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