histological features suggestive of chronic lupus erythematosus. The lupus band test, however, was negative in both involved and uninvolved skin. The skin condition was finally found to be associated with a carcinoma of the lung. The features of lupus erythematosus gyratus repens and its possible relationship to underlying neoplasia are discussed.

Nonspecific gyrate erythemas (NGE) are commonly associated with hypersensitivity reactions to exogenous or endogenous antigens. A case of NGE with clinical resemblance to tinea corporis in a patient with a dental radicular cyst is reported. Cutaneous lesions disappeared after surgical excision of the dental cyst. The clinical and pathological details are described and the relationship between radicular cyst and cutaneous lesions discussed. Earlier reports are reviewed and the possibility of a focal origin is emphasized.

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.

Pemphigus vulgaris and erythema gyratum repens were found to coexist in a woman with recurrent carcinoma of the breast. Biopsy sections of the figurate cutaneous lesions contained metastatic adenocarcinoma. Depression of both humoral and cell mediated immunity was demonstrated to exist in this patient.