NP Diagnoses Annular Lesion With Help From VisualDx

Keira S., a nurse practitioner at Vancouver Coastal Health, shares how VisualDx helped her diagnose her patient’s annular lesion.

“I was seeing a patient for an annular lesion but needed help with the diagnosis process. VisualDx showed me a number of options and I was able to match up my annular lesion to erythema annular centrifugum. Thanks for your help!”

What is erythema annular centrifugum?

Erythema annulare centrifugum (EAC) is a figurate erythema that has been postulated to be a hypersensitivity reaction to a foreign antigen. While infections, drugs, underlying systemic disease, malignancy, pregnancy, and blue cheese ingestion have occasionally been associated with EAC, in most cases, an etiologic agent is not identified.

What should we be aware of when making a diagnosis?

  • Most EAC lesions are not pruritic.
  • Look for the diagnostic “trailing edge” of scale in superficial EAC.
  • Lesions developing deeper in the dermis (deep gyrate erythema) may not have evidence of scale inside the active border.

How can we treat this?

  • Topical steroids seem to be of little benefit.
  • Antihistamines may be warranted for symptom suppression.
  • Systemic corticosteroids suppress EAC, but relapse is common.
  • PUVA therapy (2-3 times per week), topical tacrolimus, and calcipotriene have been helpful in managing some patients.

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