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Erythema annulare centrifugum in Adult
Other Resources UpToDate PubMed

Erythema annulare centrifugum in Adult

Contributors: Vivian Wong MD, PhD, Belinda Tan MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed


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.

EAC can occur at any age but tends to affect young or middle-aged adults. There is no sex or racial predilection. Idiopathic EAC is typically self-limited and spontaneous resolution is common. However, new lesions may continue to erupt while old lesions resolve.

In the superficial form of EAC, arcuate or annular plaques with a "trailing edge" of scale are seen on the trunk and proximal extremities. In the deeper form, also known as deep gyrate erythema, no scale is seen.

EAC may be asymptomatic or may be accompanied by pruritus.

While most cases of EAC are idiopathic, a number of agents have been reported to cause EAC-like lesions including piroxicam, penicillins, chloroquine and hydroxychloroquine, hydrochlorothiazide, spironolactone, cimetidine, phenolphthalein, amitriptyline, hydrochlorothiazide, salicylates, ustekinumab, rituximab, pegylated interferon alpha / ribavirin combination therapy, azacitidine, and anti-thymocyte globulin.

EAC in the setting of an underlying malignancy has been described in patients with lymphoproliferative malignancies (polycythemia vera, acute leukemia, chronic lymphocytic leukemia, Hodgkin lymphoma, non-Hodgkin lymphoma, multiple myeloma, myelodysplastic syndrome, histiocytosis), breast cancer, gastrointestinal cancer, lung cancer, prostate cancer, nasopharyngeal cancer, carcinoid tumor of the bronchus, and peritoneal cancer. The eruption may precede the diagnosis of occult malignancy.

Reported systemic disease associations include systemic lupus erythematosus, cryoglobulinemia, polychondritis, linear IgA disease, sarcoidosis, hypereosinophilic syndrome, hyperthyroidism, Hashimoto thyroiditis, Graves disease, and pemphigus vulgaris. Finally, infectious etiologies may include bacterial, viral, parasitic, and fungal agents.


L53.1 – Erythema annulare centrifugum

399914006 – Erythema annulare centrifugum

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

The differential includes other figurate erythemas:
  • Erythema migrans (marker of Lyme disease)
  • Erythema marginatum (rheumatic fever)
  • Erythema gyratum repens (faster moving)
  • Necrolytic migratory erythema (associated with Glucagonoma syndrome)
Also consider:
  • Pityriasis rosea
  • Annular Urticaria
  • Urticaria multiforme
  • Urticarial phase of Bullous pemphigoid
  • Erythema multiforme
  • Tinea corporis 
  • Psoriasis
  • Tumid lupus erythematosus
  • Subacute cutaneous lupus erythematosus
  • Granuloma annulare
  • Secondary syphilis
  • Leprosy
  • Sarcoidosis
  • Cutaneous T-cell lymphoma

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:02/21/2018
Last Updated:09/30/2019
Copyright © 2024 VisualDx®. All rights reserved.
Erythema annulare centrifugum in Adult
A medical illustration showing key findings of Erythema annulare centrifugum : Scattered few, Annular configuration, Fine scaly plaques
Clinical image of Erythema annulare centrifugum - imageId=7644. Click to open in gallery.  caption: 'A close-up of two confluent annular and erythematous plaques with central collarettes of scale.'
A close-up of two confluent annular and erythematous plaques with central collarettes of scale.
Copyright © 2024 VisualDx®. All rights reserved.