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| FIGURE 1 | FIGURE 2 |
The physician diagnosed erythema annular centrifugum (EAC) in this patient. EAC has large, scaly, erythematous plaques (FIGURE 1), which begin as papules and spread peripherally with a central clearing forming a “trailing” scale (FIGURE 2). Pruritus is common, but not always present. A skin biopsy is not always needed, but can confirm clinical suspicion. Lesions are typically found in the lower extremities—particularly the thighs—but can be found on the trunk and face, as well.
EAC may begin at any age. The mean age of onset is 40 years, with no predilection for either sex. The mean duration of this skin condition is 2.8 years, but it may last between 4 weeks and more than 30 years.
While the etiology and pathogenesis of EAC are unknown, it has been associated with other conditions such as fungal infections, malignancy, and other systemic illnesses. A few case reports have noted a diagnosis of cancer 2 years after presentation of EAC.
Bacterial infections that have been identified as triggers include cystitis, appendicitis, and tuberculosis. Viral triggers include Epstein-Barr virus, molluscum contagiosum, and herpes zoster. Parasites such as ascaris have also been linked with EAC. Certain drugs such as chloroquine, hydroxychloroquine, estrogen, cimetidine, penicillin, salicylates, piroxicam, hydrochlorothiazide, and amitriptyline can also trigger EAC.
There is no proven treatment for EAC. Identifying and treating underlying medical conditions may help resolve the skin condition. Since EAC is seen in association with certain drugs, discontinuing the offending medication may resolve the problem. Topical corticosteroids have traditionally been used, but there is little evidence to support their use. Case reports have documented the benefits of using calcipotriol (Dovonex) daily for EAC.
In this case, the family physician (FP) explained that EAC is not contagious. Since topical steroids did not provide any relief for this patient in the past, the FP prescribed calcipotriol ointment.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Zaman S, Usatine R. Erythema annular centrifugum. In: Usatine R, Smith M, Mayeaux EJ, et al, eds.The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:886-889.
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