Erythema perstans

Erythema annulare centrifugum: Description, Causes and Risk Factors:A chronic, expanding, recurring erythematous eruption consisting of small and large annular lesions, with a scant marginal scale and central clearing, usually of unknown cause.Erythema annulare centrifugum (EAC) is the most common form of gyrate erythemas. EAC has been considered to be related to various etiological factors including infections, immunological disorders, malignancy, drugs and foods.Causes and Risk Factors:Infection: Chronic dermatophyte infections, intestinal Candida albicans, molluscum contagiosum, EBV, genital herpes, Q fever, urinary system infections, tuberculosis, ascariasis.
  • Malignancy: Erythema annulare centrifugum can be considered an uncommon but genuine paraneoplastic sign. Bronchial, prostate, nasopharyngeal, ovarian, rectal and hepatic tumors, lymphoma and leukemia are examples.
  • Hematologic conditions: Polycythemia vera, myelodysplastic syndrome, hypereosinophilic syndrome, cryoglobulinemia.
  • Endocrinologic conditions: Hyperthyroidism, Hashimoto thydroiditis, autoimmune progesterone dermatitis.
  • Other: Hepatic disease, after biliary duct surgery.
  • Food allergies.
  • Drug reactions.
Both men and women are equally affected by EAC, and the disorder can develop at any age. The exact prevalence is unknown. The disease is more common in Caucasians.Symptoms:Erythema annulare centrifugumErythematous macules or urticarial papules appear first and eventually spread to form annular shapes with central clearing.
  • Vesiculation may be rarely seen.
  • Lymphadenopathy may be present in cases of EAC associated with Hodgkin or non-Hodgkin lymphoma, tuberculosis, or autoimmune processes.
  • The lesions tend to appear on the body and proximal parts of the extremities.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.
Diagnosis:A complete blood count with differential can be used to determine a suspected underlying infection (neutrophilia with bacterial infection; eosinophilia with parasitic infection or hypereosinophilic syndrome).Other Tests:Skin scrapings from lesional sites of EAC should be analyzed after preparation in potassium hydroxide (KOH) to ascertain the presence or the absence of hyphae suggestive of tinea or Candidiasis.
  • Lyme antibody titer is needed to exclude erythema migrans.
  • An antinuclear antibody (ANA) test should be performed in the appropriate clinical setting. Systemic lupus erythematosus is in the differential diagnosis of EAC, and Sj

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