Erythema Annulare Centrifugum Clinical Presentation

Updated: Sep 05, 2018
  • Author: Marisel Peralta-Abejo, MD, DPDS; Chief Editor: William D James, MD  more...
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Presentation

History

Usually, patients with erythema annulare centrifugum (EAC) present with an asymptomatic or pruritic eruption of variable duration. The eruption may be associated with an underlying disease (eg, infection, malignancy, sarcoidosis, other systemic illness) and its accompanying characteristic symptoms (eg, night sweats, fever, and chills for tuberculosis or Hodgkin lymphoma). [32]

EAC may precede malignancy by 2 years or more, but it can also occur concomitantly or after diagnosis.

The temporal relationship to other underlying diseases, if any, is also variable. Obtain a history of any antecedent infections.

A history of recent initiation of a new drug should be ascertained because many reports of medication-associated erythema annulare centrifugum exist (most commonly antimalarials, cimetidine, spironolactone, gold, salicylates, piroxicam, penicillin, and amitriptyline).

One case report [27] has described EAC as a manifestation of autoimmune progesterone dermatitis in a female with a recurring annular pruritic eruption. She experienced monthly exacerbations of the eruption a few days prior to onset of menses. A similar hormonal etiology has been reported in the case of a woman who developed EAC in the 33rd week of pregnancy. [33] The eruption resolved 1 month after delivery, without recurrence after 8 months of follow-up.

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Physical Examination

Pertinent physical findings of erythema annulare centrifugum (EAC) are usually limited to the skin, but a full physical examination should be conducted to assess for an underlying systemic process.

Skin findings are as follows:

  • Primary lesion: The eruption begins as erythematous papules that spread peripherally while clearing centrally. These lesions enlarge at a rate of approximately 2-5 mm/d to produce annular, arcuate, figurate, circinate, or polycyclic plaques, as shown in the images below. The margin, which is usually indurated, varies in width from 4-6 mm, and, often, a trailing scale is present on the inner aspect of the advancing edge. The diameter of the polycyclic lesions varies from a few to several centimeters. Vesiculation may be present. Note the images below.
  • Arcuate lesions of erythema annulare centrifugum d Arcuate lesions of erythema annulare centrifugum demonstrate minimal scale.
  • Superficial erythema annulare centrifugum demonstr Superficial erythema annulare centrifugum demonstrates a central clearing and trailing scale behind an advancing, annular, erythematous border.
  • Distribution: Lesions demonstrate a predilection for the thighs and the legs, but they may occur on the upper extremities, the trunk, or the face. The palms and the soles are spared.
  • Color: The lesions are pink to red with central clear areas. Occasionally, residual hyperpigmentation of dull red, brown, or violet is present. A case of EAC associated with hyperbilirubinemia and jaundice secondary to choledocholithiasis has been reported.

Other findings are as follows:

  • Nails: White banding of the toenails has been reported in association with EAC.
  • Lymph nodes: Lymphadenopathy may be present in cases of EAC associated with Hodgkin or non-Hodgkin lymphoma, tuberculosis, or autoimmune processes.
  • Neck: The thyroid should be palpated for enlargement or nodules because Graves disease has been associated with EAC. [4]
  • Lungs: Tuberculosis, [34] lymphoma, sarcoidosis, and malignant bronchial carcinoid have been associated with EAC, warranting examination of the lungs.
  • Abdomen: Appendicitis, [6] lymphoma (with associated splenomegaly), and liver disease [3] (eg, cholelithiasis, hepatitis), and pregnancy have been reported with EAC. The abdomen should be examined for tenderness, masses, or hepatosplenomegaly.
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Complications

Unless erythema annulare centrifugum (EAC) is associated with an underlying disease, there are usually no complications.

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