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Indian Pediatr 2012;49: 772

Multiple Annular Erythematous Lesions with Trailing Scale

Avijit Mondal, *Piyush Kumar and #Rajesh Kumar Mandal

Departments of Dermatology, College of Medicine and JNM Hospital, Kalyani, Nadia; *Katihar Medical College, Katihar,
Bihar and
#North Bengal Medical College.
Email: docpiyush@gmail.com


A 6-year-old boy presented with recurrent pruritic scaly lesions all over trunk for last 2 years. These lesions appeared spontaneously and resolved in 4-8 weeks without any sequale. Rest of the history was non-contributory and no other family member was having similar lesions. On examination, multiple, annular erythematous lesions with trailing scale at the inner border were present on trunk (Fig. 1). Few annular lesions were found on tongue too. On enquiry, tongue lesions used to appear and disappear simultaneously with trunk lesions. Palm, sole, nail, scalp and other mucosa were unremarkable. Routine investigations and KOH mount did not reveal any abnormality. Clinically, the child was diagnosed as Erythema annulare centrifugum (EAC). Histopathological findings were consistent with the diagnosis. Involvement of tongue is very rare. The incidence of disease peaks in the fifth decade.

Fig.1 Mutiple annular erythema with trailing scale at inner border.

Erythema annulare centrifugum (EAC) is the most common figurate erythema and is characterized by solitary or multiple, annular or polycyclic lesions that grow slowly (2-3 mm/day); with a trailing scale at the inner border of the annular erythema. The majority of cases are idiopathic; some association with dermatophytosis, infections, drugs, foods (tomato) and malignancy have been noted. The differential diagnosis includes those conditions that can have annular configuration and includes tinea, granuloma annulare, secondary syphilis, subacute cutaneous lupus erythematosus, erythema marginatum, erythema migrans, annular urticaria, and mycosis fungoides. The "trailing scale at inner border" of EAC is diagnostic. Most cases subside spontaneously.  


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