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Kluger N. Annular Erythemas and Purpuras. Life (Basel) 2023; 13:1245. [PMID: 37374026 DOI: 10.3390/life13061245] [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: 03/01/2023] [Revised: 05/13/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Annular dermatoses are a heterogeneous and extremely diverse group of skin diseases, which share in common annular, ring-like patterns with centrifugal spreading. Numerous skin diseases can sometimes display annular lesions, but some specific skin conditions are originally annular. We take the opportunity to review here mainly the causes of primary annular erythemas and their differential diagnoses, but also the rare causes of annular purpuras.
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Affiliation(s)
- Nicolas Kluger
- Department of Dermatology, Allergology and Venereology, Helsinki University Hospital & University of Helsinki, 00250 Helsinki, Finland
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2
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Maurelli M, Colato C, Gisondi P, Girolomoni G. Uncommon non-infectious annular dermatoses. Indian J Dermatol 2022; 67:313. [PMID: 36386081 PMCID: PMC9644792 DOI: 10.4103/ijd.ijd_743_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Several cutaneous diseases can present with annular lesions, making a distinction by physical appearance alone challenging. They can be distinguished into infectious and non-infectious, and common and uncommon annular dermatoses. Common non-infectious diseases include granuloma annulare, urticaria, and subacute lupus erythematosus. In addition, there are rare non-infectious non-neoplastic annular dermatoses whose nosographic attribution is established, including annually recurring erythema annulare centrifugum (EAC) and annular erythema in Sjögren syndrome and others whose nosographic positioning is still debated. They are neutrophilic figurate erythema, palpable migratory arciform erythema, eosinophilic annular erythema, and annular lichenoid dermatitis of youth. Their etiopathogenesis is largely unknown, although immune-mediated mechanisms are likely involved. It is difficult to establish if they are variants of reaction patterns or separate clinic-pathological entities. In fact, EAC and annually recurring EAC may represent different aspects of the same disease. Palpable migratory arciform erythema is hardly distinguishable from EAC deep type, Jessner-Kanof disease, and lupus tumidus. Neutrophilic figurate erythema and eosinophilic figurate erythema are clinically very similar and differing only in the relative proportion of eosinophils and neutrophils.
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3
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Chastagner M, Shourik J, Jachiet M, Battistella M, Lefevre G, Gibier JB, Aubert H, Musquer M, Descamps V, Deschamps L, Chosidow O, Ortonne N, Groh M, Bernier M, Jullien D, Chasset F, Staumont-Salle D, Bouaziz JD, Kanitakis J, Villani AP. Treatment of Eosinophilic Annular Erythema: Retrospective multicenter study and literature review. Ann Dermatol Venereol 2021; 149:123-127. [PMID: 34716028 DOI: 10.1016/j.annder.2021.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/21/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Eosinophilic annular erythema (EAE) is a rare eosinophil-related skin disease which typically manifests with annular erythematous plaques and severe pruritus. Besides the diagnosis, the treatment of EAE is challenging since relevant published data are sparse. METHODS The aim of this study was to assess the underlying diseases, treatments and outcomes of patients with EAE. To this end, we conducted a retrospective multicenter study and a systematic review of the MEDLINE database. RESULTS We included 18 patients with EAE followed in 8 centers. The MEDLINE database search yielded 37 relevant publications reporting 55 cases of EAE with 106 treatment sequences. The most common and efficient treatments included topical or systemic corticosteroids, hydroxychloroquine and dapsone. In refractory patients, a combination of systemic corticosteroids with hydroxychloroquine was associated with 88% of complete clinical response. DISCUSSION To improve the management of EAE patients, we discuss the following treatment strategy: in topical steroid-resistant patients, hydroxychloroquine can be given as first-line systemic treatment. Dapsone, hydroxychloroquine or systemic corticosteroids are second-line options to consider. Last, monoclonal antibodies or JAK inhibitors targeting type 2 inflammation could represent promising last-resort options in refractory patients.
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Affiliation(s)
- M Chastagner
- Department of Dermatology, CHU Lyon, Université Claude Bernard Lyon I, 69000 Lyon, France
| | - J Shourik
- Sorbonne université, Faculté de médecine, Service de Dermatologie et Allergologie, Hôpital Tenon, AP-HP, 75020 Paris, France
| | - M Jachiet
- Department of Dermatology, Hôpital Saint-Louis, AP-HP Université de Paris, 75010 Paris, France
| | - M Battistella
- Pathology Department, Hôpital Saint-Louis, AP-HP, Université de Paris, Inserm U976, 75010 Paris, France
| | - G Lefevre
- CEREO (National reference center for Hypereosinophilic Syndromes), 75010 Paris, France; Department of Internal Medicine, CHU Lille, 59000 Lille, France
| | - J-B Gibier
- Pathology Department, CHU Lille, 59000 Lille, France
| | - H Aubert
- Dermatology Department, CHU Nantes, 44000 Nantes, France
| | - M Musquer
- Pathology Department, CHU, 44000 Nantes, France
| | - V Descamps
- Dermatology Department, Hôpital Bichat, 75018 Paris, France
| | - L Deschamps
- Pathology Department, Hôpital Bichat, 75018 Paris, France
| | - O Chosidow
- Faculté de Santé de Créteil et Service de Dermatologie, APHP, Hôpital Henri-Mondor, Université Paris-Est, Créteil, France and Research Group Dynamic, EA7380, Faculté de Santé de Créteil, Ecole Nationale Vétérinaire d'Alfort, USC ANSES, Université Paris-Est Créteil, 94010 Créteil, France
| | - N Ortonne
- Pathology Department, Hôpital Mondor, CHU Créteil, 94010 Créteil, France
| | - M Groh
- CEREO (National reference center for Hypereosinophilic Syndromes), 75010 Paris, France; Department of Internal Medicine, Hôpital Foch, 92150 Suresnes, France
| | - M Bernier
- Pathology Department, Hôpital Foch, 92150 Suresnes, France
| | - D Jullien
- Department of Dermatology, CHU Lyon, Université Claude Bernard Lyon I, 69000 Lyon, France
| | - F Chasset
- Sorbonne université, Faculté de médecine, Service de Dermatologie et Allergologie, Hôpital Tenon, AP-HP, 75020 Paris, France
| | - D Staumont-Salle
- Department of Dermatology, CHU Lille, Inserm U1286 INFINITE (Institute for Translational Research in Inflammation), University Lille, 59000 Lille, France
| | - J-D Bouaziz
- Department of Dermatology, Hôpital Saint-Louis, AP-HP Université de Paris, 75010 Paris, France
| | - J Kanitakis
- Department of Dermatology, CHU Lyon, Université Claude Bernard Lyon I, 69000 Lyon, France
| | - A P Villani
- Department of Dermatology, CHU Lyon, Université Claude Bernard Lyon I, 69000 Lyon, France.
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4
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Wu J, Hu M, Sachsman SM. Annular Plaques in a Woman Receiving Systemic Immunotherapy. JAMA Dermatol 2021; 157:224-225. [PMID: 33295940 DOI: 10.1001/jamadermatol.2020.4810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jessica Wu
- David Geffen School of Medicine, University of California, Los Angeles
| | - Mengjun Hu
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Suzanne M Sachsman
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
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Wallis L, Gilson RC, Gilson RT. Dapsone for Recalcitrant Eosinophilic Annular Erythema: A Case Report and Literature Review. Dermatol Ther (Heidelb) 2017; 8:157-163. [PMID: 29222624 PMCID: PMC5825319 DOI: 10.1007/s13555-017-0214-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Indexed: 12/01/2022] Open
Abstract
Eosinophilic annular erythema (EAE) is a rare entity of unknown etiology that is possibly related to a hypersensitivity reaction and presents as annular erythematous plaques with tissue eosinophilia. It is classified as a figurate erythema with a controversial relationship to Wells syndrome (WS) in the literature, where it is generally considered a separate entity or subset based on clinical and histopathologic differences. EAE typically presents with recurrent, erythematous, arcuate, and annular plaques on the trunk and proximal extremities. The course of the disease is often chronic, recurrent, and relapsing. Responses to treatment are variable but are typically best with systemic steroids and antimalarials. We report a patient refractory to other therapies who had a striking response to dapsone.
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Affiliation(s)
- Luke Wallis
- UT Health Science Center San Antonio, San Antonio, TX, USA.
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Kieselova K, Santiago F, Cardoso JC, Cunha MF, Henrique M. Annular erythematous plaques on the trunk. Int J Dermatol 2017; 57:531-533. [PMID: 29197073 DOI: 10.1111/ijd.13842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 10/10/2017] [Accepted: 10/23/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Katarina Kieselova
- Department of Dermatology, Centro Hospitalar de Leiria, Leiria, Portugal
| | | | - José C Cardoso
- Department of Dermatology, Centro Hospitalar Universitário Coimbra, Coimbra, Portugal
| | - Maria F Cunha
- Department of Pathology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Martinha Henrique
- Department of Dermatology, Centro Hospitalar de Leiria, Leiria, Portugal
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Nakazato S, Fujita Y, Shinkuma S, Nomura T, Shimizu H. Eosinophilic annular erythema is clinically characterized by central pigmentation reflecting basal melanosis: a clinicopathological study of 10 cases. J Eur Acad Dermatol Venereol 2017; 31:1916-1923. [PMID: 28543605 DOI: 10.1111/jdv.14350] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 04/19/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Eosinophilic annular erythema (EAE) has been proposed as a clinical entity to describe annular skin lesions associated with tissue eosinophilia. However, systematic investigations on the histopathology of EAE have not been performed, and useful histopathological findings for diagnosis of EAE remain unknown. OBJECTIVE The aim of this study was to investigate the clinicopathological features of EAE. METHODS We retrospectively studied 10 patients at our hospital during a 5-year span who clinically showed annular or figurate lesions and histopathologically exhibited eosinophilic infiltration in the dermis. RESULTS Nine of the 10 cases had annular lesions with pigmentation on the interior side. Blood eosinophilia was found in only one patient. Histopathologically, basal melanosis was observed in nine cases. Infiltration of eosinophils was confined to the dermis in nine cases. Patients treated with systemic corticosteroid tended to show less recurrence than those treated with topical corticosteroid. LIMITATIONS The main limitation of our study is the small number of patients. CONCLUSION Skin biopsy should be performed when EAE is suspected, even in cases without blood eosinophilia. Basal melanosis and tissue eosinophilia confined to the dermis suggest the diagnosis of EAE. We recommend topical corticosteroids as the initial treatment for EAE.
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Affiliation(s)
- S Nakazato
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Y Fujita
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - S Shinkuma
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Nomura
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - H Shimizu
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Karataş Toğral A, Seçkin D. Eosinophilic annular erythema: A late but complete response to hydroxychloroquine. Australas J Dermatol 2016; 58:228-230. [PMID: 26768795 DOI: 10.1111/ajd.12445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/24/2015] [Indexed: 11/30/2022]
Abstract
A 69-year-old woman with a 12-month history of asymptomatic erythematous, non-scaly, annular and arciform plaques on her face, trunk and extremities is presented. The skin lesions had been unresponsive to treatment with systemic corticosteroids and antihistamines. Skin biopsy demonstrated superficial and deep dermal inflammatory infiltration consisting mainly of eosinophils and a few neutrophils. Dermal interstitial mucin deposition was also detected in the absence of vasculitis, flame figures or granulomatous reaction. The patient was diagnosed as having eosinophilic annular erythema and treated with hydroxychloroquine (2 × 200 mg/day, p.o.). Response to treatment was observed after 7 weeks and full recovery was achieved after 10 weeks. Eosinophilic annular erythema is rarely reported in the literature. Although hydroxychloroquine is a good choice for treatment, response time can vary between patients.
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Affiliation(s)
- Arzu Karataş Toğral
- Department of Dermatology, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Deniz Seçkin
- Department of Dermatology, Başkent University Faculty of Medicine, Ankara, Turkey
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Powell MR, Shaughnessy KK, Davis LS. Chronic and generalized figurate erythema. Int J Dermatol 2015; 55:617-9. [PMID: 26474919 DOI: 10.1111/ijd.12985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/18/2015] [Accepted: 01/20/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Matthew R Powell
- Division of Dermatology, Medical College of Georgia at Georgia Regents University, Augusta, GA, USA
| | - Kerry K Shaughnessy
- Division of Dermatology, Medical College of Georgia at Georgia Regents University, Augusta, GA, USA
| | - Loretta S Davis
- Division of Dermatology, Medical College of Georgia at Georgia Regents University, Augusta, GA, USA
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Thomas L, Fatah S, Nagarajan S, Natarajan S. Eosinophilic annular erythema: successful response to ultraviolet B therapy. Clin Exp Dermatol 2015; 40:883-6. [PMID: 25958878 DOI: 10.1111/ced.12668] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2014] [Indexed: 11/30/2022]
Abstract
Eosinophilic annular erythema (EAE) is a rare and relatively newly described eosinophil-rich dermatosis. Debate still exists as to whether it represent a subtype of Well syndrome or a separate disease entity. We report an 8-year-old boy with a 4-year history of recurrent, asymptomatic annular lesions, which were diagnosed after clincopathological correlation as EAE. This condition usually runs a relapsing and remitting course with resistance to multiple treatments. Prednisolone and hydroxychloroquine have been reported as successful but the response to these was limited in this case. Complete resolution occurred after treatment with ultraviolet B (UVB) therapy. To our knowledge, this is the first report of a favourable response of EAE to such therapy.
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Affiliation(s)
- L Thomas
- Department of Dermatology, James Cook University Hospital, Middlesbrough, UK
| | - S Fatah
- Department of Dermatology, James Cook University Hospital, Middlesbrough, UK
| | - S Nagarajan
- Department of Histopathology, James Cook University Hospital, Middlesbrough, UK
| | - S Natarajan
- Department of Dermatology, James Cook University Hospital, Middlesbrough, UK
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González-López MA, López-Escobar M, Fernández-Llaca H, González-Vela MC, López-Brea M. Eosinophilic annular erythema in a patient with metastatic prostate adenocarcinoma. Int J Dermatol 2014; 54:e80-2. [DOI: 10.1111/ijd.12640] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Marcos A. González-López
- Department of Dermatology; Marqués de Valdecilla University Hospital; University of Cantabria; Santander Spain
| | - María López-Escobar
- Department of Dermatology; Marqués de Valdecilla University Hospital; University of Cantabria; Santander Spain
| | - Héctor Fernández-Llaca
- Department of Dermatology; Marqués de Valdecilla University Hospital; University of Cantabria; Santander Spain
| | - M. Carmen González-Vela
- Department of Pathology; Marqués de Valdecilla University Hospital; University of Cantabria; Santander Spain
| | - Marta López-Brea
- Department of Oncology; Marqués de Valdecilla University Hospital; University of Cantabria; Santander Spain
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