Approaches to the Dermatopathologic Diagnosis of Figurate Lesions

Ríos-Martín, J.J.; Ferrándiz-Pulido, L.; Moreno-Ramírez, D.

doi:10.1016/S1578-2190(11)70814-9

Información del artículo

Abstract

Both clinical and pathologic findings must be considered when diagnosing figurate skin lesions, which are often seen in routine practice. Although a skin biopsy may sometimes be diagnostic, more often the information provided is nonspecific. In an attempt to offer an approach to diagnosing these dermatoses, we have classified annular lesions according to the presence of lymphocytic, neutrophilic-eosinophilic, or granulomatous infiltrates, and infiltrates containing plasma cells. Neoplastic annular lesions are included in a separate group. Lesions containing lymphocytic infiltrates include superficial and deep erythema annulare centrifugum and the differential diagnosis includes a large number of conditions. In the neutrophilic-eosinophilic class, we include annular psoriasis, vasculitis, linear immunoglobulin A dermatosis, eosinophilic dermatitis, erythema marginatum rheumatica, and annular erythema of infancy. Sarcoidosis and granuloma annulare are the prototypical annular lesions containing granulomas. Secondary syphilis is typical of lesions containing plasma cells. Mycosis fungoides is the principal skin tumor that may initially manifest with annular lesions.

Keywords:

Figurate erythema

Annular erythema

Dermatopathology

Resumen

Las lesiones cutáneas figuradas son muy frecuentes en la práctica diaria, y en la mayoría de las ocasiones requieren una adecuada correlación clínico-patológica para llegar a un diagnóstico correcto. En algunos casos la biopsia mostrará hallazgos específicos que permitirán hacer el diagnóstico, pero en la mayor parte de ellos los datos serán inespecíficos. En un intento de aproximarnos al diagnóstico de estas dermatosis hemos clasificado las lesiones anulares según el tipo de infiltrado inflamatorio: linfocitario, neutrofílico-eosinofílico, granulomatoso y con células plasmáticas; y hemos incluido un último apartado para las lesiones anulares neoplásicas. Entre las primeras destacamos el eritema anular centrífugo (superficial y profundo) y su amplio diagnóstico diferencial. Con infiltrado neutrofílico-esinofílico incluimos: psoriasis anular, vasculitis, dermatitis IgA lineal, dermatitis eosinofílica, eritema marginado reumático y eritemas anulares de la infancia. La sarcoidosis y el granuloma anular son los prototipos de lesiones anulares con granulomas, y la sífilis secundaria con células plasmáticas. La micosis fungoide es la principal neoplasia cutánea que puede iniciarse con lesiones anulares.

Palabras clave:

Eritemas figurados

Eritema anular

Dermatopatología

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References

[1.]

A. Kaminsky.

Eritemas figurados.

Actas Dermosifiliogr, 100 (2009), pp. 88-109

Medline

[2.]

C.L. Guill, M.P. Hoang, K.R. Carder.

Primary annular plaque-type psoriasis.

Pediatric Dermatology, 22 (2005), pp. 15-18

http://dx.doi.org/10.1111/j.1525-1470.2005.22103.x | Medline

[3.]

A. Sepher, S. Wenson, S.R. Tahan.

Histopathologic manifestations of systemic diseases: the example of cutaneous lupus erythematosus.

J Cutan Pathol, 37 (2010), pp. 112-124

http://dx.doi.org/10.1111/j.1600-0560.2010.01510.x | Medline

[4.]

S. Hsu, E.H. Le, M.R. Khoshevis.

Differential diagnosis of annular lesions.

Am Fam Physician, 64 (2001), pp. 289-296

Medline

[5.]

W. Weyers, C. Díaz-Cascajo, I. Weyers.

Erythema annulare centrifugum. Results of a clinicopathologic study of 73 patients.

Am J Dermatopathol, 25 (2003), pp. 451-462

Medline

[6.]

K.J. Kim, S.E. Chang, J.H. Choi, K.J. Sung, KCh Moon, J.K. Koh.

Clinicopathologic analysis of 66 cases of erythema annulare centrifugum.

J Dermatol, 29 (2002), pp. 61-67

Medline

[7.]

M. Ziemer, K. Eisendle, B. Zelger.

New concepts on erythema annulare centrifugum: a clinical reaction pattern that does not represent a specific clinicopathological entity.

Br J Dermatol, 160 (2009), pp. 119-126

http://dx.doi.org/10.1111/j.1365-2133.2008.08803.x | Medline

[8.]

J. Darier.

De l’érythème annulaire centrifuge. (érythème papulo-circiné migrateur et chronique) et de quelques eruptions analogues.

Ann Dermatol Syph, 6 (1916), pp. 57-76

[9.]

A.B. Ackerman.

Histologic diagnosis of inflammatory skin diseases.

1st ed., Lea and Febiger, (1978),

[10.]

A.B. Ackerman, N. Chongchitnant, J. Sánchez, Y. Guo, B. Bennin, M. Reichel, et al.

Histologic diagnosis of inflammatory skin diseases.

2nd ed., Williams and Wilkins, (1997),

[11.]

P.H. McKee, E. Calonje, S.R. Granter.

Pathology of the skin.

3rd ed., Elsevier Mosby, (2005),

[12.]

D. Weedon.

Skin pathology.

3rd ed., Churchill Livingstone, (2010),

[13.]

R. Barnhill.

Dermatopathology.

3rd ed., McGraw-Hill, (2010),

[14.]

F. Drago, F. Broccolo, A. Rebora.

Pityriasis rosae: An update with a critical appraisal of its possible herpesviral etiology.

J Am Acad Dermatol, 61 (2009), pp. 303-318

http://dx.doi.org/10.1016/j.jaad.2008.07.045 | Medline

[15.]

P. Sánchez Sambucety, P. Gil Agapito, M.A. Rodríguez Prieto.

Contact erythema annulare centrifugum.

Contact Dermatitis, 55 (2006), pp. 309-310

http://dx.doi.org/10.1111/j.1600-0536.2006.00897.x | Medline

[16.]

V. Schmitt, A.M. Mauth, S. Amler, N. Kuehn, M. Haust, G. Messer, et al.

Lupus erythematosus tumidus as a separate subtype of cutaneous lupus erythematosus.

Br J Dermatol, 162 (2010), pp. 64-73

http://dx.doi.org/10.1111/j.1365-2133.2009.09401.x | Medline

[17.]

R.R. Mullegger, M. Glazt.

Skin manifestations of borreliosis: diagnosis and management.

Am J Clin Dermatol, 9 (2008), pp. 355-368

Medline

[18.]

F. Rongioletti, R. Gallo, E. Cozzani, A. Parodi.

Leprosy: a diagnostic trap for dermatopathologists in nonendemic area.

Am J Dermatopathol, 31 (2009), pp. 607-610

http://dx.doi.org/10.1097/DAD.0b013e3181a105a1 | Medline

[19.]

B. Kreft, W.C. Marsch.

Lupus erythematosus gyratus repens.

Eur J Dermatol, 17 (2007), pp. 79-82

http://dx.doi.org/10.1684/ejd.2007.0192 | Medline

[20.]

T. Dermitsu, K. Sasaki, E. Lida, R. Azuma, N. Umemoto, M. Kakurai, et al.

Urticarial vasculitis presenting as erythema gyratum repens-like eruption.

J Eur Acad Dermatol Venereol, 23 (2009), pp. 215-217

http://dx.doi.org/10.1111/j.1468-3083.2008.02798.x | Medline

[21.]

W. Shi, W. Lioa, X. Mei, Q. Xiao, Y. Zeng, Q. Zhou.

Necrolytic migratory erythema associated with glucagonoma syndrome.

J Clin Oncol, 28 (2010), pp. e329-e331

http://dx.doi.org/10.1200/JCO.2009.25.7113 | Medline

[22.]

M.L. Gantcheva, V.K. Broshtilova, A.I. Lalova.

Necrolytic migratory erythema: the outermost marker for glucagonoma syndrome.

Arch Dermatol, 143 (2007), pp. 1221-1222

http://dx.doi.org/10.1001/archderm.143.9.1221 | Medline

[23.]

E. Vocks, W.I. Worret, J. Ring.

Erythema annulare centrifugumtype psoriasis: a particular variant of acute-eruptive psoriasis.

J Eur Acad Dermatol Venereol, 17 (2003), pp. 446-448

Medline

[24.]

P.B. Liao, R. Rubinson, R. Howard, G. Sánchez, I.J. Frieden.

Annular pustular psoriasis—most common form of pustular psoriasis in children: report of three cases and review of the literature.

Pediatr Dermatol, 19 (2002), pp. 19-25

Medline

[25.]

E. Dippel, C.E. Orfanos, Ch.C. Zouboulis.

Linear IgA dermatosis presenting with erythema annulare centrifugum lesions: report of three cases.

J Eur Acad Dermatol Venereol, 15 (2001), pp. 167-170

Medline

[26.]

R.A.C. Graham-Brown.

Bullous pemphigoid with figurate erythema associated with carcinoma of the bronchus.

Br J Dermatol, 177 (1987), pp. 385-388

[27.]

S.M. Hadi, R.S. Barnetson, D.J. Gawkroder, U. Saxena, P. Bird, T.G. Merrett.

Clinical, histological and immunological studies in 50 patients with bullous pemphigoid.

Dermatologica, 176 (1988), pp. 6-17

Medline

[28.]

M. Mastrolonoardo, A. Conte, F. Rantuccio.

Non-bullous, erythema annulare-like pemphigus.

J Eur Aacad Dermatol Venereol, 9 (1997), pp. 149-151

[29.]

D.J. Najarian.

Annular leukocytoclastic vasculitis associated with sorafenib administration.

J Drugs Dermatol, 9 (2010), pp. 697-698

Medline

[30.]

M. Meissner, R. Kaufmann.

Annular leukocytoclastic vasculitis after the administration of an amlodipine generic.

J Eur Acad Dermatol Venereol, 23 (2009), pp. 238-239

http://dx.doi.org/10.1111/j.1468-3083.2008.02824.x | Medline

[31.]

K.R. Chen, M.R. Pittelkow, D. Su, J. Gleich, W. Newman, K.M. Leiferman.

Recurrent cutaneous necrotizing eosinophilic vasculitis. A novel eosinophil-mediated syndrome.

Arch Dermatol, 130 (1994), pp. 1159-1166

Medline

[32.]

Y. Tsunemi, H. Saeki, H. Ihn, K. Tamaki.

Recurrent cutaneous eosinophilic vasculitis presenting as annular urticarial plaques.

Acta Derm Venereol, 85 (2005), pp. 380-381

http://dx.doi.org/10.1080/00015550510030113 | Medline

[33.]

K.N. Shah, P.J. Honig, A.C. Yan.

Urticaria multiforme: A case series and review of acute annular urticarial hypersensitivity syndromes in children.

Pediatrics, 119 (2007), pp. e1177-e1183

http://dx.doi.org/10.1542/peds.2006-1553 | Medline

[34.]

F. Toledo-Alberola, I. Betlloch-Mas.

Eritemas anulares en la infancia.

Actas Dermosifiliogr, 101 (2010), pp. 473-484

Medline

[35.]

J. Mijlkovic, I. Bartenjev.

Hypereosinophilic dermatitis-like erythema annulare centrifugum in a patient with chronic lymphocytic leukaemia.

J Eur Acad Dermatol Venereol, 19 (2005), pp. 228-231

http://dx.doi.org/10.1111/j.1468-3083.2005.01052.x | Medline

[36.]

C. Troyer, M.E. Grossman, D.N. Silvers.

Erythema marginatum in rheumatic fever: early diagnosis by skin biopsy.

J Am Acad Dermatol, 8 (1983), pp. 724-728

Medline

[37.]

T.N. Helm, J. Bass, L.W. Chang, W.F. Bergfeld.

Persistent annular erythema of infancy.

Pediatr Dermatol, 10 (1993), pp. 46-48

Medline

[38.]

R. Howes, L. Girgis, S. Kossard.

Eosinophilic annular erythema: A subset of Wells’ syndrome or a distinct entity?.

Australas J Dermatol, 49 (2008), pp. 159-165

http://dx.doi.org/10.1111/j.1440-0960.2008.00456.x | Medline

[39.]

A. Patrizi, F. Savoia, E. Varotti, V. Gaspari, B. Passarini, I. Neri.

Neutrophilic figurate erythema of infancy.

Pediatric Dermatology, 25 (2008), pp. 255-282

http://dx.doi.org/10.1111/j.1525-1470.2008.00646.x | Medline

[40.]

E.B. Hawryluk, L. Izikson, J.C. English.

Non-infectious granulomatous diseases of the skin and their associated systemic diseases: an evidence-based update to important clinical questions.

Am J Clin Dermatol, 11 (2010), pp. 171-181

http://dx.doi.org/10.2165/11530080-000000000-00000 | Medline

[41.]

P.R. Cyr.

Diagnosis and management of granuloma annulare.

Am Fam Physician, 74 (2006), pp. 1729-1734

Medline

[42.]

L. Requena, M.T. Fernández-Figueras.

Subcutaneous granuloma annulare.

Semin Cutan Med Surg, 26 (2007), pp. 96-99

http://dx.doi.org/10.1016/j.sder.2007.02.006 | Medline

[43.]

E. Fernández-Faith, J. McDonell.

Cutaneous sarcoidosis: differential diagnosis.

Clin Dermatol, 25 (2007), pp. 276-287

http://dx.doi.org/10.1016/j.clindermatol.2007.03.004 | Medline

[44.]

G. Tchernev, J.W. Patterson, P. Nenoff, L.C. Horn.

Sarcoidosis of the skin, a dermatologic puzzle: important differential diagnostic aspects and guidelines for clinical and histopathological recognition.

J Eur Acad Dermatol Venereol, 24 (2010), pp. 125-137

http://dx.doi.org/10.1111/j.1468-3083.2009.03396.x | Medline

[45.]

C. Cotterman, L. Eckert, L. Ackerman.

Syphilis mimicking tinea imbricate and erythema annulare centrifugum in an immunocompromised patient.

J Am Acad Dermatol, 61 (2009), pp. 165-167

http://dx.doi.org/10.1016/j.jaad.2008.10.027 | Medline

[46.]

H.S. Zackeim, T.H. McCalmont.

Mycosis fungoides: the great imitator.

J Am Acad Dermatol, 47 (2002), pp. 914-918

http://dx.doi.org/10.1067/mjd.2002.124696 | Medline