Introduction Demographics Causes Clinical features Diagnosis Differential diagnoses Treatment
Erythema gyratum repens is a rare paraneoplastic type of annular erythema with a distinctive figurate ‘wood-grain’ appearance. It has a strong association with malignancy.
*This patient's rash had a wood-grain appearance like erythema gyratum repens but the rash was actually pemphigus foliaceus.
Erythema gyratum repens is most often present in Caucasian men in their 60s. The male to female ratio is 2:1. There is an associated underlying malignancy in 80% of patients with erythema gyratum repens. Almost half of the patients with erythema gyratum repens have lung cancer (33–47%), and less commonly, oesophageal, breast, and stomach cancer [1,2].
In rare cases, erythema gyratum repens has also been described in association with mycobacterial infections, connective tissue diseases, and pregnancy [1].
The strong association between erythema gyratum repens and malignancy has led to several different pathogenetic hypotheses. These hypotheses are described below.
Erythema gyratum repens presents with concentric erythematous rings that have a distinctive wood-grain appearance. The rings progress in waves, with the leading edge migrating about 1 cm/day. A trailing or collarette scale may be seen. Erythema gyratum repens is very itchy.
The annular plaques most often involve the limbs and trunk [1].
Although erythema gyratum repens may be diagnosed clinically, a skin biopsy is often performed to exclude other conditions. The histological features of erythema gyratum repens are non-specific.
Other investigations to be undertaken may include a complete blood count, biochemistry, antinuclear antibody profile, and malignancy screens (ie, chest X-ray, mammogram, cervical smear, tumour markers, computed tomography of the chest/abdomen/pelvis and, if indicated, endoscopy or colonoscopy) [1].
Other conditions that should be considered in the course of diagnosis include:
The treatment for erythema gyratum repens is to identify and treat the primary malignancy. Erythema gyratum repens usually resolves once the malignancy has been removed, for example, with surgical resection. Topical steroids have not been found to be effective [1].
