Document Detail

New concepts on erythema annulare centrifugum: a clinical reaction pattern that does not represent a specific clinicopathological entity.
MedLine Citation:
PMID:  18721189     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Erythema annulare centrifugum (EAC) is considered an inflammatory skin disease with unknown aetiology. In most textbooks it is assigned to the incoherent conglomeration of figurate or gyrate erythemas. OBJECTIVES: To re-evaluate a large cohort of patients with EAC and to assess the evidence for infection with Borrelia. METHODS: We retrospectively investigated 90 cases with the diagnosis of EAC. Haematoxylin and eosin sections were re-examined and diagnoses were specified; these were then confirmed by clinicopathological correlation. Infection with Borrelia was assessed by focus-floating microscopy and by a Borrelia-specific polymerase chain reaction (PCR). RESULTS: Besides a miscellaneous group of annular disorders at times confused with EAC such as urticaria, leucocytoclastic vasculitis and psoriasis (20 of 90; 22%), EAC appeared to serve as a collective term for three main clinicopathological reaction patterns: (i) (tumid) lupus erythematosus (29 of 90; 32%), (ii) spongiotic dermatitides (25 of 90; 28%) and (iii) pseudolymphoma (16 of 90; 18%). In 13 of 16 (81%) cases with a pseudolymphomatous reaction pattern spirochaetes stained positive but were negative in other reaction patterns of EAC as well as in negative controls. These findings were confirmed by a Borrelia-specific PCR which was positive in two of three (67%) of these pseudolymphomatous EAC cases but was negative in all other variants of EAC (none of five) as well as 20 controls. CONCLUSIONS: We conclude that 'EAC' is a clinical reaction pattern that does not represent a specific clinicopathological entity and should lead to consideration of mainly lupus erythematosus, dermatitis and, in some cases, cutaneous Lyme disease.
M Ziemer; K Eisendle; B Zelger
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Publication Detail:
Type:  Journal Article     Date:  2008-08-20
Journal Detail:
Title:  The British journal of dermatology     Volume:  160     ISSN:  1365-2133     ISO Abbreviation:  Br. J. Dermatol.     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-09     Completed Date:  2009-02-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0004041     Medline TA:  Br J Dermatol     Country:  England    
Other Details:
Languages:  eng     Pagination:  119-26     Citation Subset:  IM    
Department of Dermatology and Venereology, Friedrich-Schiller-University, Jena, Germany.
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MeSH Terms
Aged, 80 and over
Borrelia / isolation & purification
Borrelia Infections / pathology*
Dermatitis / pathology*
Diagnosis, Differential
Erythema / pathology*
Lupus Erythematosus, Cutaneous / pathology*
Middle Aged
Polymerase Chain Reaction
Retrospective Studies
Skin / pathology
Ticks / microbiology
Young Adult

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