Archive for the ‘erythema chronicum migrans’ Tag

What are the gyrate erythemas?   Leave a comment

aka. figurate erythemas, commonly misdiagnosed as tinea corporis; usually cutaneous manifestations of internal disease.

Histology: superficial perivascular lymphohistiocytic infiltration, focal parakeratosis, mild spongiosis

There are four ‘classic’ gyrate erythemas:

  1. Erythema gyratum repens:
    • several concentric, erythematous, flat to slightly raised bands, resembling wood-grain pattern

    • fine white scales in waves at the leading edge, bands migrate rapidly up to 1cm per day

    • affects trunk and proximal extremities, sparing distal limbs and face

    • pruritic
    • paraneoplastic eruption: commonly associated with pulmonary carcinoma, also with malignancies of the breast, bladder, uterus/cervix, GIT, prostate

    • other associations: tuberculosis, autoimmune bullous diseases (eg. bullous pemphigoid), SLE, CREST, pityriasis rubra pilaris, virginal breast hypertrophy

    • actual pathogenesis unknown
  2. Erythema marginatum: the migrating erythema of rheumatic fever
  3. Erythema chronicum migrans:
    • pink annular plaque with centrifugal spread, central clearing but no scales (bullseye appearance)

    • may have crusted/vesicular advancing edge
    • usually solitary lesions at site of tick bite, occasionally with smaller distant lesions

    • present in initial phase of Lyme disease, caused by infection with the spirochaete Borrelia Burgdorferi trasmitted by the bite of the deer tick Ixodes spp.

  4. Erythema annulare centrifugum:
    • pink annular plaques with centrifugal spread, migrating slowly over weeks

    • central clearing with trailing white scales (as opposed to leading scales in erythema gyratum repens)

    • may be idiopathic, or reaction to infections or drugs

Differential diagnoses:

  • erythema multiforme, granuloma annulare
  • subacute cutaneous lupus erythematosus
  • glucagonoma syndrome
  • tinea corporis, psoriasis plaques
  • mycosis fungoides

 

Ref:

  1. DW Bray, BP Green. Photo Quiz: “Wood-Grain” Skin. Am Fam Physician. 2006 Apr 1;73(7):1249-1251.

  2. RD Rosario, KD Allen, S Kaneshiro. Erythema Gyratum Repens [online]. eMedicine (updated 5 May 2009). Available at:
    http://emedicine.medscape.com/article/1081565-overview

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