Dapsone for Recalcitrant Eosinophilic Annular Erythema: A Case Report and Literature Review

Abstract

Eosinophilic annular erythema (EAE) is a rare entity of unknown etiology that is possibly related to a hypersensitivity reaction and presents as annular erythematous plaques with tissue eosinophilia. It is classified as a figurate erythema with a controversial relationship to Wells syndrome (WS) in the literature, where it is generally considered a separate entity or subset based on clinical and histopathologic differences. EAE typically presents with recurrent, erythematous, arcuate, and annular plaques on the trunk and proximal extremities. The course of the disease is often chronic, recurrent, and relapsing. Responses to treatment are variable but are typically best with systemic steroids and antimalarials. We report a patient refractory to other therapies who had a striking response to dapsone.

Refractory eosinophilic annular erythema treated successfully with dupilumab

“…Therapy of relapsing EAE can be difficult and frustrating, although spontaneous resolution has been described. Therapeutic options include steroids, dapsone, indomethacin, nicotinamide, and ultraviolet B phototherapy [5][6][7]. All these options are moderately effective and may be associated with side effects.…”

Erfolgreiche Therapie eines refraktären eosinophilen anulären Erythems mit Dupilumab

“…Die Therapie des rezidivierenden EAE kann schwierig und frustrierend sein, obwohl auch Spontanheilungen beschrieben wurden. Zu den therapeutischen Optionen zählen Steroide, Dapson, Indometacin, Nicotinamid und die UV-B-Phototherapie [5][6][7]. Alle diese Optionen sind moderat effektiv und können mit Nebenwirkungen einhergehen.…”

Efficacy of suplatast tosilate in a case of recurrent eosinophilic annular erythema

“…It is unclear whether EAE should be classified as a new and distinct entity or as a subtype of Wells syndrome (WS). Responses to treatment vary, but most patients show good responses to systemic steroids and antimalarials . Relapses have been observed in some patients treated with topical corticosteroids alone .…”

“…Although EAE has been regarded as a subtype of WS, subtle clinical and pathological differences can enable their differential diagnosis . Clinically, EAE is characterized by more prominent gyrate erythema than WS.…”

“…The absence of peripheral eosinophilia in EAE suggests a better pharmacological response and full recovery. Pathologically, EAE is characterized primarily by perivascular inflammatory infiltrates and the absence of flame figures, eosinophilic degranulation, or granulomatous inflammation . The ability to distinguish EAE from WS enables the selection of drugs with fewer side effects to treat patients with EAE.…”