Author: Dr Cathy Yunjia Zhao, Dermatology Registrar, Westmead Hospital, Sydney, New South Wales, Australia, November 2018. DermNet NZ Editor-in-Chief A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy-edited by Gus Mitchell. January 2019.
* 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 of erythema gyratum repens. Almost half of the patients have lung cancer (33–47%), and less commonly, oesophageal, breast and stomach cancer [3–4].
In rare cases, erythema gyratum repens has also been described in association with mycobacterial infections, connective tissue diseases and pregnancy .
The strong association between erythema gyratum repens and malignancy have led to several different pathogenetic hypotheses.
Erythema gyratum repens presents with concentric erythematous rings that have a distinctive wood-grain appearance. The rings progress in waves, with the leading age 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 .
Other investigations may include complete blood count, biochemistry, antinuclear antibody profile and malignancy screens (chest x-ray, mammogram, cervical smear, tumour markers, CT chest/abdomen/pelvis and, if indicated, endoscopy or colonoscopy) .
Other conditions that should be considered in the 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 gone, for example with surgical resection. Topical steroids have not been effective .
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