Erythema annular centrifugal Darrieus: causes, symptoms, diagnosis, treatment

Erythema ring-shaped centrifugal Daria (synonyms: long-flowing figurative and annular erythema, persistent erythema) is a kind of polytheological reaction of the skin to various exogenous and endogenous stimuli (toxic, infectious, medicinal, food, etc.), which is based on toxic-allergic and immune mechanisms.

The disease was first described by Daria in 1916.

The causes and pathogenesis of the erythema of the annular centrifugal Darje are not fully understood.

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

The role of helminthiases is possible. In a number of cases, annular centrifugal erythema proceeds as paraneoplasia. The disease usually develops in adults, but the appearance of ring shaped erythema (mostly not classified) and in children is noted. Clinically, the disease is characterized by the presence of small coin-like, usually non-peeling spots, more often pinkish-red with eccentric growth in the peripheral roller zone with the formation of ring-shaped and figured foci of a wide variety of contours that are localized mainly on the trunk. Sometimes there is peeling, vesiculation, especially in the case of paraneoplasia. The course is chronic (2-3 months or more), individual foci regress for 2-3 weeks, leaving pigmentation after itself, but new ones appear which, when merged with fragments of resolved ring-shaped elements, can form bizarre polycyclic figures. Atypical forms of the disease include purpurea, telangiectatic and condensed varieties.

Symptoms of erythema ring-shaped centrifugal Daria. Both sexes are affected approximately equally, in young and middle age. In the beginning, the primary elements are red spots that quickly transform into papules or plaques. Due to the peripheral growth of the element, annular foci of large sizes (15-20 cm) appear. The central part of them is slightly sunken, often pigmented, sometimes has a pinkish-red color. The growth of the element along the periphery, the fusion of nearby elements are marked, and as a result arched, annularly rising foci of defeat. The course of the disease has a peculiar character: next to the old, there are new elements. Rashes may be located in any area of the skin and are accompanied by an itch of varying severity. The disease proceeds chronically, with exacerbations often in the spring. In the literature, rare. Variants of the course of dermatosis (flaking, vesicle-bullous, etc.) are described.

Histopathology. In the malpighian layer of the epidermis there is a small intercellular and intracellular edema, in the dermis - moderate edema, widening of capillaries, small perivascular infiltrates from lymphocytes and histiocides, sometimes with an admixture of eosinophils and neutrophils.

Pathomorphology. The epidermis is more often unchanged, in the dermis - edema and rather significant perivascular and perifollicular infiltrates of lymphogistocyte character. A. Ackerman (1978), on the basis of differences in the histological pattern of annular centrifugal erythema, identified two types of this disease: superficial and deep. In this connection, GS Bressler (1981) proposed instead of the term "annular centrifugal erythema" to use the term "superficial and deep annular erythema".

Histogenesis. The immune genesis of the disease is assumed in connection with the detection of IgG deposits in the basal membrane of the epidermis.

Differential diagnosis. The disease should be distinguished from an annular granuloma, multi-form exudative erythema, urticaria.

Treatment. Assign antihistamine, hyposensitizing drugs, multivitamins. It is necessary to treat foci of infection, diseases of the gastrointestinal tract. In particularly persistent cases, systemic corticosteroids are prescribed. Outer corticosteroids and analgesics are used.

[1], [2], [3], [4], [5]