Erythema annulare centrifugal Darier: causes, symptoms, diagnosis, treatment

Erythema annulare centrifugum Darier (synonyms: long-term figured and annular erythema, persistent erythema) is a unique polyetiological reaction of the skin to various exogenous and endogenous irritants (toxic, infectious, medicinal, food, etc.), which is based on toxic-allergic and immune mechanisms.

The disease was first described by Darier in 1916.

The causes and pathogenesis of erythema annulare centrifugum Darier are not fully understood.

Apparently, the disease should be considered as a reactive process. There is a connection between erythema and fungal infection of the feet, candidiasis, and drug intolerance. In addition, there are cases of the onset of the disease in patients with leukemia and systemic lupus erythematosus.

Helminthiasis may play a role. In some cases, annular centrifugal erythema occurs as paraneoplasia. The disease usually develops in adults, but the appearance of annular figured erythema (mostly unclassified) has been noted in children. Clinically, the disease is characterized by the presence of small coin-shaped, usually non-flaking spots, often pinkish-red in color with eccentric growth in the peripheral ridge zone with the formation of annular and figured foci of various shapes, localized mainly on the trunk. Sometimes peeling, vesiculation are observed, especially in the case of paraneoplasia. The course is chronic (2-3 months or more), individual foci regress within 2-3 weeks, leaving behind pigmentation, but new ones appear, which, when merging with fragments of resolving annular elements, can form bizarre polycyclic figures. Atypical forms of the disease include purpuric, telangiectatic and compacted varieties.

Symptoms of erythema annulare centrifugum Darier. Both sexes are affected approximately equally, in young and middle age. Initially, the primary elements are red spots, which quickly transform into papules or plaques. Due to the peripheral growth of the element, large annular lesions (15-20 cm) arise. Their central part is slightly sunken, often pigmented, sometimes pink-red. There is growth of the element along the periphery, fusion of nearby elements and, as a result, arcuate, annularly elevated lesions arise. The course of the disease has a peculiar character: there are new elements next to the old ones. The rash can be located on any area of the skin and are accompanied by itching of varying severity. The disease is chronic, with exacerbations often in the spring. Rare variants of the course of dermatosis (flaky, vesiculobullous, etc.) are described in the literature.

Histopathology. In the Malpighian layer of the epidermis, slight intercellular and intracellular edema is observed, in the dermis - moderate edema, capillary dilation, small perivascular infiltrates of lymphocytes and histiocytes, sometimes with an admixture of eosinophils and neutrophils.

Pathomorphology. The epidermis is usually unchanged, in the dermis there is edema and quite significant perivascular and perifollicular infiltrates of a lymphohistiocytic nature. A. Ackerman (1978) on the basis of differences in the histological picture of annular centrifugal erythema identified two types of this disease: superficial and deep. In this regard, GS Bressler (1981) proposed to use the term "superficial and deep annular erythema" instead of the term "annular centrifugal erythema".

Histogenesis. The immune genesis of the disease is assumed due to the detection of IgG deposits in the basement membrane zone of the epidermis.

Differential diagnosis. The disease should be distinguished from annular granuloma, erythema multiforme exudative, urticaria.

Treatment. Antihistamines, hyposensitizing drugs, and multivitamins are prescribed. It is necessary to treat foci of infection and gastrointestinal diseases. In particularly persistent cases, systemic corticosteroids are prescribed. Corticosteroids and itching relievers are used externally.

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