Eosinophilic annular erythema in adults: report of two cases and review of the literature

Abstract

We herein report two cases of eosinophilic annular erythema in adults, which is rare. In both patients, lesions developed rapidly in few days and were located mainly on the trunk, buttocks, and extremities. Diagnosis was histopathological, with typical features including acute dermal inflammatory infiltrate with abundant eosinophils. One of the patients recurred after treatment on three occasions and finally cured spontaneously. The second patient recurred once and was then successfully treated with topical clobetasol. Clinical and histopathological features of eosinophilic annular erythema in adults have rarely been reported. A review of the literature and discussion of relationship with Wells syndrome are also included.

Multiple annular plaques in an adult woman

“…It manifests as papules and erythematous annular plaques on the trunk and extremities, which tend to cure spontaneously in the central part. They are asymptomatic or slightly pruriginous; this is part of the differential diagnosis from the figurate erythemas and other conditions such as early bullous pemphigoid, Ofuji's disease and urticarial vasculitis [1,[4][5][6]. The histopathology is characterized by an inflammatory lymphocytic infiltrate with numerous eosinophils at superficial and deep levels of the dermis, without flame figures; this is one of the main aspects that differentiate it from Wells syndrome [1,2].…”

“…Although its prognosis is good, with no systemic impairment and with complete remission after corticoid use, in most cases there is recurrence after suspension of the therapeutic corticoids, after a lapse of four months to several years. There are reports of a good response to hydroxychloroquine, dapsone and cyclosporine; in most cases these are given together with prednisone [4,9,10]. Thus prospective studies and new therapies are needed to find an alternative to the use of corticoids and reduce the high rate of recurrence for this uncommon pathology.…”

Eosinophiles anuläres Erythem bei einem 20 Monate alten Mädchen

“…Klinisch ist das EAE durch anuläre, erythematöse oder urtikarielle Läsionen mit zentrifugalem Wachstum charakterisiert, die teilweise zentral livid-bräunlich imponieren. Bei Progredienz kann es zur Ausbildung von gyrierten Erythemen mit zentraler Abblassung kommen, die Ta [4,5]. In einer rezenten japanischen Studie an 10 Erwachsenen mit EAE, von denen 9 klinisch eine Hyperpigmentierung im Zentrum der Läsionen aufwiesen, wurden als zusätzliches histologisches Kriterium des EAE eine vermehrte Melaninablagerung im Stratum basale sowie eine Pigmentinkontinenz gefunden [7].…”

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

“…Clinically, EAE is characterized by more prominent gyrate erythema than WS. Moreover, findings observed in WS, such as prodromal burning, painful edematous cellulitis‐like nodules, and peripheral induration, are absent in patients with EAE . The absence of peripheral eosinophilia in EAE suggests a better pharmacological response and full recovery.…”

“…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.…”