AUTHOR AND EDITOR INFORMATION

Section 1 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

INTRODUCTION

Section 2 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Background

Erythema annulare centrifugum (EAC) is classified as one of the figurate or gyrate erythemas. First described by Darier in 1916, it is characterized by a scaling or nonscaling, nonpruritic, annular or arcuate, erythematous eruption. It tends to spread peripherally while clearing centrally. Histologically, an intense lymphohistiocytic cuffing occurs about the superficial and deep dermal vessels without epidermal involvement. The etiology is uncertain, but it may be due to a hypersensitivity to malignancy, infection, drugs, or chemicals, or it may be idiopathic.

Controversy exists in the classification of the gyrate erythemas, and the literature is wrought with ambiguity and contradictions. Since its initial description in 1916, the term erythema annulare centrifugum has grown to include several histologic and clinical variants. Ackerman, and later Bressler and Jones,¹ suggested a classification in which only 2 types of gyrate erythema are considered: superficial (pruritic, scaling) and deep (nonpruritic, nonscaling). The original description of EAC was of the latter type. However, the superficial type is more commonly seen with its characteristic trailing scale behind an advancing, erythematous border.

In this article, EAC is considered to include all the gyrate erythemas, except for erythema marginatum rheumaticum, erythema chronicum migrans, and erythema gyratum repens. When taken in this broad sense, EAC can be scaly or nonscaly, pruritic or nonpruritic, and rarely vesicular.

Other eMedicine erythema articles include the following:

• Erythema Ab Igne
• Erythema Dyschromicum Perstans
• Erythema Elevatum Diutinum
• Erythema Gyratum Repens
• Erythema Induratum (Nodular Vasculitis)
• Erythema Infectiosum (Fifth Disease)
• Erythema Multiforme
• Erythema Nodosum
• Erythema Toxicum Neonatorum

Pathophysiology

The pathogenesis of erythema annulare centrifugum (EAC) is unknown, but it is probably due to a hypersensitivity reaction to a variety of agents, including drugs, arthropod bites, infections (bacterial, mycobacterial, viral, fungal, filarial), ingestion (blue cheese Penicillium), and malignancy. Injections of Trichophyton, Candida, tuberculin, and tumor extracts have been reported to induce EAC, supporting a type IV hypersensitivity reaction as at least one mechanism for its development. Another purported mechanism in the pathogenesis of EAC is that of a Th1-mediated reaction with elevated levels of tumor necrosis factor-alpha and associated proinflammatory cytokines. Minni and Sarro² reported response to (and relapse following cessation of) etanercept in a 57-year-old white man as evidence supporting this theory.

Other cases of erythema annulare centrifugum have been found in association with an underlying systemic or infectious disease (eg, liver disease,³ Sjögren syndrome, systemic lupus erythematosus, Graves disease,⁴ hypereosinophilic syndrome,⁵ appendicitis⁶), herpes zoster, chronic lymphocytic leukemia, and HIV. Drugs reported to cause EAC include finasteride, piroxicam, hydroxychloroquine, amitriptyline, and spironolactone. Still other cases have been attributable to a familial form. However, in most cases, no underlying cause can be found. One study of 24 cases of EAC with special reference to its association with an underlying disease found no increased incidence of systemic disease, malignancy, or infection.⁷ In another study of 113 cases of gyrate erythemas, 7 cases (none of which was erythema gyratum repens) were associated with internal malignancy compared with 6 cases in the control group.

Hypotheses about the mechanism of annularity focus on the interaction between mediators of inflammation and ground substance as foreign antigens diffuse through the skin.

Frequency

International

Defining the incidence and the prevalence of erythema annulare centrifugum (EAC) is difficult because the literature mostly consists of case reports and brief reviews. In a review of 24 cases in England, the incidence was reported to be approximately 1 case per 100,000 population per year in a catchment area of 500,000 people.

Mortality/Morbidity

The mean duration of erythema annulare centrifugum (EAC) is 11 months. However, the course has ranged from 4-6 weeks to 34 years (recurrent attacks). Most cases require no treatment and resolve spontaneously. Others have been reported in association with malignancy, with the eruptions responding to treatment of the underlying neoplasm. In those cases, the prognosis is affected by the underlying malignancy.

Race

Whether any racial predilection exists for erythema annulare centrifugum (EAC) is not known.

Sex

No bias for either sex is apparent.

Age

Erythema annulare centrifugum (EAC) has been reported in patients from infancy to the ninth decade of life.

CLINICAL

Section 3 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

History

• Usually, patients with erythema annulare centrifugum (EAC) present with an asymptomatic or pruritic eruption of variable duration. The eruption may be associated with an underlying disease (eg, infection, malignancy, sarcoidosis, other systemic illness) and its accompanying characteristic symptoms (eg, night sweats, fever, and chills for tuberculosis or Hodgkin lymphoma).
• EAC may precede malignancy by 2 years or more, but it can also occur concomitantly or after diagnosis.
• The temporal relationship to other underlying diseases, if any, is also variable. Obtain a history of any antecedent infections.
• A history of recent initiation of a new drug should be ascertained because many reports of medication-associated erythema annulare centrifugum exist (most commonly antimalarials, cimetidine, spironolactone, gold, salicylates, piroxicam, penicillin, and amitriptyline).
• One case report⁸ has described EAC as a manifestation of autoimmune progesterone dermatitis in a female with a recurring annular pruritic eruption. She experienced monthly exacerbations of the eruption a few days prior to onset of menses. A similar hormonal etiology has been reported in the case of a woman who developed EAC in the 33rd week of pregnancy.⁹ The eruption resolved 1 month after delivery, without recurrence after 8 months of follow-up.

Physical

Pertinent physical findings of erythema annulare centrifugum (EAC) are usually limited to the skin, but a full physical examination should be conducted to assess for an underlying systemic process.

• Skin
• • Primary lesion: The eruption begins as erythematous papules that spread peripherally while clearing centrally. These lesions enlarge at a rate of approximately 2-5 mm/d to produce annular, arcuate, figurate, circinate, or polycyclic plaques. The margin, which is usually indurated, varies in width from 4-6 mm, and, often, a trailing scale is present on the inner aspect of the advancing edge. The diameter of the polycyclic lesions varies from a few to several centimeters. Vesiculation may be present.
  • Distribution: Lesions demonstrate a predilection for the thighs and the legs, but they may occur on the upper extremities, the trunk, or the face. The palms and the soles are spared.
  • Color: 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.
• Nails: White banding of the toenails has been reported in association with EAC.
• Lymph nodes: Lymphadenopathy may be present in cases of EAC associated with Hodgkin or non-Hodgkin lymphoma, tuberculosis, or autoimmune processes.
• Neck: The thyroid should be palpated for enlargement or nodules because Graves disease has been associated with EAC.⁴
• Lungs: Tuberculosis,¹⁰ lymphoma, sarcoidosis, and malignant bronchial carcinoid have been associated with EAC, warranting examination of the lungs.
• Abdomen: Appendicitis,⁶ lymphoma (with associated splenomegaly), and liver disease³ (eg, cholelithiasis, hepatitis), and pregnancy have been reported with EAC. The abdomen should be examined for tenderness, masses, or hepatosplenomegaly.

Causes

Most commonly, no cause is found for the erythema annulare centrifugum (EAC).¹¹ However, the literature contains numerous case reports documenting association with other diseases. Often, the eruption of EAC resolves after treatment of the underlying illness.

• Infections
• • Bacteria: Associations include Escherichia coli. One case associated EAC with a urinary tract infection that cleared 3 weeks after treatment of the urinary tract infection.¹² Other associated bacterial infections include streptococcal infections (eg, bacterial meningitis.
  • Fungi: Dermatophytes (Trichophyton, tinea pedis, Pityrosporum orbiculare/Malassezia furfur) are associated, as is Candida albicans and blue cheese Penicillium.
  • Mycobacteria: Mycobacterium tuberculosis is associated. Treatment with isoniazid, rifampin, and streptomycin cleared the eruption of EAC within 20 day of starting therapy for tuberculosis in a patient.
  • Parasites: These include Ascaris lumbricoides¹³; EAC resolved after treatment with piperazine and thiabendazole. Also, EAC has been reported in association with Phthirus pubis infestation.¹⁴
  • Viruses: EAC has been reported in association with Epstein-Barr virus (EBV) in an infant¹⁵ and with molluscum contagiosum in an 8-year-old child. In the infant, the appearance and subsequent resolution of the eruption coincided with the patient's anti-EBV antibody titer, supporting EBV as the inciting agent. In addition, the viral genome has been found in the DNA of Reed-Sternberg cells in patients with Hodgkin disease and in patients with nasopharyngeal carcinoma. Both of these neoplasms have been associated with EAC. Two cases of EAC were reported in a dermatomal distribution within the exact distributions of recent prior herpes zoster infections. These cases were cited as examples of "Wolf's isotopic response."¹⁶ In 2006, erythema annulare centrifugum (EAC) was reported in an HIV-positive patient.¹⁷
• Drugs: In each of the following cases, the eruption of EAC appeared after initiation of the drug and resolved after its cessation. In the cases of the antimalarials chloroquine and hydroxychloroquine, the eruptions took 5 months to a year to clear, believed to be secondary to their strong DNA-binding properties and affinity for melanin.
• • Finasteride
  • Chloroquine
  • Hydroxychloroquine¹⁸
  • Estrogen
  • Cimetidine
  • Penicillin
  • Salicylates
  • Piroxicam
  • Hydrochlorothiazide
  • Gold sodium thiomalate
  • Amitriptyline¹⁹
  • Etizolam²⁰
• Neoplasms: In each of the following cases, EAC resolved with successful treatment of the malignancy but relapsed with tumor recurrence in the cases of Hodgkin disease, acute myelogenous leukemia (AML), and squamous cell carcinoma in a sebaceous cyst. However, in the latter case, EAC cleared in the terminal stage of the disease. This was purported to be due to immune compromise with tumor progression.
• • Squamous cell carcinoma (in a sebaceous cyst)
  • Nasopharyngeal carcinoma
  • Acute myelogenous leukemia
  • Peritoneal carcinomatosis
  • Primary bronchial carcinoid²¹
  • Hodgkin lymphoma^{22, 23}
  • Chronic lymphocytic leukemia
  • Multiple myeloma
  • Prostate cancer
  • Malignant histiocytosis
  • Ovarian carcinoma (mucinous)
• Foods: Blue cheese and tomatoes have been reported to cause EAC.
• Other causes
• • Recurrent acute appendicitis: The lesions of EAC resolved 1 month after appendectomy.⁶
  • Cholestatic liver disease (secondary to choledocholithiasis): EAC resolved within 3 days of removal of the stone.³
  • Graves disease: The patient's eruption disappeared 2 weeks after treatment with I-131 for thyroid ablation.⁴
  • Menstruation: A case has been reported of a woman with EAC whose lesions stopped progressing premenstrually and enlarged again with the onset of menses. Another patient experienced exacerbations of EAC premenstrually as a type of autoimmune progesterone dermatitis.⁸
  • Hypereosinophilic syndrome: A patient with 31% eosinophilia (with no underlying cause found), pruritus, and EAC was treated with ketoconazole, dapsone, and trimethoprim-sulfamethoxazole with resolution of the eruption occurring after 2 weeks.⁵
  • Sjögren syndrome
  • Sarcoidosis: EAC was reported in association with underlying systemic sarcoidosis.
  • Osteoarthritis: A 73-year-old man with an 11-week history of EAC that was associated with the onset of left knee osteoarthritis received injections of intra-articular hyaluronic acid that effected resolution of both his osteoarthritis and the EAC.²⁴

DIFFERENTIALS

Section 4 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Other Problems to be Considered

• Annular urticaria
• Benign lymphocytic infiltrate
• Erythema migrans: These lesions are typically less numerous, less circinate in configuration, and often accompanied by a history of a tick bite (Ixodes scapularis).
• Erythema gyratum repens: EAC can be distinguished from this condition by its slower rate of spread (weeks rather than days) and by its less bizarre configuration. Also, erythema gyratum repens is almost always associated with an underlying malignancy.
• Erythema marginatum rheumaticum: This is a nonscaling gyrate erythema that by definition is found in association with rheumatic fever (10-18% of patients with rheumatic fever). The rate of spread is measurable in hours, and the skin infiltrate is neutrophilic as opposed to lymphohistiocytic.
• Facial granuloma
• Subacute cutaneous lupus erythematosus (annular variant): These lesions tend to coalesce and can be accompanied by central hypopigmentation and telangiectasias.

WORKUP

Section 5 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Lab Studies

• Skin scrapings from lesional sites of erythema annulare centrifugum (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 test should be performed in the appropriate clinical setting. Systemic lupus erythematosus is in the differential diagnosis of EAC, and Sjögren syndrome has been reported in association with EAC.
• A purified protein derivative (PPD) test and an anergy panel can be used to determine if an underlying M tuberculosis infection is present.
• 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).
• If compatible with the clinical presentation of erythema annulare centrifugum, liver function studies may be useful because hyperbilirubinemia secondary to cholestasis and elevated transaminase levels secondary to hepatitis have been reported with EAC.
• With an appropriate history of gastrointestinal complaints, a stool examination may be useful to search for ova and parasites (ascariasis has been reported with EAC).
• For females, serum or urine beta-human chorionic gonadotropin testing may be indicated.

Imaging Studies

• Chest radiography can be used to exclude pulmonary nodules or hilar adenopathy suggestive of tuberculosis, malignancy (primary or metastatic), sarcoidosis, or lymphoma, all of which have been associated with EAC.

Procedures

• A skin punch biopsy may be performed.

Histologic Findings

A biopsy is helpful in confirming a diagnosis of EAC. Two histologic subtypes exist: deep and superficial. In the classic or deep type, an intense, superficial and deep lymphocytic or lymphohistiocytic perivascular infiltrate in a coat-sleeve fashion is observed in the middle and lower dermis. No epidermal changes are observed. Clinically, these erythema annulare centrifugum (EAC) lesions have indurated borders and are nonscaly and nonpruritic.

In the superficial type of erythema annulare centrifugum, a more nonspecific perivascular lymphohistiocytic infiltrate about the superficial dermal vessels and edema of the papillary dermis is present. The epidermal changes of parakeratosis and spongiosis may be present. Clinically, these lesions have a scale, may be pruritic, and may have vesiculations.

TREATMENT

Section 6 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Medical Care

EAC is usually self-limited. Topical steroids usually cause involution of the treated lesions, but they do not prevent the occurrence of new lesions or recurrence of the eruption. Systemic or injection steroid therapy is effective, but the eruption returns once these drugs are withdrawn. As previously mentioned, several cases of EAC have resolved once the underlying diseases were treated. Therefore, a search for and treatment of the underlying disorder is the primary therapy. However, an exhaustive workup for occult malignancy is not warranted because the relationship between EAC and cancer is not consistent. Remember that no cause is found in most cases.

The patient's medications should be reviewed with particular attention to and discontinuation of the drugs known to be associated with EAC. Recent additions to the patient's drug regimen should be eliminated, and the patient should be observed for signs of resolution.

In a case of EAC associated with hypereosinophilic syndrome, the eruption resolved after treatment with ketoconazole, dapsone, and trimethoprim-sulfamethoxazole.⁵

A case of EAC of infantile onset in the French literature documents dramatic improvement with interferon alpha therapy.²⁵

Case reports have documented success in the treatment of EAC with drugs previously unreported to be useful for EAC.

• Hyaluronic acid: A 73-year-old man with an 11-week history of EAC that was associated with the onset of left knee osteoarthritis received injections of intra-articular hyaluronic acid that effected improvement of his osteoarthritis and resolution of his EAC.²⁴
• Calcipotriol: A case of EAC of 3 years' duration in a 73-year-old woman responded to calcipotriol after the patient did not respond to topical and systemic corticosteroids, antifungals, and psoralen with UV-A therapy. The eruption cleared completely after 3 months of treatment with calcipotriol.²⁶ One report also described EAC responding to combination calcipotriol and narrow-band UVB.²⁷
• Metronidazole: A 38-year-old man with a 2-year history of EAC for which an underlying cause could not be found and that failed to respond to systemic antibiotics (ie, ciprofloxacin, clarithromycin), antifungal agents (ie, itraconazole, terbinafine), and topical calcipotriol did respond to oral metronidazole. The drug had been given to treat papulopustular rosacea. His EAC was coincidentally found to resolve, as did his rosacea, after 1 month of therapy. No recurrence of EAC was noted after 1 year of follow-up. A possible causal relationship between rosacea and EAC was postulated in the report.²⁸
• Etanercept: A 57-year-old man with erythema annulare centrifugum, unsuccessfully treated previously with narrow-band UVB, topical steroids, and methotrexate, responded with complete resolution of his eruption after 4 weeks of therapy with etanercept at 25 mg SQ twice weekly. The erythema annulare centrifugum eruption recurred upon cessation of etanercept therapy and resolved again with resumption of therapy.²

Consultations

• Consult a dermatologist for diagnosis and evaluation of the underlying cause of EAC.
• Consult an internal medicine specialist for evaluation of the underlying cause of EAC.

MEDICATION

Section 7 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

The goals of pharmacotherapy for erythema annulare centrifugum (EAC) are to reduce morbidity and to prevent complications.

Drug Category: Corticosteroids

Topical agents are used for treatment of inflammatory lesions of EAC and for symptomatic relief of pruritus. A short course of systemic steroid therapy may be considered for very symptomatic cases of EAC (eg, severe pruritus).

FOLLOW-UP

Section 8 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Prognosis

• The prognosis for erythema annulare centrifugum (EAC) is excellent, except when associated with an underlying malignancy and other systemic disease.

MISCELLANEOUS

Section 9 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Medical/Legal Pitfalls

• Failure to make the diagnosis of erythema annulare centrifugum (EAC) is a pitfall. Underlying diseases should be ruled out.

MULTIMEDIA

Section 10 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Media file 1:  Arcuate lesions of erythema annulare centrifugum demonstrate minimal scale.
	View Full Size Image
Media type:  Photo

Media file 2:  Superficial erythema annulare centrifugum demonstrates a central clearing and trailing scale behind an advancing, annular, erythematous border.
	View Full Size Image
Media type:  Photo

REFERENCES

Section 11 of 11

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

1. Bressler GS, Jones RE Jr. Erythema annulare centrifugum. J Am Acad Dermatol. May 1981;4(5):597-602. [Medline].
2. Minni J, Sarro R. A novel therapeutic approach to erythema annulare centrifugum. J Am Acad Dermatol. Mar 2006;54(3 Suppl 2):S134-5. [Medline].
3. Tsuji T, Kadoya A. Erythema annulare centrifugum associated with liver disease. Arch Dermatol. Nov 1986;122(11):1239-40. [Medline].
4. Braunstein BL. Erythema annulare centrifugum and Graves' disease. Arch Dermatol. Sep 1982;118(9):623. [Medline].
5. Shelley WB, Shelley ED. Erythema annulare centrifugum as the presenting sign of the hypereosinophilic syndrome: observations on therapy. Cutis. Jan 1985;35(1):53-5. [Medline].
6. Sack DM, Carle G, Shama SK. Recurrent acute appendicitis with erythema annulare centrifugum. Arch Intern Med. Oct 1984;144(10):2090-2. [Medline].
7. Mahood JM. Erythema annulare centrifugum: a review of 24 cases with special reference to its association with underlying disease. Clin Exp Dermatol. Jul 1983;8(4):383-7. [Medline].
8. Halevy S, Cohen AD, Lunenfeld E, Grossman N. Autoimmune progesterone dermatitis manifested as erythema annulare centrifugum: Confirmation of progesterone sensitivity by in vitro interferon-gamma release. J Am Acad Dermatol. Aug 2002;47(2):311-3. [Medline].
9. Rosina P, D'Onghia FS, Barba A. Erythema annulare centrifugum and pregnancy. Int J Dermatol. Aug 2002;41(8):516-7. [Medline].
10. Burkhart CG. Erythema annulare centrifugum. A case due to tuberculosis. Int J Dermatol. Nov 1982;21(9):538-9. [Medline].
11. White JW Jr. Gyrate erythema. Dermatol Clin. Jan 1985;3(1):129-39. [Medline].
12. Borbujo J, de Miguel C, Lopez A, de Lucas R, Casado M. Erythema annulare centrifugum and Escherichia coli urinary infection. Lancet. Mar 30 1996;347(9005):897-8. [Medline].
13. Hendricks AA, Lu C, Elfenbein GJ, Hussain R. Erythema annulare centrifugum associated with ascariasis. Arch Dermatol. Sep 1981;117(9):582-5. [Medline].
14. Bessis D, Chraibi H, Guillot B, Guilhou JJ. Erythema annulare centrifugum induced by generalized Phthirus pubis infestation. Br J Dermatol. Dec 2003;149(6):1291. [Medline].
15. Hammar H. Erythema annulare centrifugum coincident with Epstein-Barr virus infection in an infant. Acta Paediatr Scand. Sep 1974;63(5):788-92. [Medline].
16. Lee HW, Lee DK, Rhee DY, Chang SE, Choi JH, Moon KC, et al. Erythema annulare centrifugum following herpes zoster infection: Wolf's isotopic response?. Br J Dermatol. Dec 2005;153(6):1241-3. [Medline].
17. González-Vela MC, González-López MA, Val-Bernal JF, Echevarría S, Arce FP, Fernández-Llaca H. Erythema annulare centrifugum in a HIV-positive patient. Int J Dermatol. Dec 2006;45(12):1423-5. [Medline].
18. Hudson LD. Erythema annulare centrifugum: an unusual case due to hydroxychloroquine sulfate. Cutis. Aug 1985;36(2):129-30. [Medline].
19. García-Doval I, Peteiro C, Toribio J. Amitriptyline-induced erythema annulare centrifugum. Cutis. Jan 1999;63(1):35-6. [Medline].
20. Kuroda K, Yabunami H, Hisanaga Y. Etizolam-induced superficial erythema annulare centrifugum. Clin Exp Dermatol. Jan 2002;27(1):34-6. [Medline].
21. Everall JD, Dowd PM, Ardalan B. Unusual cutaneous associations of a malignant carcinoid tumour of the bronchus--erythema annulare centrifugum and white banding of the toe nails. Br J Dermatol. Sep 1975;93(3):341-5. [Medline].
22. Leimert JT, Corder MP, Skibba CA, Gingrich RD. Erythema annulare centrifugum and Hodgkin's disease: association with disease activity. Arch Intern Med. Apr 1979;139(4):486-7. [Medline].
23. Yaniv R, Shpielberg O, Shpiro D, Feinstein A, Ben-Bassat I. Erythema annulare centrifugum as the presenting sign of Hodgkin's disease. Int J Dermatol. Jan 1993;32(1):59-61. [Medline].
24. Ioannidou D, Krasagakis K, Stefanidou M, Tosca A. Erythema annulare centrifugum and osteoarthritis treated with hyaluronic acid. Clin Exp Dermatol. Nov 2002;27(8):720-2. [Medline].
25. Guillet MH, Dorval JC, Larrégue M, Guillet G. [Darier's erythema annulare centrifugum of neonatal onset with a 15 years' follow-up. Efficacy of interferon and role of cytokines]. Ann Dermatol Venereol. 1995;122(6-7):422-6. [Medline].
26. Gniadecki R. Calcipotriol for erythema annulare centrifugum. Br J Dermatol. Feb 2002;146(2):317-9. [Medline].
27. Reuter J, Braun-Falco M, Termeer C, Bruckner-Tuderman L. [Erythema annulare centrifugum Darier. Successful therapy with topical calcitriol and 311 nm-ultraviolet B narrow band phototherapy]. Hautarzt. Feb 2007;58(2):146-8. [Medline].
28. De Aloe G, Rubegni P, Risulo M, Sbano P, Poggiali S, Fimiani M. Erythema annulare centrifugum successfully treated with metronidazole. Clin Exp Dermatol. Sep 2005;30(5):583-4. [Medline].
29. Janss G, Schmidt K, Gattuso P, Massa M, Welykyj S. An intensive care unit nurse with a recurring annular lesion. Erythema annulare centrifugum (EAC). Arch Dermatol. Jul 1992;128(7):977, 980. [Medline].
30. Lazar P. Cancer, erythema annulare centrifugum, autoimmunity. Arch Dermatol. 1963;87:246-51.

Article Last Updated: Aug 13, 2008