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Dear Editor, Bullous pemphigoid (BP), a relatively common autoimmune blistering disease in the elderly, is characterized by large, tense bullae on urticarial, erythematous, or normal skin. However, atypical BP with polymorphic clinical presentations is rarely encountered, leading to misdiagnosis and delayed treatments (1). BP with lesions resembling erythema gyratum repens or figurate erythema has been regarded as a paraneoplastic phenomenon (1). Herein we report a case with erythema annulare centrifugum-like presentation of BP without evidence of underlying malignancy. A 64-year-old woman first presented with multiple large, tense bullae on the trunk and four extremities. She was diagnosed with BP according to the typical clinical, histopathological, and direct immunofluorescence findings. There were no annular lesions at that time. After a treatment course of systemic corticosteroids and azathioprine, the cutaneous symptoms were controlled. One year after discontinuing her medications, a pruritic bullous eruption reappeared with several annular erythematous plaques (Figure 1, a). The patient reported no mucosal involvement and took no new medications before the onset of skin lesions. On physical examination, multiple circular and arcuate erythematous lesions with slightly raised borders were seen on the trunk and both legs. Some erosions and tiny vesicles were noted on the erythematous edges. There were no other systemic symptoms or abnormalities. Laboratory studies, including complete blood count, liver and renal function tests, electrolytes, antinuclear antibody, complement levels, anti-Ro and anti-La antibodies, urine routine, stool routine, and chest X-ray, were normal. The biopsy specimen obtained from the rim of the annular lesions revealed slight vacuolar change at the dermoepidermal junction and perivascular and interstitial lymphocytic infiltration with numerous eosinophils in the upper dermis (Figure 1, b). Direct immunofluorescence showed linear deposits of immunoglobulin G (IgG) and C3 along the basement membrane (Figure 1, c). Histopathological features and immunofluorescence examinations were consistent with BP. There was no evidence of hematological or solid malignancy from further imaging and laboratory testing. The patient was started on oral prednisolone 30 mg/day and azathioprine 150 mg/day, with significant improvement over the following month. Complete regression of all skin lesions was achieved two months later, so the prednisolone dose was gradually tapered and then ceased. Under maintenance monotherapy of azathioprine 100 mg/day, there were no signs of BP recurrence or malignant disease during the one-year follow-up period. The annular erythema variant of BP is extremely rare. Therefore, in this case, erythema multiforme, subacute cutaneous lupus erythematosus, erythema annulare centrifugum, and urticarial vasculitis should be considered in the clinical differential diagnoses. Pathological features and immunofluorescence results can clearly rule out these possibilities. Until now, only 13 cases of BP presenting as annular erythema had been documented in the English literature, described as figurate erythema-like, erythema gyratum repens-like, or erythema annulare centrifugum-like manifestations (1-3). An association with internal malignancy in patients with these types of lesions had been reported (1). Nevertheless, as in most previous case reports (3), malignant diseases were not found in our patient. The precise mechanism of the annular erythema form of BP is unknown. Some authors considered it a variant of pre-bullous phase lesions, usually presenting as itchy erythematous patches or urticarial plaques (4). Based on this case, however, this assumption is less likely because the annular, erythema annulare centrifugum-like skin lesions appeared one year after the initial onset of bullous eruption, and simultaneously with the exacerbation of the bullous phase of BP. The exact pathogenesis of annular BP may be similar to that in erythema annulare centrifugum. Further investigations are warranted to clarify this issue. It should be noted that an erythema annulare centrifugum-like or figurate erythema-like manifestation in the absence of underlying malignancy can occasionally be a feature of BP. Making the correct diagnosis may be difficult if there is no concurrent bullous presentation. Clinicians should be vigilant for the development of this type of BP. The histological and direct immunofluorescence findings and the detection of circulating autoantibodies by indirect immunofluorescence or enzyme-linked immunosorbent assay remain crucial tools for establishing a definitive diagnosis.

The classification of annular centrifugal erythemas can be confusing and has always been one of the most discussed issues in medicine. We report a case of 58 years old woman who had a 3 –days post vaginal-plastic surgery. The patient presented non- pruritic annular skin eruptions on the abdomen and extremities, spreading gradually and forming large rings. She was treated during this period at the gynecologist department and later was admitted to a tertiary care hospital with the diagnosis "enoxaparin-sodium drug" reaction. The skin lesion was not associated with the drug allergy reaction. Urino–culture grew Proteus Mirabilis, Vulgaris. Presence of Proteus mirabilis and annular centrifugal erythema eruption lesions, suggests a pathogenetic effect of the gram-negative bacterium on the skin lesion. Considering the anamnesis and the clinical manifestation, the patient was treated with antibiotic therapy, corticosteroid therapy, anti-histaminic and local corticosteroid cream. To our knowledge, no other case of EAC associated with Proteus mirabilis infection has been published.&nbsp

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.

Reactive dermatoses may occur related to many underlying causes including infections, inflammatory diseases, medications and malignancies. In the management of these dermatoses the investigation of underlying cause is crucial besides the therapy of dermatosis. In this review, mainly the paraneoplastic potentials of reactive dermatoses have been evaluated and additionally the etiology, follow-up and treatment have been discussed. Recent literature about figurated erythemas (erythema annulare centrifugum, erythema gyratum repens, necrolytic migratory erythema), neutrophilic dermatoses (Sweet’s syndrome, pyoderma gangrenosum, subcorneal pustular dermatosis) and erythema nodosum have been scrutinized.

Erythema papulosa semicircularis recidivans (EPSR) is a new entity characterised by centrifugally expanding erythematous plaques that exacerbate after excessive sweating or during warm seasons [1, 2]. EPSR clinically resembles erythema annulare centrifugum of Darier, however, the edge of the annular ring is composed of papules rather than erythema and scales [1, 2]. Herein, we report the first case of EPSR associated with primary pancreas B-cell lymphoma.A 39-year-old woman was referred to our [...]

Lyme Borreliosis, or Lyme’s disease, manifests itself in numerous skin conditions. Therapeutic intervention should be initiated as soon as a clinical diagnosis of erythema migrans is made. The histopathology of some of the skin conditions associated with Lyme Borreliosis is characterised by structural changes to collagen, and sometimes also elastic fibres. These conditions include morphea, lichen sclerosus et atrophicus and acrodermatitis chronica atrophicans. More recently, further skin conditions have been identified by the new microscopic investigation technique of focus floating microscopy: granuloma annulare, necrobiosis lipoidica, necrobiotic xanthogranuloma, erythema annulare centrifugum, interstitial granulomatous dermatitis, cutaneous sarcoidosis and lymphocytic infiltration; these conditions also sometimes cause changes in the connective tissue. In the case of ligaments and tendons, collagen and elastic fibres predominate structurally. They are also the structures that are targeted by Borrelia. The resultant functional disorders have previously only rarely been associated with Borreliosis in clinical practice. Ligamentopathies and tendinopathies, spontaneous ruptures of tendons after slight strain, dislocation of vertebrae and an accumulation of prolapsed intervertebral discs as well as ossification of tendon insertions can be viewed in this light.

Erythema annulare centrifugum (EAC) is a slow progressing and recurring skin disease with unknown etiology, characterized by ring shaped erythematous skin rashes. EAC was first described by Darier in 1916, and classified in 1978 by Ackerman into a superficial and a deep type [1]. EAC has been associated with many different entities, including infections, food allergy and drug reactions, polycythemia vera, cryoglobulinaemia, myelodysplastic syndrome, hypereosinophilic syndrome, hyperthyroidism, autoimmune thyroidities, hepatic diseases, pregnancy and malignant neoplasms [2]. Relapsing polychondritis (RP) is a disease which progresses with inflammatory attacks on articular and non-articular cartilaginous tissue and is most commonly encountered as auricular chondritis. In auricular chondritis, that the earlobe is not affected and existence of one or two sided fulminant rubescence, sensitivity and oedema on external ear cartilaginous tissue are salient [3]. We report a case, who was diagnosed with acute myeloblastic leukemia (AML) two months after EAC was detected. Bilateral auricular chondritis developed in the third day of her chemotherapy and EAC lesions relapsed during the course of chemotherapy.

Erythema annulare centrifugum is a reactive erythema of various possible etiologies including, although less often, an associated cancer. Cancer-related erythema annulare centrifugum is most commonly associated with lymphoproliferative malignancies, specifically lymphoma and leukemia. Malignancy-associated erythema annulare centrifugum is more frequently seen in women than men and the presence of skin lesions usually precedes the clinical diagnosis of the underlying malignancy. Neoplasm-derived erythema annulare centrifugum lesions often resolve following treatment of the cancer. Recurrence of erythema annulare centrifugum may occur along with the relapse of the underlying malignancy. Paraneoplastic erythema annulare centrifugum eruption (PEACE) is speculated to be a result of a cytokine or other tumor-associated factors.

Id reactions are a type of secondary inflammatory reaction that develops from a remote localized immunological insult. To date, id reactions caused by various fungal, bacterial, viral, and parasitic infections have been reported. Superficial fungal infections, especially tinea pedis, are the most common cause of id reactions. Id reactions exhibit multiple clinical presentations, including localized or widespread vesicular lesions, maculopapular or scarlatiniform eruptions, erythema nodosum, erythema multiforme, erythema annulare centrifugum, Sweet's syndrome, guttate psoriasis, and autoimmune bullous disease. The mechanisms underlying id reactions vary depending on the type of clinical presentation. The most important aspect of therapy involves the identification and adequate treatment of the underlying infection or dermatitis. This review comprehensively discusses the current state of the field concerning cutaneous id reactions, including diagnostic criteria, clinical presentations, underlying infectious conditions, etiologic agents, immunologic characteristics, histopathologic findings, and management strategies.

Erythema annulare centrifugum (EAC) presents as erythematous or urticarial papules, each with an annular shape, that exhibit peripheral extension. Internal malignancies are occasionally associated with EAC, and infectious diseases, including fungal, bacterial or viral infections, have also been regarded as possible causes of EAC. A 35-year-old man had a 1-week history of a painful vesicular eruption over the trunk corresponding to dermatomes Th8-10. Concomitantly, he developed several annular eruptions over the trunk. We diagnosed the former lesions as herpes zoster and the latter as EAC associated with herpes zoster. Although DNA was extracted from the EAC region, no varicella-zoster virus DNA was detected. We consider that this is Wolf's isotopic response, which is caused by an alteration of the local immunity due to viral infection. An etiologic relationship between EAC and herpes zoster is strongly suggested by the present case and by our review.

Both clinical and pathologic findings must be considered when diagnosing figurate skin lesions, which are often seen in routine practice. Although a skin biopsy may sometimes be diagnostic, more often the information provided is nonspecific. In an attempt to offer an approach to diagnosing these dermatoses, we have classified annular lesions according to the presence of lymphocytic, neutrophilic-eosinophilic, or granulomatous infiltrates, and infiltrates containing plasma cells. Neoplastic annular lesions are included in a separate group. Lesions containing lymphocytic infiltrates include superficial and deep erythema annulare centrifugum and the differential diagnosis includes a large number of conditions. In the neutrophilic-eosinophilic class, we include annular psoriasis, vasculitis, linear immunoglobulin A dermatosis, eosinophilic dermatitis, erythema marginatum rheumatica, and annular erythema of infancy. Sarcoidosis and granuloma annulare are the prototypical annular lesions containing granulomas. Secondary syphilis is typical of lesions containing plasma cells. Mycosis fungoides is the principal skin tumor that may initially manifest with annular lesions.

Both clinical and pathologic findings must be considered when diagnosing figurate skin lesions, which are often seen in routine practice. Although a skin biopsy may sometimes be diagnostic, more often the information provided is nonspecific. In an attempt to offer an approach to diagnosing these dermatoses, we have classified annular lesions according to the presence of lymphocytic, neutrophilic-eosinophilic, or granulomatous infiltrates, and infiltrates containing plasma cells. Neoplastic annular lesions are included in a separate group. Lesions containing lymphocytic infiltrates include superficial and deep erythema annulare centrifugum and the differential diagnosis includes a large number of conditions. In the neutrophilic-eosinophilic class, we include annular psoriasis, vasculitis, linear immunoglobulin A dermatosis, eosinophilic dermatitis, erythema marginatum rheumatica, and annular erythema of infancy. Sarcoidosis and granuloma annulare are the prototypical annular lesions containing granulomas. Secondary syphilis is typical of lesions containing plasma cells. Mycosis fungoides is the principal skin tumor that may initially manifest with annular lesions.

Erythema annulare centrifugum (EAC) is a clinical reaction pattern and not a specific clinicohistologic entity. The clinical and histologic differential diagnosis of EAC should take at least three main disease groups into consideration, which are often classified under this disorder: (tumid) lupus erythematosus, spongiotic dermatitides, and pseudolymphomas.

Summary: Unusual forms of Trichophyton rubrum infection seen in 40 patients are described. Observed were localized lesions resembling the following clinical entities: discoid lupus erythematosus (14 patients), granulomatous folliculitis and perifolliculitis (4), abscesses (3), granuloma annulare (3), annular lichen planus (4, erythema chronicum migrans (2), keloid-like lesion (1) and condylomata lata-like lesions on the scrotum of a young man. Widely desseminated lesions were seen in 10 patients with endocrinologic neoplastic and immunologic disturbances. These showed the following dermatological aspects: disseminated neurodermatitis (2), psoriasis gyrata (t), seborrheic dermatitis (2), erythema annulare centrifugum (4, papular pityriasis rosea (1) and dermatitis herpetiformis (1). In four cases there was en ectothrix invasion of affected hairy areas. The granular variety of T. rubrum was isolated from one case with localized infection, and from two cases with disseminated lesions. Zusammenfassung: Ungewohnliche Formen einer Trichophyton rubrum Infektion die bei 40 Patienten beochachtet wurden, werden beschrieben. Es wurden umschriebene Hautveranderungen beobachtet, die den folgenden klinischen Diagnosen ahnelten: Discoider Lupus erythematodes (14 Patienten), granulomatase Follikulitis und Perifollikulitis (3), Abszesse (3), Granuloma anulare (3), Lichen ruber planus anularis (2), Erythema chronicum migrans (2), keloidartige Hautveranderungen (I), Condylomata lata-artige Hautveranderungen am Scrotum eines jungen Mannes. Grosflachig disseminierte Herde wurden bei 10 Patienten mit endokrinologischen, neoplastischen und immunologischen Erkrankungen gesehen. Bei diesen fanden sich morphologische Anklange an die folgenden dermatologischen Erkrankungen: Disseminierte Neurodermitis (2), gyrierte Psoriasis vulgaris (2), seborrhoische Dermatitis (2), Erythema anulare centrifigum (2), papulose Pityriasis rosea (1) und Herpetitis herpetiformis Duhring (1). Bei 4 Fallen wurde ein ektotriches Wachstum im Haar beobachtet. Die granulare Variante des T. rubrum wurde von einem Fall mit einer umschriebenen Infektion und von 2 Fallen mit disseminierten Herden isoliert.

Summary Background Erythema annulare centrifugum (EAC) is considered an inflammatory skin disease with unknown aetiology. In most textbooks it is assigned to the incoherent conglomeration of figurate or gyrate erythemas. Objectives To re-evaluate a large cohort of patients with EAC and to assess the evidence for infection with Borrelia. Methods We retrospectively investigated 90 cases with the diagnosis of EAC. Haematoxylin and eosin sections were re-examined and diagnoses were specified; these were then confirmed by clinicopathological correlation. Infection with Borrelia was assessed by focus-floating microscopy and by a Borrelia-specific polymerase chain reaction (PCR). Results Besides a miscellaneous group of annular disorders at times confused with EAC such as urticaria, leucocytoclastic vasculitis and psoriasis (20 of 90; 22%), EAC appeared to serve as a collective term for three main clinicopathological reaction patterns: (i) (tumid) lupus erythematosus (29 of 90; 32%), (ii) spongiotic dermatitides (25 of 90; 28%) and (iii) pseudolymphoma (16 of 90; 18%). In 13 of 16 (81%) cases with a pseudolymphomatous reaction pattern spirochaetes stained positive but were negative in other reaction patterns of EAC as well as in negative controls. These findings were confirmed by a Borrelia-specific PCR which was positive in two of three (67%) of these pseudolymphomatous EAC cases but was negative in all other variants of EAC (none of five) as well as 20 controls. Conclusions We conclude that ‘EAC’ is a clinical reaction pattern that does not represent a specific clinicopathological entity and should lead to consideration of mainly lupus erythematosus, dermatitis and, in some cases, cutaneous Lyme disease.

We report here a new case of neutrophilic figurate erythema of infancy in a 1-year and 9-month-old white boy. Neutrophilic figurate erythema of infancy is a rare inflammatory dermatosis which is part of the figurate inflammatory dermatoses of infancy and is considered a variant of annular erythema of infancy. The disease is clinically characterized by annular erythematous lesions, sometimes with a polycyclic configuration, and histologically by a dermal neutrophilic infiltration with leukocytoclasia. Differential diagnosis mainly includes clear-cut severe diseases with a well-known etiology, such as neonatal lupus erythematosus and its variant erythema gyratum atrophicans transiens neonatale, erythema chronicum migrans and erythema marginatum rheumaticum, and diseases of unknown origin and with less clear limits, such as erythema annulare centrifugum and its variant familial annular erythema. Anamnesis, laboratory findings, clinical features, and histology allow the correct diagnosis and therefore, having excluded severe diseases, parents should be reassured as neutrophilic figurate erythema of infancy, as the annular erythema of infancy, is a benign disease, in most cases unassociated with other conditions and usually self-limiting over a few months, even though a chronic course may rarely occur. Our case was characterized by a chronic persistent course and by a complete resolution of the lesions only during febrile episodes.

The gyrate erythemas are a heterogeneous group of dermatoses clinically defined by the presence of circinate, annular, and/or polycyclic lesions that are often associated with serious underlying systemic diseases. The gyrate erythemas consist of the entities erythema annulare centrifugum (EAC), erythema marginatum rheumaticum (EMR), erythema gyratum repens (EGR), and erythema chronicum migrans (ECM). The latter two entities, namely, EGR and ECM, are associated with potentially deadly underlying disorders and thus will be discussed in greater detail.

Introduction Erythema annulare centrifugum is a rare cutaneous disease characterized by erythematous and violaceous annular plaques that usually involved the thighs and the legs. The eruption may be associated with an underlying disease and its accompanying characteristic symptoms. For these reasons, a full physical examination should be conducted to exclude underlying disorders. Annually recurring erythema annulare centrifugum is a rare and peculiar variant of erythema annulare centrifugum with the same clinical and histopathological characteristics. The lesions of annually recurring erythema annulare centrifugum tend to regress spontaneously after a variable period of days to months with yearly recurrence for many years. Case presentation We present the case of a 46-year-old caucasian woman affected by annually recurring erythema annulare centrifugum, which is a peculiar form of superficial erythema annulare centrifugum. The lesions have the same clinical and histopathological characteristics of the classical superficial form of erythema annulare centrifugum and tend to regress spontaneously after a variable period of days to months. In our case, no precipitating factors were identified and no underlying diseases were found. Every year for the last 12 years the lesions started to appear in the summer months and regressed spontaneously in autumn. Conclusions Cases of annually recurring erythema annulare centrifugum are rarely reported in the literature and generally no causative agent can be detected. The main feature of annually recurring erythema annulare centrifugum is the constant annual and seasonal recurrence of the lesions for many years.

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.

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Skin lesions accompanying hematological malignancies can be formed due to either direct tumor infiltration of the skin or indirect effects. Indirectly developing lesions may be a component of paraneoplastic syndrome. Erythema annulare centrifugum (EAC) is considered to be a hypersensitivity reaction developed against various antigens associated with infections, drugs, and endocrine diseases. EAC, rarely seen in neoplastic diseases, has been reported in lymphoma, leukemia, histiocytosis, and prostate cancer. Here we report EAC in a patient using a hypomethylating agent, azacitidine. A 69-year-old female patient was admitted to our polyclinic with weakness and ecchymosis in her legs existing for 3 months. She was considered as having refractory anemia with excess blasts-2 according to myelodysplastic syndrome (MDS) classification [1]. Because there was only hyperdiploidy in conventional cytogenetic examination, she was classified in group intermediate-2 of the International Prognostic Scoring System. She had a history of radical mastectomy and adjuvant chemoradiotherapy for breast cancer 3 years ago. She said that variously sized round and oval erythematous, itching, painless lesions had formed in the abdominal region on the 4th day of azacitidine usage (75 mg/m2/day, 7 days, s.c.) (Figure 1 and 2). There were no concomitant complaints or physical examination findings except fatigue. After azacitidine was stopped, a skin biopsy was taken. In the biopsy, mild perivascular inflammatory infiltration accompanying vascular ectasia in the papillary dermis was detected. The possibility of paraneoplastic syndrome was excluded due to the disappearance of all lesions by 1 week after cessation of treatment. During the second course of azacitidine, the lesions reoccurred on the second day. Subsequently to the second course, the patient died of sepsis, which developed after pneumonia.

Erythema annulare centrifugum is classified generally into a superficial and a deep type. Whether those types are variants of the same process or unrelated to one another, and whether they represent non-specific patterns or specific clinico-pathologic entities, is controversial. To answer those questions, we analyzed 82 biopsy specimens from 73 patients with a clinical and histopathologic diagnosis of erythema annulare centrifugum, gyrate erythema, or figurate erythema regarding a variety of clinical and histopathologic findings. We found substantial differences between cases with a wholly superficial type and cases with a superficial and deep infiltrate. Clinically, a collarette of scales was seen only in the superficial type. Histopathologically, some findings were much more common in the superficial type (eg, spongiosis, parakeratosis, crusts, edema of the papillary dermis, epidermal hyperplasia) and others in the deep type (eg, sleeve-like arrangement of the infiltrate, melanophages, subtle vacuolar changes at the dermo-epidermal junction, individual necrotic keratinocytes). Whereas cases of the superficial type could be distinguished from differential diagnoses by a variety of clinical and histopathologic findings, most cases of the deep type showed subtle signs of lupus erythematosus. Neither type was associated consistently with any other systemic disease. Because the superficial and the deep type of erythema annulare centrifugum seem to be unrelated to one another, they should not be referred to by the same name. We believe that the term should be reserved for the superficial type because the latter seems to be a specific clinico-pathologic entity. By contrast, most cases of the deep type seem to be annular examples of tumid lupus erythematosus and should be diagnosed that way. If findings militate against the diagnosis of lupus erythematosus, we suggest using a descriptive term that signals non-specificity-namely, deep figurate erythema.

Background: Erythema annulare centrifugum (EAC) represents a hypersensitivity reaction to a variety of conditions, many of which have been reported in the literature. Methods and Results: We report on a 38-year-old woman with a 5-year history of recurrent polycylic, arcuate, scaly, erythematous patches with central clearing on her thighs and trunk. Clinical examination and biopsy were both consistent with a diagnosis of EAC. Two years after the initial presentation, she was diagnosed with mild Crohn disease. Conclusions: The prolonged nature of EAC in our patient and our inability to identify known associations of malignancies, including medications, connective tissue disorders, systemic disorders, and infections, led us to postulate that her EAC was related to her Crohn disease. A thorough review of the literature failed to detect any previous reports linking Crohn disease and EAC. Renseignements de base: L'érythème centrifuge (EAC) représente une réaction d'hypersensibilité à une variété de conditions dont beaucoup ont été signalées dans la littérature. Méthodes et résultats: Nous présentons un rapport sur le cas d'une femme de 38 ans présentant 5 ans d'antécédents de taches érythémateuses squameuses, arquées, polycycliques récurrentes avec guérison centrale sur les cuisses et le tronc. L'examen clinique et la biopsie étaient tous les deux compatibles avec un diagnostic d'EAC. Deux ans après la présentation initiale, elle a été diagnostiquée avec une forme bénigne de la maladie de Crohn. Conclusions: La nature prolongée de l'EAC chez notre patiente, et notre incapacité à identifier les associations connues, y compris les médicaments, les maladies du tissu conjonctif, les troubles systémiques, et des infections, des tumeurs malignes, nous a conduit à postuler que son EAC était lié à sa maladie de Crohn. Un examen approfondi de la littérature ne nous a pas permis de trouver des rapports antérieurs qui établissent un lien entre la maladie de Crohn et l'EAC.

Erythema annulare centrifugum (EAC) is a reactive erythema with distinct, annular, erythematous plaques with trailing scale. This condition has been associated with various etiologies, which include an associated malignant condition. EAC with cancers or paraneoplastic erythema annulare centrifugum eruptions (PEACE), is more likely to be associated with lymphoproliferative malignancies such as lymphomas and leukemias. Histopathologic features include a superficial and deep, lymphohistiocytic perivascular infiltrate. We present a patient with a history of diffuse large B cell lymphoma in remission for two years, who presented with a one-year history of EAC.

Erythema annulare centrifugum (EAC) denotes a group of eruptions characterized by slowly migrating annular or configurate erythematous lesions. It can be classified histopathologically as the deep or superficial type. Although there are many case reports of EAC associated with various underlying conditions, no recent clinicopathologic studies exist. The purpose of this study was aimed at analyzing the clinical and histopathologic features of EAC. Sixty-six patients who have been diagnosed as EAC by clinical and histopathological examination were collected. The medical records and skin biopsy specimens of these patients were reviewed retrospectively. There were 24 male patients and 42 female ones. The mean age was 39.7 years, and the mean durtion of the disease was 2.8 years. The lower extremities, particularly the thigh, were the most frequently involved locations. The most common clinical manifestation was large (>1 cm), scaly, erythematous, indurated plaques. Forty-eight patients (72%) had combined diseases including cutaneous fungal infection (48%), such as tinea pedis, other skin diseases (18%), internal malignancies (13%), and other systemic diseases (21%). By histopathologic examination, 33 of 42 patients (78%) were identified as superficial type, and 9 patients (22%) were deep type. Therapeutic trials with systemic or topical corticosteroid and oral antihistamine did not affect the chronic and recurrent course of these patients. EAC is a chronic and recurrent disease despite treatment. EAC is thought to be highly associated with internal disease as well as with superificial fungal infection. However, it was difficult to prove a causal association. The recognition and exact diagnosis of EAC is important, because it may be a quite stressful condition and lead to unnecessary over-treatments.

Off-label use of lenalidomide (Len) in chronic lymphocytic leukemia (CLL) is becoming increasingly frequent. When compared with thalidomide, Len has been reported to have more potent anti-tumour activity and a better safety profile. However, dermatological side-effects are known to occur with both drugs. Clinical trial design often precludes precise quantification of infrequent toxicities and studies frequently report only grade 3-4 toxicities without a detailed description of rashes, leading to under-recognition of these complications in the community. Careful long-term tracking of late adverse effects with prompt reporting on recognition is imperative while monitoring patients for potential adverse events as we enter the new era of targeted therapies. We present an unusual case of CLL that was complicated by erythema annulare centrifugum and neutrophilic dermatosis (Sweet's syndrome) after starting Len.

A case of systemic lupus erythematosus presenting as erythema annulare centrifugum involving atypical sites (face, palm and sole) and raised serum angiotensin-converting enzyme levels has been illustrated.

Erythema annulare centrifugum is a figurate erythema that has been associated with many different entities. A case of erythema annulare centrifugum related to non-Hodgkin's lymphoma in a 38-year-old woman is described in this case report. Response of the lymphoma to a combination chemotherapy was accompanied by disappearance of skin lesions. When therapy was discontinued, both disorders recurred, and both responded to reinstitution of a different chemotherapy regimen. To our knowledge, this case is the first reported association of erythema annulare centrifugum and non-Hodgkin's lymphoma in the medical literature.

A considerable number of recent reports have documented mycosis fungoides resembling many other dermatoses. Due to highly variable presentations and the sometimes non-specific nature of histological findings, an accurate diagnosis of mycosis fungoides can be difficult. Erythema annulare centrifugum-like mycosis fungoides with a variety of annular, polycyclic erythematous skin lesions is a recently recognized atypical manifestation of mycosis fungoides, and only a few cases have been reported to date.

We evaluated 130 prepubertal girls presenting with a vulvar complaint to determine the spectrum and frequency of conditions seen in this age group. Of the patients, 41 (33%) had atopic or irritant dermatitis, 23 (18%) had lichen sclerosus, 21 (17%) had psoriasis, 15 (12%) had vulvar lesions, most often hemangiomas and nevi, and 13 (10%) had streptococcal vulvovaginitis. Diagnoses less frequently seen were staphylococcal folliculitis (four patients), labial fusion (three patients), genital warts (two patients), molluscum contagiosum of the vulva only (one patient), vulvar bullous pemphigoid (two patients), scabies nodules (one patient), erythema annulare centrifugum (one patient), tinea (two patients), and vitiligo (one patient). We also encountered vulvar presentations of systemic diseases (varicella, staphylococcal scalded skin syndrome, and Henoch-Schönlein purpura, all one patient each). We did not see candidal vulvovaginitis in this age group nor did we encounter bacterial infection with pathogens other than Staphylococcus aureus and S. pyogenes.