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Xiang W, Zhang S, Li Q, Zheng W. Treatment of eosinophilic annular erythema with upadacitinib. J DERMATOL TREAT 2025; 36:2490282. [PMID: 40326741 DOI: 10.1080/09546634.2025.2490282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Accepted: 03/11/2025] [Indexed: 05/07/2025]
Abstract
INTRODUCTION Eosinophilic ring erythema (EAE) is a rare eosinophilic dermatosis characterized by ring-shaped or arc-shaped papules and plaques, with eosinophilic infiltration throughout the dermis. Due to the rarity of EAE, established treatment guidelines are currently lacking. CASE REPORT In this report, we present a case of a middle-aged male patient with EAE who exhibited a poor response to systemic immunosuppressants but responded favorably to upadacitinib. CONCLUSION This case highlights the potential utility of upadacitinib in managing EAE, particularly in patients unresponsive to conventional therapies.
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Affiliation(s)
- Wanyan Xiang
- Department of Dermatology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Siqi Zhang
- Department of Dermatology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qiuju Li
- Department of Dermatology and Venereology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Wenjun Zheng
- Department of Dermatology and Venereology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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2
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Houpe J, Gibons R, Franklin M, Miller A, Schaffer A, Richardson SK. Refractory eosinophilic annular erythema responsive to dupilumab: A case report and review of the literature. JAAD Case Rep 2025; 59:117-121. [PMID: 40290796 PMCID: PMC12022400 DOI: 10.1016/j.jdcr.2025.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2025] Open
Affiliation(s)
- Jessica Houpe
- Department of Dermatology, University of Central Florida/HCA Healthcare Dermatology Residency Program, Tallahassee, Florida
| | - Rebecca Gibons
- Florida State University College of Medicine, Tallahassee, Florida
| | - Molly Franklin
- Department of Dermatology, Dermatology Associates of Tallahassee, Research and Practical Scholars Program, Tallahassee, Florida
| | - Austinn Miller
- Department of Dermatology, University of Central Florida/HCA Healthcare Dermatology Residency Program, Tallahassee, Florida
| | - Andras Schaffer
- Department of Dermatology, University of Central Florida/HCA Healthcare Dermatology Residency Program, Tallahassee, Florida
| | - Stephen K. Richardson
- Department of Dermatology, University of Central Florida/HCA Healthcare Dermatology Residency Program, Tallahassee, Florida
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3
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Castellanos-Molina V, García LAG, Cortés MM, Tamayo M. Eosinophilic Annular Erythema: Report of a Case and Successful Management. Int J Dermatol 2025. [PMID: 40248995 DOI: 10.1111/ijd.17801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2024] [Accepted: 04/09/2025] [Indexed: 04/19/2025]
Affiliation(s)
| | | | - Maddy Mejía Cortés
- Pontificia Universidad Javeriana - Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Margarita Tamayo
- Pontificia Universidad Javeriana - Hospital Universitario San Ignacio, Bogotá, Colombia
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4
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Bettolini L, Maione V, Bighetti S, Venturini M, Incardona P, Calzavara-Pinton P, Brunetti AP, Stabile G, Rongioletti F. Eosinophilic Annular Erythema: Clinicopathologic Analysis and Therapeutic Outcomes from a Multicenter Cohort. Dermatol Pract Concept 2025; 15:dpc.1502a5143. [PMID: 40401866 PMCID: PMC12090946 DOI: 10.5826/dpc.1502a5143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 05/23/2025] Open
Abstract
INTRODUCTION Eosinophilic annular erythema (EAE) is a rare dermatosis characterized by persistent pruritic erythematous annular plaques with dermal eosinophilic infiltrates. It typically has a chronic, relapsing course with variable treatment responses and frequent refractory cases. OBJECTIVES This retrospective multicenter study reports the clinical and histopathological features of EAE and the treatment outcomes in a case series of 10 patients. METHODS Ten patients with a confirmed clinical and histopathological diagnosis of EAE were referred to the Dermatology Departments of the University of Brescia and the University San Raffaele of Milan for evaluation and treatment. RESULTS The cohort included six females and four males, all Caucasian, with a median age of 56 years. Time from lesion onset to diagnosis ranged from two days to seven years. Patients exhibited annular, figurate, or polycyclic plaques with erythematous borders-dashed in 80% and centrally pigmented in 70% of cases. Intense itching was reported by 90%. Histopathology displayed dermal infiltrate primarily composed of lymphocytes with various numbers of eosinophils, ranging from scattered (10%) to abundant (40%) and numerous (50%). Treatment responses were variable, oral corticosteroids, either alone or in combination with hydroxychloroquine, being the most used therapies. However, flares frequently occurred following discontinuation of treatment. Dupilumab has shown promise in achieving long-term remission. CONCLUSION Most patients exhibited pruritic lesions with dashed borders and central pigmentation, strongly suggesting a diagnosis of EAE. The positive response to dupilumab in refractory cases, along with long-term follow-up, reinforces the growing body of scientific evidence from case reports documented in the literature.
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Affiliation(s)
- Luca Bettolini
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
- Faculty of Medicine and Surgery, University of Brescia, Brescia, Italy
| | - Vincenzo Maione
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Stefano Bighetti
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
- Faculty of Medicine and Surgery, University of Brescia, Brescia, Italy
| | - Marina Venturini
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
- Faculty of Medicine and Surgery, University of Brescia, Brescia, Italy
| | - Paolo Incardona
- Pathology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Piergiacomo Calzavara-Pinton
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
- Faculty of Medicine and Surgery, University of Brescia, Brescia, Italy
| | - Antonio Podo Brunetti
- Department of Clinical Dermatology, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Dermatology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giorgio Stabile
- Department of Clinical Dermatology, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Dermatology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Franco Rongioletti
- Department of Clinical Dermatology, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Dermatology, IRCCS San Raffaele Hospital, Milan, Italy
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5
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Janušonytė E, Kaya G, Menzinger S. Erythematous Annular and Polycyclic Lesions with Central Hyperpigmentation: A Quiz. Acta Derm Venereol 2025; 105:adv42532. [PMID: 39791513 PMCID: PMC11744705 DOI: 10.2340/actadv.v105.42532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Accepted: 12/03/2024] [Indexed: 01/12/2025] Open
Affiliation(s)
- Eglė Janušonytė
- Department of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland.
| | - Guerkan Kaya
- Department of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland
| | - Sébastien Menzinger
- Department of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland
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6
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Zheng C, Yu Y, Zhou G, Liu H. A case of generalized eosinophilic pustular folliculitis: treatment with JAK inhibitor. J DERMATOL TREAT 2024; 35:2331785. [PMID: 38531388 DOI: 10.1080/09546634.2024.2331785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/27/2024] [Indexed: 03/28/2024]
Abstract
AIM This case study aims to report the efficacy and safety of a Janus kinase (JAK) inhibitor in the treatment of generalized eosinophilic pustular folliculitis (EPF). METHODS We present a case of a 16-year-old Chinese patient who had been suffering from EPF for two years and had shown no response to both topical and systemic glucocorticoids. The patient was subsequently treated with oral tofacitinib at a dosage of 5mg daily. RESULTS Significant remission of eruption and pruritus was observed in the patient upon treatment with tofacitinib. However, a relapse occurred upon dose reduction. Subsequent switch to the highly selective JAK1 inhibitor upadacitinib resulted in complete recovery, with the patient achieving a symptom-free status after six months. CONCLUSIONS JAK inhibitors show promise as a potential treatment option for EPF patients who do not respond to traditional therapies.
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Affiliation(s)
- Chunzhi Zheng
- Hospital for Skin Diseases, Shandong First Medical University, Jinan, Shandong, China
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Yueqian Yu
- Hospital for Skin Diseases, Shandong First Medical University, Jinan, Shandong, China
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Guizhi Zhou
- Hospital for Skin Diseases, Shandong First Medical University, Jinan, Shandong, China
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Hong Liu
- Hospital for Skin Diseases, Shandong First Medical University, Jinan, Shandong, China
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China
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7
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Franceschin L, Guidotti A, Mazzetto R, Tartaglia J, Ciolfi C, Alaibac M, Sernicola A. Repurposing Historic Drugs for Neutrophil-Mediated Inflammation in Skin Disorders. Biomolecules 2024; 14:1515. [PMID: 39766222 PMCID: PMC11673839 DOI: 10.3390/biom14121515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 11/23/2024] [Accepted: 11/26/2024] [Indexed: 01/11/2025] Open
Abstract
Neutrophil-mediated inflammation is a key feature of immune-mediated chronic skin disorders, but the mechanistic understanding of neutrophil involvement in these conditions remains incomplete. Dapsone, colchicine, and tetracyclines are established drugs within the dermatologist's therapeutic armamentarium that are credited with potent anti-neutrophilic effects. Anti-neutrophilic drugs have established themselves as versatile agents in the treatment of a wide range of dermatological conditions. Some of these agents are approved for the management of specific dermatologic conditions, but most of their current uses are off-label and only supported by isolated reports or case series. Their anti-inflammatory and immunomodulatory properties make them particularly valuable in managing auto-immune bullous diseases, neutrophilic dermatoses, eosinophilic dermatoses, interface dermatitis, and granulomatous diseases that are the focus of this review. By inhibiting inflammatory pathways, reducing cytokine production, and modulating immune responses, they contribute significantly to the treatment and management of these complex skin conditions. Their use continues to evolve as our understanding of these diseases deepens, and they remain a cornerstone of dermatological therapy.
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Affiliation(s)
| | | | - Roberto Mazzetto
- Dermatology Unit, Department of Medicine (DIMED), University of Padua, 35121 Padova, Italy; (L.F.); (A.G.); (J.T.); (C.C.); (M.A.)
| | | | | | | | - Alvise Sernicola
- Dermatology Unit, Department of Medicine (DIMED), University of Padua, 35121 Padova, Italy; (L.F.); (A.G.); (J.T.); (C.C.); (M.A.)
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8
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López Sanz P, de Sande Rivera N, Guerrero Ramírez C, Manso Córdoba S, Rodríguez de Vera Guardiola C, Escario Travesedo E. A case of eosinophilic annular erythema as a presenting sign for primary biliary cholangitis. An Bras Dermatol 2024; 99:951-953. [PMID: 39112281 PMCID: PMC11551272 DOI: 10.1016/j.abd.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 10/26/2024] Open
Affiliation(s)
- Pablo López Sanz
- Department of Dermatology, University General Hospital of Albacete, Albacete, Castilla-La Mancha, Spain.
| | - Noelia de Sande Rivera
- Department of Gastroenterology and Hepatology, University General Hospital of Albacete, Albacete, Castilla-La Mancha, Spain
| | - Claudia Guerrero Ramírez
- Department of Dermatology, University General Hospital of Albacete, Albacete, Castilla-La Mancha, Spain
| | - Silvia Manso Córdoba
- Department of Dermatology, University General Hospital of Albacete, Albacete, Castilla-La Mancha, Spain
| | | | - Eduardo Escario Travesedo
- Department of Dermatology, University General Hospital of Albacete, Albacete, Castilla-La Mancha, Spain
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9
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Okazaki T, Takahashi T, Asano Y. Eosinophilic annular erythema successfully treated with dupilumab: A case report. J Dermatol 2024; 51:e249-e250. [PMID: 38366734 DOI: 10.1111/1346-8138.17158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 02/18/2024]
Affiliation(s)
- Toshiki Okazaki
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takehiro Takahashi
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshihide Asano
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
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10
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Maronese CA, Derlino F, Moltrasio C, Cattaneo D, Iurlo A, Marzano AV. Neutrophilic and eosinophilic dermatoses associated with hematological malignancy. Front Med (Lausanne) 2024; 10:1324258. [PMID: 38249974 PMCID: PMC10796805 DOI: 10.3389/fmed.2023.1324258] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Cutaneous manifestations of hematologic malignancy represent both a clinical challenge for the treating physician and a pathophysiological model for advancing the knowledge on individual neoplasms. Indeed, a growing body of evidence supports the concept of recurrent molecular defects associating with specific clinical features, as best exemplified by VEXAS. Herein neutrophilic and eosinophilic dermatoses of potential interest for both hematologists and dermatologists will be reviewed, including subcorneal pustular dermatosis-type IgA pemphigus, neutrophilic eccrine hidradenitis, Sweet's syndrome as well as myelodysplasia cutis and VEXAS, pyoderma gangrenosum, eosinophilic annular erythema, eosinophilic dermatosis of hematological malignancy, Wells syndrome and cutaneous involvement in hypereosinophilic syndromes. Possible management approaches are discussed for each, emphasizing scenarios that require treatment of the underlying condition to achieve remission at the skin level.
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Affiliation(s)
- Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Federica Derlino
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Cattaneo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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11
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Young JN, Chung J, Fett N. Eosinophilic Annular Erythema Responding to Doxycycline. Cureus 2023; 15:e47478. [PMID: 38022231 PMCID: PMC10660796 DOI: 10.7759/cureus.47478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
Eosinophilic annular erythema (EAE) is a rare skin disease characterized by relapsing and remitting pruritic, annular erythematous plaques and tissue eosinophilia. A 39-year-old male presented with a mildly pruritic, relapsing, and remitting urticarial rash. A biopsy revealed superficial and deep perivascular dermatitis with numerous eosinophils and some neutrophils, with an absence of flame figures. Based on clinical and histopathologic findings, the patient was given a diagnosis of eosinophilic annular erythema. Treatment was initiated with doxycycline 100 mg twice daily. The patient reported substantial improvement at three months and sustained clearance at one year, remaining on doxycycline well tolerated throughout. To our knowledge, no cases of EAE improving with doxycycline have been reported in the literature and, thus, our findings highlight a potential new therapy to consider in a patient with EAE.
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Affiliation(s)
- Jade N Young
- School of Medicine, Oregon Health and Science University School of Medicine, Portland, USA
| | - Jina Chung
- Department of Dermatology, Oregon Health and Science University School of Medicine, Portland, USA
| | - Nicole Fett
- Department of Dermatology, Oregon Health and Science University School of Medicine, Portland, USA
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12
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Lachance M, Vallée S, Gagné É. Vesiculobullous eosinophilic annular erythema: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231181024. [PMID: 37359280 PMCID: PMC10288418 DOI: 10.1177/2050313x231181024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/01/2023] [Indexed: 06/28/2023] Open
Abstract
Eosinophilic annular erythema is a rare eosinophilic dermatosis, characterized by arcuate erythematous urticarial plaques of unclear etiology. Vesiculobullous forms are even rarer, with only few cases described in the English literature. We report a case of vesiculobullous eosinophilic annular erythema with extensive cutaneous involvement poorly responsive to prednisone but showing complete remission with dapsone.
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Affiliation(s)
- Madeleine Lachance
- Department of Dermatology, CHU de Québec-Université Laval, Québec, QC, Canada
| | - Sheila Vallée
- Department of Dermatology, CHU de Québec-Université Laval, Québec, QC, Canada
| | - Éric Gagné
- Department of Pathology, CHU de Québec-Université Laval, Québec, QC, Canada
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13
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Kingsley JT, Lee EB, Adams JL. A case of annular erythema of infancy accompanied by elevated tryptase. Pediatr Dermatol 2022; 39:748-751. [PMID: 35859272 PMCID: PMC9795958 DOI: 10.1111/pde.15037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 05/02/2022] [Indexed: 12/30/2022]
Abstract
Annular erythema of infancy (AEI) is characterized by self-limited eruptions of erythematous, annular to polycyclic patches and plaques, the etiology of which is thought to involve a hypersensitivity reaction to an unknown antigen. We present a case of AEI mistaken for systemic mastocytosis due to elevated serum tryptase. We were unable to find prior reports of an association between AEI and elevated tryptase in the literature.
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Affiliation(s)
- Jacob T Kingsley
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Erica B Lee
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jennifer L Adams
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
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14
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Eljazouly M, Chahboun F, Alj M, Oqbani K, Chiheb S. Eosinophilic Annular Erythema: A New Entity of Eosinophilic Dermatosis. Cureus 2022; 14:e22657. [PMID: 35371819 PMCID: PMC8963823 DOI: 10.7759/cureus.22657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2022] [Indexed: 12/02/2022] Open
Abstract
Eosinophilic annular erythema (EAE) is a rare dermatosis. Its relationship with Wells syndrome (WS) is debated. We report a case treated with hydroxychloroquine. A 31-year-old patient presented with a mildly pruritic rash that had been evolving by flares for two weeks. Clinical examination revealed inflammatory erythematous-annular plaques on the trunk and limbs. The blood count was normal. Skin histology showed an eosinophilic-rich inflammatory infiltrate. After local steroid treatment, the patient was treated with oral steroids with a momentary improvement. The course with new relapses is treated by synthetic antimalarial drugs with the complete disappearance of the lesions at a six-month follow-up. Although some authors consider EAE to be a variant of WS, we believe that there are subtle differences that differentiate them despite their clinical similarity.
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