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New concepts on erythema annulare centrifugum: a clinical reaction pattern that does not represent a specific clinicopathological entity.

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Abstract

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.

Br J Dermatol. 2009 Jan;160(1):119-26. doi: 10.1111/j.1365-2133.2008.08803.x. Epub 2008 Aug 20.

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