A New Type of Annular Erythema with Perieccrine Inflammation: Erythema Papulatum Centrifugum

Abstract

Erythema papulatum centrifugum (EPC) was first described in 1962 by Watanabe [Jpn J Dermatol 1962;72:573] as eczematous lesions extending centrifugally. To date, more than 150 cases have been reported, but only in the Japanese literature. A review of the Japanese literature including our 5 new cases reveals that EPC occurs in middle-aged persons, predominantly in males, as a single lesion on the trunk that is self-limiting but recurs frequently. Although EPC shares several characteristics with the superficial type of erythema annulare centrifugum or asymmetrical periflexural exanthema, EPC differs from erythema annulare centrifugum in clinical manifestation, showing annular rings composed of grouped, tiny papules, and in the histology of perieccrine inflammation, while it differs from asymmetrical periflexural exanthema by male preponderance, onset age, high relapse rate and unique annular configuration. We discuss EPC as compared with other cutaneous disorders showing annular erythema or similar histopathology and suggest that EPC is a distinct clinical entity.

Erythema papulatum centrifugum and new diagnostic criteria

“…Some patients experience exacerbation after sweating or eating spicy food . The histopathologic features of EPC are quite inconspicuous, which usually show superficial perivascular inflammation with or without mild inflammation around sweat glands in the middle dermis . In our patients, only 3 cases relapsed in warm spring or summer, but inflammation around sweat glands was not found in all cases.…”

“…Erythema papulatum centrifugum has been accepted as a new and independent entity . Although EPC is not uncommon, especially in Asia, it has not received much attention, with few reports in the English language literature.…”

“…Erythema papulatum centrifugum has been accepted as a new and independent entity. [2][3][4]7 Although EPC is not uncommon, especially in Asia, it has not received much attention, with few reports in the English language literature. The majority of our 7 cases involved the trunk and presented as single lesions, the minority may involve the neck and have multiple lesions.…”

“…However, in EPC the number of lesions are less, and the edge of lesions consists of grouped tiny red papules or maculopapules. Histopathologically, although EPC and EAC share several histological findings such as spongiosis, parakeratosis and superficial perivascular mononuclear cell infiltrate, inflammation around intraepidermal as well as dermal eccrine ducts is reported only in EPC . EPC and EAC share several dermoscopic appearances such as red background, local white scales and local linear and dotted vessels, but the vessels and scales are more numerous and more widespread in EAC.…”

“…It has been speculated to be a sweating-related dermatitis. [2][3][4] It has also been associated with primary pancreatic B cell lymphoma, 5 and melanoma (with lesions disappearing after excision of the melanoma). 6 Some patients experience exacerbation after sweating or eating spicy food.…”