Eosinophilic anular erythema L53.1

Peterson and Jarrat, 1981

Eosinophilic anular erythema (EAE) is a rare eosinophilic dermatosis of unknown etiology, possibly due to a "hypersensitivity reaction". The independent nature of this clinical picture is currently still unclear.

The clinical picture was primarily described in children. More recent casuistics, however, confirm the occurrence in all age groups.

Eosinophilic annular erythema typically presents with recurrent, erythematous, annular or even circinate, sometimes non-figured large plaques on the trunk and proximal extremities. The course of the disease is often chronic, recurrent and relapsing. The lesions disappear without atrophy or scarring, but new lesions can also develop in the old lesions.

Associations with eosinophilic pneumonia and asthma are known (Yanagihara S et al. 2021).

Biopsies show an interstitial, perivascular dermal infiltrate that is predominantly lymphocytic and eosinophilic, but poor in neutrophils and without plasma cells. There is no evidence of flaming, granuloma or vasculitis. Mucin deposits may be present. Vacuolization of the basement membrane and spongiosis and exocytosis in the epidermis are also noted. Circulating hypereosinophilia is inconsistent.

The response to treatment varies. Systemic steroids and antimalarials appear to have the best effect. Dapsone also showed a remarkable effect in individual cases (Wallis L et al. 2018).

The clinical picture is interpreted in the literature as figurative erythema with a controversial relationship to Wells syndrome (WS).

52-year-old woman with persistent, non-pruritic anular exanthema for 6 years. She complained of lethargy and arthralgia. There were annular, also polycyclic and arcuate plaques, which began as erythematous papules (see figure).

Laboratory tests with blood count, examination of stool samples for parasites and computer tomography of the chest, abdomen and pelvis revealed no abnormalities.

Skin biopsy showed a superficial to deep cellular infiltrate consisting of numerous eosinophils, with lymphocytes and scattered neutrophils. No flame figures, no evidence of vasculitis.

1. Abarzua A et al (2016) Eosinophilic annular erythema in childhood-Case report. An Bras Dermatol 91:503-505.
2. El-Khalawany M et al. (2013) Eosinophilic annular erythema is a peculiar subtype in the spectrum of Wells syndrome: a multicentre long-term follow-up study. J Eur Acad Dermatol Venereol 27:973-979.
3. Gordon SC et al. (2018) Eosinophilic annular erythema treated with dupilumab. Pediatr Dermatol 35:e255-e256.
4. Heras MO et al. (2017) Eosinophilic annular erythema in adults: report of two cases and review of the literature. An Bras Dermatol 92:65-68.
5. Howes R et al. (2008) Eosinophilic annular erythema: a subset of Wells' syndrome or a distinct entity? Australas J Dermatol 49:159-163.
6. Kahofer P et al. (2000) Treatment of eosinophilic annular erythema with chloroquine. Acta Derm Venereol 80: 70-71.
7. Lobo MA et al. (2017) Eritema anular eosinofílico en un adulto Eosinophilic anular erythema in an adult. Dermatol Online J 23:13030/qt22c95125
8. Masaki K et al. (2021) Eosinophilic annular erythema showing eosinophil cytolytic ETosis successfully treated with benralizumab. Asia Pac Allergy 11: e28.
9. Paulitschke V et al. (2021) Eosinophilic annular erythema in a 20-month-old girl. Dermatology 72: 332-336.
10. Peterson AO (1981) Annular erythema of infancy. Arch Dermatol 117: 145-148.
11. Wallis L et al. (2018) Dapsone for Recalcitrant Eosinophilic Annular Erythema: A Case Report and Literature Review. Dermatol Ther (Heidelberg) 8:157-163.
12. Yanagihara S et al. (2021) Eosinophilic annular erythema associated with eosinophilic pneumonia and asthma. Int J Dermatol 60: 1034-1035.