ERYTHEMA ANNULARE CENTRIFUGUM
Erythema annulare centrifugum (EAC) is a figurate erythema that favors the trunk and proximal extremities. The superficial variant is characterized by annular plaques with central clearing and a “trailing edge” of scale. The deep variant has a firm, indurated border often without scale. Most cases are idiopathic although it has been postulated that it is a hypersensitivity reaction and has been linked to various systemic diseases, infections, medications, malignancy, and pregnancy. Identifying and addressing the underlying disorder may lead to resolution. First-line treatment is often with topical corticosteroids and antipruritic agents for symptom management. Other treatments have been reported although data are limited and spontaneous remission is possible, making assessment of therapy difficult.
Levels of evidence are based on the Journal of the American Academy of Dermatology guidelines: Level IA evidence includes evidence from meta-analysis of randomized controlled trials; level IB evidence includes evidence from ≥1 randomized controlled trial; level IIA evidence includes evidence from ≥1 controlled study without randomization; level IIB evidence includes evidence from ≥1 other type of experimental study; level III evidence includes evidence from non-experimental descriptive studies, such as comparative studies, correlation studies, and case control studies; and level IV evidence includes evidence from expert committee reports or opinions or clinical experience of respected authorities, or both. See Table 32-1.
Table 32-1Erythema Annulare Centrifugum Treatment Table ||Download (.pdf) Table 32-1 Erythema Annulare Centrifugum Treatment Table
|MEDICATION NAME ||INDICATION ||MECHANISM OF ACTION ||DOSING ||ADVERSE EFFECTS ||SUGGESTED MONITORING ||LEVEL OF EVIDENCE (REFERENCE) |
|Topical Therapy |
|Corticosteroids || ||Anti-inflammatory || |
Usually BID. Potency depends on location.
Duration depends on response.
|Skin atrophy, telangiectasias, striae, acneiform eruptions ||None ||IV |
|Calcipotriol || ||Anti-inflammatory, inhibits keratinocyte proliferation, regulates epidermal differentiation ||50 ug/g daily for 3 mo ||None ||None ||IV1 |
|Tacrolimus || ||Anti-inflammatory ||0.1% BID ||None ||None ||IV2 |
|Systemic Therapy |
|Apremilast || ||Anti-inflammatory. Phosphodiesterase 4 inhibitor ||30 mg BID > 1 y ||Mild gastrointestinal side effects ||None ||IV3 |
|Azithromycin || ||Anti-bacterial. Anti-inflammatory ||250 mg QD up to 3 wk ||None ||None ||III4 |
|Doxycycline || ||Anti-bacterial. Anti-inflammatory ||200 mg/d for 10 d ||None ||None ||IV5 |
|Erythromycin || ||Anti-bacterial. Anti-inflammatory ||250 mg 4 times daily for 14 d ||None ||None ||III6 |
|Etanercept || ||Anti-inflammatory ||25 mg twice weekly ||None ||QuantiFERON gold annually, viral hepatitis panel, CBC w/diff and LFTS periodically ||IV7 |
|Fluconazole || ||Anti-fungal ||3-6 mg/kg/d for 2-14 wk ||None ||None ||IV8 |
|Metronidazole || ||Antibiotic. Anti-inflammatory ||400 mg/d for 6 wk ||None ||None ||IV9 |
|Procedural Therapy |
|Narrowband UVB phototherapy || ||Unknown || |
TIW for 4 mo
|None ||None ||IV10 |
R. Calcipotriol for erythema annulare centrifugum. Br J Dermatol. 2002;146(2):317–319. doi: 10.1046/j.0007-0963.2001.04572.x.
RJ. Annular erythema responding to tacrolimus ointment. J Drugs Dermatol