Erythema gyratum repens

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Erythema gyratum repens
Specialty Dermatology   OOjs UI icon edit-ltr-progressive.svg
Symptoms Expanding swirly wavy red lines, scale, itch [1]
Usual onsetOlder adults (60s) [1]
Causes Cancer: lung cancer, oesophageal cancer, breast cancer [1]
Diagnostic method
Differential diagnosis Necrolytic migratory erythema, erythema migrans, erythrokeratodermia variabilis, subacute cutaneous lupus erythematosus, tinea corporis [1]
TreatmentTreat underlying cause [1]
Medication Antihistamines [2]
Prognosis Resolves with successful cancer treatment [1]
FrequencyRare, male:females (2:1) [1]

Erythema gyratum repens is a skin condition that has a strong association with internal cancers. [1] It characteristically presents with red wavy lines, generally in older adults. [1] These regular whirly rings rapidly and repetitively appear within existing ones, giving the impression that the rash is moving. [3] The resulting pattern is similar to wood grain. [1] There is often an intense itch and scale over the leading edge, which may be slightly raised. [2]

Contents

The cause is believed to have an immunological base. [4] 80% of cases have an underlying cancer, of which almost half have lung cancer. [1] Sometimes no cause is found. [3]

Diagnosis is generally by its appearance, although tests may be required to exclude other conditions. [3] These tests may include blood tests. [1] A cancer may be located using medical imaging. [1] Necrolytic migratory erythema and erythema migrans are some of many other skin conditions that may appear similar. [1]

Treatment and outlook depend on the underlying cause. [1] Antihistamines may help to reduce the itch. [2] [5] The rash typically resolves with successful cancer treatment. [3]

The condition is rare. [1] Males are affected twice as frequently as females. [1] J. A. Gammel first described the condition in 1952. [6] [7]

Signs and symptoms

Erythema gyratum repens characteristically presents as wavy red lines on the skin. [1] These regular whirly rings rapidly and repetitively appear within existing ones, expanding outward at a rate of up to 1cm a day, giving the impression that the rash is moving. [3] The resulting pattern is similar to wood grain. [1] There is typically an intense itch and scale over the leading edge, which may be slightly raised. [2] The trunk and limbs are most frequently affected. [5] Thickening of the skin of the palms co-exists in around 10% of affected individuals, whatever the underlying cause. [1] The skin may become extremely dry. [3] Onset is generally in older adults; after the age of 60-years. [1]

Cause

The cause is believed to have an immunological base. [4] 80% of cases have an underlying cancer, of which almost half have lung cancer. [1] Other cancers reported to be associated include cancers of the oesophagus and breast, and less frequently gastric cancer, uterine cancer, throat cancer, pancreas cancer and lymphoma. [1] The rash generally precedes the cancer diagnosis by around 9-months. [2] Less frequently, the cause may be tuberculosis of the lung, or no cause is found. [3] Other rare reported associations have included cryptogenic organizing pneumonia and rheumatoid arthritis. [2]

Diagnosis

Diagnosis is generally by its appearance. [3] Tests include blood tests such as a complete blood count which may reveal raised eosinophils. [2] Other blood tests include PSA, antinuclear antibodies and biochemistry. [1] Medical imaging may locate a cancer; chest X-ray, mammogram, CT scan of pelvis and abdomen. [1] If indicated then an endoscopy may be required; colonoscopy, gastroscopy. [1]

Differential diagnosis

Necrolytic migratory erythema, erythema migrans, tinea corporis, erythrokeratodermia variabilis, and subacute cutaneous lupus erythematosus are some of many other skin conditions that may appear similar. [1]

Treatment

Treatment and outlook depend on the underlying cause. [1] Antihistamines may help to reduce the itch, although the role of applying a steroid cream is unclear. [2] [5] The rash typically resolves with successful cancer treatment. [3]

Epidemiology

The condition is rare. [1] Males are affected twice as frequently as females. [1]

History

J. A. Gammel first described the condition in 1952, in an individual who was later found to have breast cancer. [6] [7]

See also

Related Research Articles

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Itch is a sensation that causes the desire or reflex to scratch. Itches have resisted many attempts to be classified as any one type of sensory experience. Itches have many similarities to pain, and while both are unpleasant sensory experiences, their behavioral response patterns are different. Pain creates a withdrawal reflex, whereas itches leads to a scratch reflex.

<span class="mw-page-title-main">Contact dermatitis</span> Human disease

Contact dermatitis is a type of acute or chronic inflammation of the skin caused by exposure to chemical or physical agents. Symptoms of contact dermatitis can include itchy or dry skin, a red rash, bumps, blisters, or swelling. These rashes are not contagious or life-threatening, but can be very uncomfortable.

<span class="mw-page-title-main">Hives</span> Skin disease characterized by red, raised, and itchy bumps

Hives, also known as urticaria, is a kind of skin rash with red, raised, itchy bumps. Hives may burn or sting. The patches of rash may appear on different body parts, with variable duration from minutes to days, and does not leave any long-lasting skin change. Fewer than 5% of cases last for more than six weeks. The condition frequently recurs.

<span class="mw-page-title-main">Pityriasis rosea</span> Skin disease

Pityriasis rosea is a type of skin rash. Classically, it begins with a single red and slightly scaly area known as a "herald patch". This is then followed, days to weeks later, by an eruption of many smaller scaly spots; pinkish with a red edge in people with light skin and greyish in darker skin. About 20% of cases show atypical deviations from this pattern. It usually lasts less than three months and goes away without treatment. Sometimes malaise or a fever may occur before the start of the rash or itchiness, but often there are few other symptoms.

<span class="mw-page-title-main">Cold urticaria</span> Allergic reaction to low temperatures

Cold urticaria is a disorder in which large red welts called hives (urticaria) form on the skin after exposure to a cold stimulus. The hives are usually itchy and often the hands and feet will become itchy and swollen as well. Hives vary in size from about 7 mm in diameter to as big as about 27 mm or larger.

<span class="mw-page-title-main">Polymorphous light eruption</span> Medical condition

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<span class="mw-page-title-main">Physical urticaria</span> Medical condition

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<span class="mw-page-title-main">Pruritic urticarial papules and plaques of pregnancy</span> Chronic rash that occurs during pregnancy

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<span class="mw-page-title-main">Necrolytic migratory erythema</span> Medical condition

Necrolytic migratory erythema is a red, blistering rash that spreads across the skin. It particularly affects the skin around the mouth and distal extremities; but may also be found on the lower abdomen, buttocks, perineum, and groin. It is strongly associated with glucagonoma, a glucagon-producing tumor of the pancreas, but is also seen in a number of other conditions including liver disease and intestinal malabsorption.

<span class="mw-page-title-main">Erythema annulare centrifugum</span> Medical condition

Erythema annulare centrifugum (EAC), is a descriptive term for a class of skin lesion presenting redness (erythema) in a ring form (anulare) that spreads from a center (centrifugum). It was first described by Darier in 1916. Many different terms have been used to classify these types of lesions and it is still controversial on what exactly defines EAC. Some of the types include annular erythema, erythema perstans, erythema gyratum perstans, erythema gyratum repens, darier erythema and erythema figuratum perstans.

Acrodermatitis chronica atrophicans (ACA) is a skin rash indicative of the third or late stage of European Lyme borreliosis.

Aquagenic urticaria, also known as water allergy and water urticaria, is a rare form of physical urticaria in which hives develop on the skin after contact with water, regardless of its temperature. The condition typically results from contact with water of any type, temperature or additive.

<span class="mw-page-title-main">Drug eruption</span> Medical condition

In medicine, a drug eruption is an adverse drug reaction of the skin. Most drug-induced cutaneous reactions are mild and disappear when the offending drug is withdrawn. These are called "simple" drug eruptions. However, more serious drug eruptions may be associated with organ injury such as liver or kidney damage and are categorized as "complex". Drugs can also cause hair and nail changes, affect the mucous membranes, or cause itching without outward skin changes.

Gianotti–Crosti syndrome, also known as infantile papular acrodermatitis, papular acrodermatitis of childhood, and papulovesicular acrolocated syndrome, is a reaction of the skin to a viral infection. Hepatitis B virus and Epstein–Barr virus are the most frequently reported pathogens. Other viruses implicated are hepatitis A virus, hepatitis C virus, cytomegalovirus, coxsackievirus, adenovirus, enterovirus, rotavirus, rubella virus, HIV, and parainfluenza virus.

Id reactions are types of acute dermatitis developing after days or weeks at skin locations distant from the initial inflammatory or infectious site. They can be localised or generalised. This is also known as an 'autoeczematous response' and there must be an identifiable initial inflammatory or infectious skin problem which leads to the generalised eczema. Often intensely itchy, the red papules and pustules can also be associated with blisters and scales and are always remote from the primary lesion. It is most commonly a blistering rash with itchy vesicles on the sides of fingers and feet as a reaction to fungal infection on the feet, athlete's foot. Stasis dermatitis, allergic contact dermatitis, acute irritant contact eczema and infective dermatitis have been documented as possible triggers, but the exact cause and mechanism is not fully understood. Several other types of id reactions exist including erythema nodosum, erythema multiforme, Sweet's syndrome and urticaria.

Senile pruritus is one of the most common conditions in the elderly or people over 65 years of age with an emerging itch that may be accompanied with changes in temperature and textural characteristics. In the elderly, xerosis, is the most common cause for an itch due to the degradation of the skin barrier over time. However, the cause of senile pruritus is not clearly known. Diagnosis is based on an elimination criteria during a full body examination that can be done by either a dermatologist or non-dermatologist physician.

Cutaneous manifestations of COVID-19 are characteristic signs or symptoms of the Coronavirus disease 2019 that occur in the skin. The American Academy of Dermatology reports that skin lesions such as morbilliform, pernio, urticaria, macular erythema, vesicular purpura, papulosquamous purpura and retiform purpura are seen in people with COVID-19. Pernio-like lesions were more common in mild disease while retiform purpura was seen only in critically ill patients. The major dermatologic patterns identified in individuals with COVID-19 are urticarial rash, confluent erythematous/morbilliform rash, papulovesicular exanthem, chilbain-like acral pattern, livedo reticularis and purpuric "vasculitic" pattern. Chilblains and Multisystem inflammatory syndrome in children are also cutaneous manifestations of COVID-19.

References

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  7. 1 2 Gammel, J. A. (October 1952). "Erythema gyratum repens; skin manifestations in patient with carcinoma of breast". A.M.A. Archives of Dermatology and Syphilology. 66 (4): 494–505. doi:10.1001/archderm.1952.01530290070010. ISSN   0096-5979. PMID   12975861.