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By Lawrence A. Schiffman, DO, and Stephen M. Schleicher, MD
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CASE:
A 19-year-old African-American woman presents with an annular, reddened rash on her central forehead and upper nasal bridge. She states that the condition first appeared a few months ago as two discrete patches that later became confluent. The rash has remained asymp- tomatic. She denies any muscle or joint pain, recent sun exposure, or use of prescription medications. Physical examination finds an erythematous, arcuate plaque with slight induration and no scale. The surrounding skin appears normal.
WHAT IS YOUR DIAGNOSIS? |
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Erythema annulare centrifugum is classified as a gyrate erythema. It may occur in association with medications, systemic disease, infection, or malignancy, although many cases are never traced to a specific cause. Lesions begin as small erythematous papules that spread peripherally to produce polycyclic or annular plaques and can occur on the head, neck, trunk, or proximal extremities. Topical or intralesional steroids, or a combination of both, may hasten resolution of lesions. The differential diagnosis includes sarcoidosis, systemic lupus erythematosus, and erythema migrans. |
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Dr. Schiffman is a resident at St. John’s Episcopal Hospital in Far Rockaway, New York. Dr. Schleicher is director of DermDx Centers and a clinical instructor of dermatology at the Philadelphia College of Osteopathic Medicine, at Kings College in Wilkes-Barre, Pennsylvania, and at Arcadia University in Glenside, Pennsylvania. He is also a member of the emergency medicine editorial board.
Emerg Med 39(7):45-6, 2007
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