Relapsing annular erythema

Abstract

A 20-month-old child presented with annular erythematous plaques.The lesions started at 6 months of age, first in the malar region ( Figure 1) and then on the lower limbs (Figures 2 and 3). Physical examination revealed annular and polycyclic erythematous plaques with raised borders and clear center, with no trailing scale or vesicles. The lesions expanded centrifugally. According to her parents, the lesions disappeared spontaneously every 4 to 6 weeks, with no residual hyperpigmentation or atrophy. Afterward, the child remained lesion-free for a period of 4 to 6 weeks, when the lesions would relapse again in the same areas.She had received no previous medication and had no history of infection or insect bite. The child did not have any constitutional symptoms.Her growth rate was normal and past medical history unremarkable.Her twin brother was healthy and had no similar lesions.Her complete blood count was normal. Immunoglobulin levels were within the normal range, and anti-nuclear antibodies were negative. A punch biopsy was performed on the margin of one lesion (Figure 4).

Misdiagnosis of neutrophilic erythema of infancy as leukocytoclastic vasculitis: A potential diagnostic pitfall in an infantile inflammatory dermatosis

“…1 Only six cases of NFEI have been reported in the literature (Table 1). 1,2,[4][5][6][7] NFEI is characterized clinically by annular or figurate erythematous lesions and histopathologically by neutrophilic infiltration of the dermis with leukocytoclasia and without primary vascular damage. 1 As shown in our case, the diagnosis may be challenging, and there is a significant potential for misdiagnosis as leukocytoclastic vasculitis without clear communication and correlation with pediatric dermatology colleagues.…”

“…While the pathogenesis of NFEI and annular erythema of infancy is unknown, many of the figurate erythemas are hypothesized to occur as a hypersensitivity reaction to an unidentified antigen 2 . Based on the review of the literature, the majority of cases of NFEI are self‐limiting over the course of a few months 1,2,4–7 . Importantly, there is a case of a 2‐year‐old girl developing juvenile myelomonocytic leukemia shortly after being diagnosed with NFEI 5 .…”

“…This has led some to consider NFEI to be a neutrophilic dermatosis, but additional studies are needed to determine whether a true association exists. While a standard treatment for NFEI has not been established, topical corticosteroids are ineffective 2,4,6 . Considering the lack of clinical response to empiric treatments in prior case reports as well as the self‐limited course of NFEI, treatment may not be indicated.…”

“…2 Based on the review of the literature, the majority of cases of NFEI are selflimiting over the course of a few months. 1,2,[4][5][6][7] Importantly, there is a case of a 2-year-old girl developing juvenile myelomonocytic leukemia shortly after being diagnosed with NFEI. 5 This has led some to consider NFEI to be a neutrophilic dermatosis, but additional studies are needed to determine whether a true association exists.…”

“…While a standard treatment for NFEI has not been established, topical corticosteroids are ineffective. 2,4,6 Considering the lack of clinical response to empiric treatments in prior case reports as well as the self-limited course of NFEI, treatment may not be indicated.…”