Erythema annulare centrifugum
- M. Tye Haeberle, MD
M. Tye Haeberle, MD
- Clinical Instructor
- Division of Dermatology, University of Louisville
Erythema annulare centrifugum (EAC) is a chronic, reactive phenomenon of the skin presenting with arcuate or annular patches or thin plaques that frequently exhibit trailing scale (picture 1A-D). EAC has been reported to occur in association with a wide variety of conditions, including infections, drug exposures, food exposures, autoimmune disease, and malignancy. EAC also may occur in the absence of an identifiable exposure or disease.
The clinical features, diagnosis, and management of EAC are reviewed here. An overview of cutaneous annular eruptions is provided separately. (See "Approach to the patient with annular skin lesions".)
The pathogenesis of EAC is unclear. EAC is thought to be a delayed-type hypersensitivity response to a wide variety of antigens, with the specific trigger dependent upon an underlying disease process or exposure. In support of this hypothesis, cultured lymphocytes from a woman with progesterone-induced EAC exhibited a marked increase in interferon-gamma release upon in vitro exposure to progesterone . In addition, the rapid response of EAC to the tumor necrosis factor inhibitor etanercept described in a case report suggests a delayed-type hypersensitivity reaction pattern .
In many patients, a specific trigger for EAC cannot be identified. However, numerous reports have cited conditions such as diseases, medication exposures, food exposures, and stress as triggers for EAC . Data are insufficient to confirm a causative relationship. Case series have yielded the following findings:
●In a retrospective study of 66 patients with EAC, 48 (72 percent) had a concomitant disease . The most common associated disease was cutaneous fungal infection, which accounted for 48 percent of associated diseases. Other associations included other skin diseases (18 percent), internal malignancies (13 percent), and other systemic diseases (21 percent).
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