Erythema Annulare Centrifugum Treatment & Management
- Author: Marisel Peralta-Abejo, MD, DPDS; Chief Editor: William D James, MD more...
Erythema annulare centrifugum (EAC) is usually self-limited. Topical steroids usually cause involution of the treated lesions, but they do not prevent the occurrence of new lesions or recurrence of the eruption. Systemic or injection steroid therapy is effective, but the eruption returns once these drugs are withdrawn. As previously mentioned, several cases of EAC have resolved once the underlying diseases were treated. Therefore, a search for and treatment of the underlying disorder is the primary therapy. However, an exhaustive workup for occult malignancy is not warranted because the relationship between EAC and cancer is not consistent. Remember that no cause is found in most cases.
The patient's medications should be reviewed with particular attention to and discontinuation of the drugs known to be associated with EAC. Recent additions to the patient's drug regimen should be eliminated, and the patient should be observed for signs of resolution.
In a case of EAC associated with hypereosinophilic syndrome, the eruption resolved after treatment with ketoconazole, dapsone, and trimethoprim-sulfamethoxazole.
A case of EAC of infantile onset in the French literature documents dramatic improvement with interferon alpha therapy.
Case reports have documented success in the treatment of EAC with drugs previously unreported to be useful for EAC. Note the following:
- Hyaluronic acid: A 73-year-old man with an 11-week history of EAC that was associated with the onset of left knee osteoarthritis received injections of intra-articular hyaluronic acid that effected improvement of his osteoarthritis and resolution of his EAC.
- Calcipotriol: A case of EAC of 3 years' duration in a 73-year-old woman responded to calcipotriol after the patient did not respond to topical and systemic corticosteroids, antifungals, and psoralen with UV-A therapy. The eruption cleared completely after 3 months of treatment with calcipotriol. One report also described EAC responding to combination calcipotriol and narrow-band UVB.
- Metronidazole: A 38-year-old man with a 2-year history of EAC for which an underlying cause could not be found and that failed to respond to systemic antibiotics (ie, ciprofloxacin, clarithromycin), antifungal agents (ie, itraconazole, terbinafine), and topical calcipotriol did respond to oral metronidazole. The drug had been given to treat papulopustular rosacea. His EAC was coincidentally found to resolve, as did his rosacea, after 1 month of therapy. No recurrence of EAC was noted after 1 year of follow-up. A possible causal relationship between rosacea and EAC was postulated in the report.
- Etanercept: A 57-year-old man with erythema annulare centrifugum, unsuccessfully treated previously with narrow-band UVB, topical steroids, and methotrexate, responded with complete resolution of his eruption after 4 weeks of therapy with etanercept at 25 mg SQ twice weekly. The erythema annulare centrifugum eruption recurred upon cessation of etanercept therapy and resolved again with resumption of therapy.
- Erythromycin: Eight patients with EAC in Kaohsiung Chang Gung Memorial Hospital (a tertiary referral medical center in Taiwan) were included in the study, All patients responded poorly to previous treatments, including topical steroids, oral antihistamines, and even systemic steroids. Oral erythromycin stearate at a daily dose of 1000 mg (250 mg 4 times a day) for 2 weeks was given to all patients. Three of the patients had recurrence of the disease and all lesions resolved after re-administration of erythromycin. These patients had more widespread lesions. It was concluded in the study that erythromycin can be an effective treatment option for EAC.
Consult a dermatologist for diagnosis and evaluation of the underlying cause of erythema annulare centrifugum (EAC). Consult an internal medicine specialist for evaluation of the underlying cause of EAC.
Unless erythema annulare centrifugum (EAC) is associated with an underlying disease, there are usually no complications.
Bressler GS, Jones RE Jr. Erythema annulare centrifugum. J Am Acad Dermatol. 1981 May. 4(5):597-602. [Medline].
Minni J, Sarro R. A novel therapeutic approach to erythema annulare centrifugum. J Am Acad Dermatol. 2006 Mar. 54(3 Suppl 2):S134-5. [Medline].
Tsuji T, Kadoya A. Erythema annulare centrifugum associated with liver disease. Arch Dermatol. 1986 Nov. 122(11):1239-40. [Medline].
Braunstein BL. Erythema annulare centrifugum and Graves' disease. Arch Dermatol. 1982 Sep. 118(9):623. [Medline].
Shelley WB, Shelley ED. Erythema annulare centrifugum as the presenting sign of the hypereosinophilic syndrome: observations on therapy. Cutis. 1985 Jan. 35(1):53-5. [Medline].
Sack DM, Carle G, Shama SK. Recurrent acute appendicitis with erythema annulare centrifugum. Arch Intern Med. 1984 Oct. 144(10):2090-2. [Medline].
Ohmori S, Sugita K, Ikenouci-Sugita A, Nakamura M. Erythema annulare centrifugum associated with herpes zoster. J UOEH. 2012 Sep 1. 34(3):225-9. [Medline].
Mahood JM. Erythema annulare centrifugum: a review of 24 cases with special reference to its association with underlying disease. Clin Exp Dermatol. 1983 Jul. 8(4):383-7. [Medline].
Mandel VD, Ferrari B, Manfredini M, Giusti F, Pellacani G. Annually recurring erythema annulare centrifugum: a case report. J Med Case Rep. 2015 Oct 22. 9:236. [Medline].
Carlesimo M, Fidanza L, Mari E, et al. Erythema annulare centrifugum associated with mantle b-cell non-Hodgkin's lymphoma. Acta Derm Venereol. 2009. 89(3):319-20. [Medline].
Halevy S, Cohen AD, Lunenfeld E, Grossman N. Autoimmune progesterone dermatitis manifested as erythema annulare centrifugum: Confirmation of progesterone sensitivity by in vitro interferon-gamma release. J Am Acad Dermatol. 2002 Aug. 47(2):311-3. [Medline].
Rosina P, D'Onghia FS, Barba A. Erythema annulare centrifugum and pregnancy. Int J Dermatol. 2002 Aug. 41(8):516-7. [Medline].
Burkhart CG. Erythema annulare centrifugum. A case due to tuberculosis. Int J Dermatol. 1982 Nov. 21(9):538-9. [Medline].
White JW Jr. Gyrate erythema. Dermatol Clin. 1985 Jan. 3(1):129-39. [Medline].
Borbujo J, de Miguel C, Lopez A, de Lucas R, Casado M. Erythema annulare centrifugum and Escherichia coli urinary infection. Lancet. 1996 Mar 30. 347(9005):897-8. [Medline].
Hendricks AA, Lu C, Elfenbein GJ, Hussain R. Erythema annulare centrifugum associated with ascariasis. Arch Dermatol. 1981 Sep. 117(9):582-5. [Medline].
Bessis D, Chraibi H, Guillot B, Guilhou JJ. Erythema annulare centrifugum induced by generalized Phthirus pubis infestation. Br J Dermatol. 2003 Dec. 149(6):1291. [Medline].
Hammar H. Erythema annulare centrifugum coincident with Epstein-Barr virus infection in an infant. Acta Paediatr Scand. 1974 Sep. 63(5):788-92. [Medline].
Lee HW, Lee DK, Rhee DY, Chang SE, Choi JH, Moon KC, et al. Erythema annulare centrifugum following herpes zoster infection: Wolf's isotopic response?. Br J Dermatol. 2005 Dec. 153(6):1241-3. [Medline].
González-Vela MC, González-López MA, Val-Bernal JF, Echevarría S, Arce FP, Fernández-Llaca H. Erythema annulare centrifugum in a HIV-positive patient. Int J Dermatol. 2006 Dec. 45(12):1423-5. [Medline].
García-Doval I, Peteiro C, Toribio J. Amitriptyline-induced erythema annulare centrifugum. Cutis. 1999 Jan. 63(1):35-6. [Medline].
Turan Erkek E, Kalayoğlu Beşışık S. An Unexpected Innocent Complication Associated with Azacitidine Treatment of Myelodysplastic Syndrome: Erythema Annulare Centrifugum. Turk J Haematol. 2016 Mar 5. 33 (1):81-82. [Medline].
Kuroda K, Yabunami H, Hisanaga Y. Etizolam-induced superficial erythema annulare centrifugum. Clin Exp Dermatol. 2002 Jan. 27(1):34-6. [Medline].
Hudson LD. Erythema annulare centrifugum: an unusual case due to hydroxychloroquine sulfate. Cutis. 1985 Aug. 36(2):129-30. [Medline].
Gönül M, Külcü Çakmak S, Ozcan N, Deniz Oguz I, Ozhamam E. Erythema annulare centrifugum due to pegylated interferon-a-2a plus ribavirin combination therapy in a patient with chronic hepatitis C virus infection. J Cutan Med Surg. 2014 Jan-Feb. 18(1):65-8. [Medline].
Mendes-Bastos P, Coelho-Macias V, Moraes-Fontes MF, Milheiro A, Rodrigues AM, Cardoso J. Erythema annulare centrifugum during rituximab treatment for autoimmune haemolytic anaemia. J Eur Acad Dermatol Venereol. 2014 Aug. 28(8):1125-7. [Medline].
Chou WT, Tsai TF. Recurrent erythema annulare centrifugum during ustekinumab treatment in a psoriatic patient. Acta Derm Venereol. 2013 Mar 27. 93(2):208-9. [Medline].
Everall JD, Dowd PM, Ardalan B. Unusual cutaneous associations of a malignant carcinoid tumour of the bronchus--erythema annulare centrifugum and white banding of the toe nails. Br J Dermatol. 1975 Sep. 93(3):341-5. [Medline].
Leimert JT, Corder MP, Skibba CA, Gingrich RD. Erythema annulare centrifugum and Hodgkin's disease: association with disease activity. Arch Intern Med. 1979 Apr. 139(4):486-7. [Medline].
Yaniv R, Shpielberg O, Shpiro D, Feinstein A, Ben-Bassat I. Erythema annulare centrifugum as the presenting sign of Hodgkin's disease. Int J Dermatol. 1993 Jan. 32(1):59-61. [Medline].
Panasiti V, Devirgiliis V, Curzio M, Rossi M, Roberti V, Bottoni U, et al. Erythema annulare centrifugum as the presenting sign of breast carcinoma. J Eur Acad Dermatol Venereol. 2009 Mar. 23(3):318-20. [Medline].
Ioannidou D, Krasagakis K, Stefanidou M, Tosca A. Erythema annulare centrifugum and osteoarthritis treated with hyaluronic acid. Clin Exp Dermatol. 2002 Nov. 27(8):720-2. [Medline].
Ibrahim SF, Pryor J, Tausk FA. Stress-induced erythema annulare centrifugum. Dermatol Online J. 2009 Apr 15. 15(4):15. [Medline].
Dogan G. Pregnancy as a possible etiologic factor in erythema annulare centrifugum. Am J Clin Dermatol. 2009. 10(1):33-5. [Medline].
Cotterman C, Eckert L, Ackerman L. Syphilis mimicking tinea imbricata and erythema annulare centrifugum in an immunocompromised patient. J Am Acad Dermatol. 2009 Jul. 61(1):165-7. [Medline].
Chodkiewicz HM, Cohen PR. Paraneoplastic erythema annulare centrifugum eruption: PEACE. Am J Clin Dermatol. 2012 Aug 1. 13(4):239-46. [Medline].
Guillet MH, Dorval JC, Larrégue M, Guillet G. [Darier's erythema annulare centrifugum of neonatal onset with a 15 years' follow-up. Efficacy of interferon and role of cytokines]. Ann Dermatol Venereol. 1995. 122(6-7):422-6. [Medline].
Gniadecki R. Calcipotriol for erythema annulare centrifugum. Br J Dermatol. 2002 Feb. 146(2):317-9. [Medline].
Reuter J, Braun-Falco M, Termeer C, Bruckner-Tuderman L. [Erythema annulare centrifugum Darier. Successful therapy with topical calcitriol and 311 nm-ultraviolet B narrow band phototherapy]. Hautarzt. 2007 Feb. 58(2):146-8. [Medline].
De Aloe G, Rubegni P, Risulo M, Sbano P, Poggiali S, Fimiani M. Erythema annulare centrifugum successfully treated with metronidazole. Clin Exp Dermatol. 2005 Sep. 30(5):583-4. [Medline].
Chuang FC, Lin SH, Wu WM. Erythromycin as a Safe and Effective Treatment Option for Erythema Annulare Centrifugum. Indian J Dermatol. 2015 Sep-Oct. 60 (5):519. [Medline].