Case Number : Case 1854 - 06 July - Dr Iskander Chaudhry (Invited) Posted By: Guest

Elegant example of Eosinophilic Annular Erythema!

Erythema annulare centrifugum, deep variety

Tricky case. The pattern is of an erythema annulare centrifugum one. But edema or mucin in dermis? And there are more than occasional eosinophils.  

My spot is EAC-like drug reaction, for CPC, but consider a dermatomyositis or lupus tumidus also. 

I agree with the diagnosis of Eosinophilic Annular Erythema. 

The histological patter is that of a gyrate erythema, for me consistent with erythema annulare centrifugum

Esinophils quiet frequent, esinophilic annular erythema is a good possibility. 

I don’t know this entity, but after having read something about that,  fully agree, because clinical pathological findings fit a lot.  

I don't believe eosinophilic annular erythema is a real entity, but rather a figurate clinical presentation of Wells’ syndrome.

Likewise, I don't believe erythema annulare centrifugum is a real entity, but rather a reaction pattern triggered by many underlying factors, including drugs, helminthes, arthropods, hypereosinophilic syndrome, and other conditions in which eosinophils can be easily found. In the personal observation of A. Neil Crowson (from Barnhill's book), eosinophils are seen in roughly 10% to 20% of erythema annulare centrifugum cases, and in the so-called deep type of erythema annulare centrifugum, superficial and deep perivascular infiltrate without epidermal changes is the characteristic histological picture.

Having said that, and considering the interstitial mucin deposition and the interstitial inflammatory infiltrate, I favor figurate Wells’ syndrome.

Many thanks for your thoughts on this case. The clinician felt that the rash was entirely in keeping with Eosinophilic Annular Erythema when she received the histology report back describing conspicuous number of eosinophils in the dermis!

As Robledo commented there is some discussion on the nosological relationship of this condition with Well’s syndrome but is likely a clinical and pathological polymorphism of Wells syndrome ;)

Erythema annulare centrifugum also appears on the thighs and legs with histopathology showing perivascular chronic lymphocytic infiltration. Eosinophils are not usually a feature.

Iskander