Erythema Annulare Centrifugum Treatment & Management

  • Author: Robert J Willard, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jul 12, 2010
 

Medical Care

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 Systemic or injection steroid therapy is effective, but the eruption returns once these drugs are withdrawn.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.[5]

A case of EAC of infantile onset in the French literature documents dramatic improvement with interferon alpha therapy.[30]

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.[26]
  • 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.[31] One report also described EAC responding to combination calcipotriol and narrow-band UVB.[32]
  • 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.[33]
  • 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.[2]
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Consultations

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.

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Contributor Information and Disclosures
Author

Robert J Willard, MD  Dermatologist and Mohs Surgeon, Private Practice, Dermatology and Mohs Surgery Center, PC

Robert J Willard, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, and American Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Andrew D Montemarano, DO  Consulting Staff, The Skin Cancer Surgery Center

Andrew D Montemarano, DO is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Society for Dermatologic Surgery, and MedChi

Disclosure: Nothing to disclose.

Specialty Editor Board

Evan R Farmer, MD  Clinical Professor of Pathology and Dermatology, Department of Pathology, Virginia Commonwealth University School of Medicine

Evan R Farmer, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society of Dermatopathology, and International Society of Dermatology

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Warren R Heymann, MD  Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey

Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Bressler GS, Jones RE Jr. Erythema annulare centrifugum. J Am Acad Dermatol. May 1981;4(5):597-602. [Medline].

  2. Minni J, Sarro R. A novel therapeutic approach to erythema annulare centrifugum. J Am Acad Dermatol. Mar 2006;54(3 Suppl 2):S134-5. [Medline].

  3. Tsuji T, Kadoya A. Erythema annulare centrifugum associated with liver disease. Arch Dermatol. Nov 1986;122(11):1239-40. [Medline].

  4. Braunstein BL. Erythema annulare centrifugum and Graves' disease. Arch Dermatol. Sep 1982;118(9):623. [Medline].

  5. Shelley WB, Shelley ED. Erythema annulare centrifugum as the presenting sign of the hypereosinophilic syndrome: observations on therapy. Cutis. Jan 1985;35(1):53-5. [Medline].

  6. Sack DM, Carle G, Shama SK. Recurrent acute appendicitis with erythema annulare centrifugum. Arch Intern Med. Oct 1984;144(10):2090-2. [Medline].

  7. Mahood JM. Erythema annulare centrifugum: a review of 24 cases with special reference to its association with underlying disease. Clin Exp Dermatol. Jul 1983;8(4):383-7. [Medline].

  8. 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].

  9. 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. Aug 2002;47(2):311-3. [Medline].

  10. Rosina P, D'Onghia FS, Barba A. Erythema annulare centrifugum and pregnancy. Int J Dermatol. Aug 2002;41(8):516-7. [Medline].

  11. Burkhart CG. Erythema annulare centrifugum. A case due to tuberculosis. Int J Dermatol. Nov 1982;21(9):538-9. [Medline].

  12. White JW Jr. Gyrate erythema. Dermatol Clin. Jan 1985;3(1):129-39. [Medline].

  13. Borbujo J, de Miguel C, Lopez A, de Lucas R, Casado M. Erythema annulare centrifugum and Escherichia coli urinary infection. Lancet. Mar 30 1996;347(9005):897-8. [Medline].

  14. Hendricks AA, Lu C, Elfenbein GJ, Hussain R. Erythema annulare centrifugum associated with ascariasis. Arch Dermatol. Sep 1981;117(9):582-5. [Medline].

  15. Bessis D, Chraibi H, Guillot B, Guilhou JJ. Erythema annulare centrifugum induced by generalized Phthirus pubis infestation. Br J Dermatol. Dec 2003;149(6):1291. [Medline].

  16. Hammar H. Erythema annulare centrifugum coincident with Epstein-Barr virus infection in an infant. Acta Paediatr Scand. Sep 1974;63(5):788-92. [Medline].

  17. 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. Dec 2005;153(6):1241-3. [Medline].

  18. 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. Dec 2006;45(12):1423-5. [Medline].

  19. Hudson LD. Erythema annulare centrifugum: an unusual case due to hydroxychloroquine sulfate. Cutis. Aug 1985;36(2):129-30. [Medline].

  20. García-Doval I, Peteiro C, Toribio J. Amitriptyline-induced erythema annulare centrifugum. Cutis. Jan 1999;63(1):35-6. [Medline].

  21. Kuroda K, Yabunami H, Hisanaga Y. Etizolam-induced superficial erythema annulare centrifugum. Clin Exp Dermatol. Jan 2002;27(1):34-6. [Medline].

  22. 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. Sep 1975;93(3):341-5. [Medline].

  23. Leimert JT, Corder MP, Skibba CA, Gingrich RD. Erythema annulare centrifugum and Hodgkin's disease: association with disease activity. Arch Intern Med. Apr 1979;139(4):486-7. [Medline].

  24. 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. Jan 1993;32(1):59-61. [Medline].

  25. 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. Mar 2009;23(3):318-20. [Medline].

  26. Ioannidou D, Krasagakis K, Stefanidou M, Tosca A. Erythema annulare centrifugum and osteoarthritis treated with hyaluronic acid. Clin Exp Dermatol. Nov 2002;27(8):720-2. [Medline].

  27. Ibrahim SF, Pryor J, Tausk FA. Stress-induced erythema annulare centrifugum. Dermatol Online J. Apr 15 2009;15(4):15. [Medline].

  28. Dogan G. Pregnancy as a possible etiologic factor in erythema annulare centrifugum. Am J Clin Dermatol. 2009;10(1):33-5. [Medline].

  29. Cotterman C, Eckert L, Ackerman L. Syphilis mimicking tinea imbricata and erythema annulare centrifugum in an immunocompromised patient. J Am Acad Dermatol. Jul 2009;61(1):165-7. [Medline].

  30. 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].

  31. Gniadecki R. Calcipotriol for erythema annulare centrifugum. Br J Dermatol. Feb 2002;146(2):317-9. [Medline].

  32. 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. Feb 2007;58(2):146-8. [Medline].

  33. De Aloe G, Rubegni P, Risulo M, Sbano P, Poggiali S, Fimiani M. Erythema annulare centrifugum successfully treated with metronidazole. Clin Exp Dermatol. Sep 2005;30(5):583-4. [Medline].

 
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Arcuate lesions of erythema annulare centrifugum demonstrate minimal scale.
Superficial erythema annulare centrifugum demonstrates a central clearing and trailing scale behind an advancing, annular, erythematous border.
 
 
 
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