ERYTHEMA GYRATUM REPENS AND MALIGNANCY. /. ERITEMA GYRATUM REPENS Y MALIGNIDAD.

 Erythema Gyratum Repens, another cutaneous marker of malignancy. ??

 
 Eritema Gyratum Repens, otro marcador cutaneo de malignidad.??

 

EDITORIAL ENGLISH 
=================== 
Hello friends of the network, DERMAGIC again with ANOTHER CUTANEOUS SIGN of MALIGNANCY in most cases. THE ERYTHEMA GYRATUM REPENS or The GAMMEL syndrome. For the first time described in the year 1.952 by GAMMEL in a female patient of 55 years with breast cancer with axillary invasion, the cutaneous sign appeared 9 months before the malignancy and disappeared 10 days after the surgery. 

In 1.975 SKOLNICK and MAIMAN reviewed the literature and found 31 cases of ERYTHEMA GYRATUM REPENS, all of them ASSOCIATED WITH MALIGNANCY, by that date only 3 cases NOT ASSOCIATED WITH MALIGNANCY had been reported. 

By the year 1.985, 28 cases of ERYTHEMA GYRATUM REPENS had been reported, of which 24 (85%) were associated with malignancy. In 15 cases (68%) the CUTANEOUS SIGN was present before the malignancy, in 6 cases (27%) it appeared after the malignancy was detected, and in 1 case (4%) it appeared at the same time as the malignancy. 

By the year 1.995, 60 cases of ERYTHEMA GYRATUM REPENS had been described, of which 46 (77%) were associated with malignancy. And 14 cases (23%) not associated with malignancy. 

In recent years, rashes have been described "LIKE" to ERYTHEMA GYRATUM REPENS in different pathologies, type EGR-like eruption. 

By the year 2.012 One hundred twelve original cases of EGR were selected from the literature for detailed review. Among these, 58 cases (70%) were associated with an underlying neoplasm, 25 non-paraneoplastic cases, and 29 cases were considered as different dermatoses simulating EGR in its clinical presentation (EGR-like eruption). 

Based on these findings, we can classify the ERYTHEMA GYRATUM REPENS in three variants: ASSOCIATED WITH MALIGNITY, in most cases, and the minority is NOT ASSOCIATED with MALIGNANCY. And another VARIANT: CUTANEOUS ERUPTIONS MIMICKING (LIKE) ERITEMA GYRATUM REPENS. 

A.) MALIGNITIES ASSOCIATED WITH ERITEMA GIRATUM REPENS:
 
1.) LUNG.

2.) ESOPHAGUS. 

3.) BREAST.

4.) UTERUS.
 

5.) PHARYNX. 

6.) STOMACH. 

7.) ANUS. 

8.) BLADDER. 

9.) INTESTINE. 

10.) HODGKINS DISEASE 

11.) TONGUE. 

12.) PROSTATE. 

13.) PANCREAS. 

14.) MYELOMA. 

15.) METASTASIS 

B.) ERITEMA GIRATUM REPENS NOT ASSOCIATED WITH MALIGNANCY: 

1.) ICHTHYOSIS.

2.) PALMAR AND PLANTAR HYPERKERATOSI.

3. PITYRIASIS RUBRA PILARIS.

4.) PSORIASIFORM LESIONS.

5.) BULLOUS PEMPHIGOID.

6.) PEMPHIGUS VULGARIS.

7.) BULLAE DISEASES.

8.) DISCOID LUPUS ERYTHEMATOSUS.

9.) PNEUMONIA..

10.) RHEUMATOID ARTHRITIS.

11.) HEALTHY PEOPLE.

12.) BREAST HYPERTROPHY.

13.) TUBERCULOSIS.

14.) HYPEREOSINOPHILIC SYNDROME. 

C.) ERITEMA GIRATUM REPENS-LIKE ERUPTIONS: 

1.) LEPROSY.

2.) LEUCOCYTHOCLASTIC VASCULITIS.
 

3.) URTICARIAL VASCULITIS.
 

4.) PSORIASIS.
 

5.) EPIDERMOLYSIS BULLOSA ACQUISITA.
 

6.) MYCOSIS FUNGOIDES.
 

7.) ERYTHROKERATODERMIA VARIABILIS.
 

8.) SJOGREN SYNDROME.
 

9.) SYSTEMIC LUPUS ERYTHEMATOSUS.
 

10.) DRUGS (PENICILLIN). 

" ...The pattern of EGR has been described as wood-grained,serpiginous, zebralike, cypress rings gyrate, whorled,and  swirls of rope. The expanding borders are usually macular but may occasionally be palpable Scale is usually present. The eruption of EGR moves rapidly across the surface of the skin, usually about 1 cm per day...."

So friends and colleagues dermatologists, if you find this CUTANEOUS SIGN in any of your patients, check yourself with this bibliographic review and perform the appropriate tests, mainly rule out MALIGNANCY, but remember that a Lower percentage is not associated with it.

In the 70 references the facts, in the attach, clasic ERYTEMA GYRATUM REPENS 

Greetings to all. 

Dr Jose Lapenta.

EDITORIAL ESPAÑOL
=================== 
Hola amigos de la red DERMAGIC de nuevo con ustedes OTRO SIGNO CUTANEO marcador de MALIGNIDAD en la mayoria de los casos. EL ERITEMA GYRATUM REPENS O sindrome de GAMMEL. Por primera vez descrito en el año de 1.952 por GAMMEL en una paciente femenina de 55 años con cancer de seno con invasion axilar, el signo cutaneo aparecio 9 meses antes de la malignidad y desaparecio 10 dias despues de la cirugia. 

En el año de 1.975 SKOLNICK y MAIMAN revisaron la literatura y encontraron 31 casos de ERITEMA GYRATUM REPENS, todos ASOCIADOS A MALIGNIDAD, para esa fecha solo se habian reportado 3 casos NO ASOCIADOS A MALIGNIDAD. 

Para el año de 1.985 se habian reportado 28 casos de ERITEMA GIRATUM REPENS, de los cuales 24 (85%) estaban asociados a malignidad. En 15 de los casos (68%) el SIGNO CUTANEO se presento antes que la malignidad, en 6 casos (27%) aparecio luego de detactada la malignidad, y en 1 caso (4 %) aparecio al mismo tiempo que la malignidad. 

Para el año de 1.995 se habian descrito 60 casos de ERITEMA GIRATUM REPENS, de los cuales 46 (77%) estuvo asociado a malignidad. y 14 casos(23%) no asociado a malignidad. 

En los ultimos años se han descrito erupciones cutaneas "similares al ERITEMA GYRATUM REPENS en diferentes patologias, tipo LIKE-EGR.

Para el año 2.012 Ciento doce casos originales de EGR fueron seleccionados de la literatura para su revisión detallada. Entre estos, 58 casos (70%) se asociaron con una neoplasia subyacente, 25 casos (30%) no paraneoplásicos y 29 casos fueron considerados como diferentes dermatosis simulando EGR en su presentación clínica (erupción tipo EGR). 

En base a estos hallazgos podemos clasificar al ERITEMA GYRATUM REPENS en TRES variantes: ASOCIADO A MALIGNIDAD, en la mayoria de los casos, Y NO ASOCIADO A MALIGNIDAD la minoria. y otra VARIANTE: ERUPCIONES CUTANEAS QUE SIMULAN al ERITEMA GIRATUM REPENS. 

A.) MALIGNIDADES ASOCIADAS AL ERITEMA GIRATUM REPENS: 

1.) PULMON.

2.) ESOFAGO.

3.) SENOS.

4.) UTERO.

5.) FARINGE.

6.) ESTOMAGO.

7.) ANO.

8.) VEJIGA.

9.) INTESTINO.

10.) ENFERMEDAD DE HODGKINS

11.) LENGUA.

12.) PROSTATA.

13.) PANCREAS.

14.) MIELOMA.

15.) METASTASIS  

B.) ERITEMA GIRATUM REPENS NO ASOCIADO A MALIGNIDAD: 

1.) ICTIOSIS.

2.) HIPERQUERATOSIS PALMO PLANTAR.

3.) PITIRIASIS RUBRA PILAR.

4.) LESIONES PSORIASIFORMES.

5.) PENFIGOIDE BULOSO.

6.) PENFIGO VULGAR.

7.) ENFERMEDADES AMPOLLARES.

8.) LUPUS ERITEMATOSOS DISCOIDEO CRONICO.

9.) NUEMONIA.

10.) ARTRITIS REUMATOIDE.

11.) PERSONAS SANAS.

12.) HIPERTROFIA MAMARIA.

13.) TUBERCULOSIS.

14.) SINDROME HIPEREOSINOFILICO. 

C.) ERITEMA GIRATUM REPENS-LIKE ERUPCIONES: 

1.) LEPRA.
 

2.) VASCULITIS LEUOCITOCLASTICA.
 

3.) VASCULITIS URTICARIANA.
 

4.) PSORIASIS.
 

5.) EPIDERMOLISIS BULOSA ADQUIRIDA.
 

6.) MICOSIS FUNGOIDES.
 

7.) ERITROQUERATODERMIA VARIABILIS.
 

8.) SINDROME DE SJOGREN.
 

9.) LUPUS ERITEMATOSOS SISTEMICO.
 

10.) DROGAS (PENICILINA). 

"...El patrón de EGR se ha descrito como disposicion de anillos longitudinales tipo "madera-veteada" serpiginoso, cebra-like, anillos de ciprés, y Remolinos de cuerda. Los bordes de expansión suelen ser maculares pero ocasionalmente puede ser palpable, la descamacion está generalmente presente. La erupción de EGR. Se mueve rápidamente a través de la superficie de la piel, usualmente alrededor de 1 cm por día...."

De modo amigos y colegas dermatologos, si se te presenta este SIGNO CUTANEO en alguno de sus pacientes, orientate con esta revision bibliografica y realiza los examenes adecuados, principalmente descartar MALIGNIDAD, pero recordemos que un porcentaje menor no esta asociado a ella.

En las 70 referencias los hechos, en el adjunto: ERITEMA GYRATUM REPENS CLASICO. 

Saludos a todos.
 

Dr Jose Lapenta.

================================================================== 
REFERENCIAS BIBLIOGRAFICAS / BIBLIOGRAPHICAL REFERENCES 
================================================================== 
1.) Erythema gyratum repens: A paraneoplastic eruption; Clinical review 
2.) Cutaneous manifestations of cancer. 
3.) Erythema gyratum repens in association with renal cell carcinoma. 
4.) Erythema gyratum repens: another case of a rare disorder but no new insight into pathogenesis. 
5.) Cutaneous paraneoplastic syndromes in solid tumors. 
6.) Erythema gyratum repens unassociated with underlying malignancy. 
7.) Erythema gyratum repens-like eruption in a patient with Sjogren syndrome. 
8.) Paraneoplastic bullous pemphigoid resembling erythema gyratum repens. 
9.) Eruption resembling erythema gyratum repens in linear IgA dermatosis. 
10.) Erythema gyratum repens associated with hypereosinophilic syndrome. 
11.) Erythema gyratum repens. A case studied with immunofluorescence, 
immunoelectron microscopy and immunohistochemistry. 
12.) Erythema gyratum repens: direct immunofluorescence microscopic findings. 
13.) Erythema gyratum repens without underlying disease. 
14.)Reactive erythemas: erythema annulare centrifugum and erythema gyratum 
repens. 
15.) Subcorneal accumulation of Langerhans cells in erythema gyratum repens. 
16.) Erythema gyratum repens in a healthy woman. 
17.)[Gammel's non-paraneoplastic erythema gyratum repens]. 
18.) [Erythema gyratum repens type eruption]. 
19.) A mechanism of peripheral spread or localization of inflammatory 
reactions--role of the localized ground substance adaptive phenomenon. 
20.) Episodic erythema gyratum repens with ichthyosis and palmoplantar 
hyperkeratosis without signs of internal malignancy. 
21.) Erythema gyratum repens. A cutaneous marker of malignancy. 
22.) Bullous pemphigoid with figurate erythema associated with carcinoma of the bronchus. 
23.) Erythema figuratum versus erythema gyratum repens. 
24.) Erythema gyratum repens, a stage in the resolution of pityriasis rubra 
pilaris? 
25.)[Erythema gyratum repens--a paraneoplastic dermatosis]. 
26.)Erythema gyratum repens unassociated with internal malignancy. 
27.) Erythema gyratum repens. 
28.) Gyrate erythema. 
29.) Infantile epidermodysplastic erythema gyratum responsive to imidazoles. A new entity? 
30.) Erythema gyratum repens with associated squamous cell carcinoma of the lung. 
31.) [Cutaneous paraneoplastic syndromes]. 
32.) [Erythema gyratum repens and primary bronchial cancer. Disappearance of the dermatosis under general corticoid therapy]. 
33.) [Erythema gyratum repens of Gammel and Hodgkin's disease]. 
34.) Erythema gyratum repens-like figurate eruption in bullous pemphigoid. 
35.) [Erythema gyratum repens]. 
36.) [Erythema gyratum repens]. 
37.) Erythema gyratum repens: spontaneous resolution in a healthy man. 
38.) Erythema gyratum repens with pulmonary tuberculosis. 
39.) [Gammel's erythema gyratum repens and acquired ichthyosis associated with esophageal carcinoma]. 
40.) [Erythema gyratum repens or Gammel paraneoplastic syndrome. A case with 
epidermoid carcinoma developed on a megaesophagus]. 
41.) Erythema gyratum repens--an immunologically mediated dermatosis? 
42.) Erythema gyratum repens with metastatic adenocarcinoma. 
43.) [Erythema gyratum repens (Gammel's syndrome)] 
44.) Figurate and bullous eruption in association with breast carcinoma. 
45.) [Erythema gyratum repens associated with bronchial carcinoma] 
46.) Erythema gyratum repens. Reports of two further cases associated with 
carcinoma. 
47.) Carcinoma of the breast, pemphigus vulgaris and gyrate erythema. 
48.) [Premycotic erythema simulating erythema gyratum repens]. 
49.) [An unusual paraneoplastic syndrome: erythema "gyratum repens" or Gammel's syndrome]. 
50.) [An unusual paraneoplastic syndrome: erythema gyratum repens. Its relation with bronchial cancer]. 
51.) Cutaneous manifestations of lung cancer.
52.) Cutaneous manifestations of breast cancer.
53.) Erythema gyratum repens.
54.) Erythema gyratum repens unassociated with underlying malignancy.
55.) Erythema gyratum repens unassociated with internal malignancy.
56.) Erythema gyratum repens associated with cryptogenic organizing pneumonia.
57.) Erythema gyratum repens preceding the onset of rheumatoid arthritis.
58.) Erythema gyratum repens associated with hypereosinophilic syndrome.
59.) [Erythema gyratum repens of Gammel and Hodgkin's disease].
60.) Erythema gyratum repens is not an obligate paraneoplastic disease: a systematic review of the literature and personal experience.
61.) Novel presentation of lepromatous leprosy in an erythema gyratum repens-like pattern.
62.) Leucocytoclastic vasculitis presenting as an erythema gyratum repens-like eruption.
63.) Urticarial vasculitis presenting as erythema gyratum repens-like eruption.
64.) Erythema gyratum repens-like eruption occuring in resolving psoriasis during methotrexate therapy.
65.) Erythema gyratum repens-like eruption in a patient with epidermolysis bullosa acquisita
associated with ulcerative colitis.
66.) Erythema gyratum repens-like eruption in mycosis fungoides: is dermatophyte superinfection
underdiagnosed in cutaneous T-cell lymphomas?
67.) Erythrokeratodermia variabilis with erythema gyratum repens-like lesions.
68.) Erythema gyratum repens-like eruption in a patient with Sjögren syndrome.
69.) Neutrophilic dermatosis with an erythema gyratum repens-like pattern in systemic lupus erythematosus.
70.) Penicillin-induced anti-p200 pemphigoid: an unusual morphology.
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============================================================= 
1.) Erythema gyratum repens: A paraneoplastic eruption; Clinical review 
============================================================= 
SOURCE: J AM ACAD DERMATOL 1992;26:757-62. 
Alan S. Boyd, MD, Kenneth H. Neldner, MD, and Alan Menter, MD Lubbock and 
Dallas, Texas 
 
 

Erythema gyratum repens is a slowly expanding, mildly scaling dermatosis 
with a "wood-grain" pattern and is seen in patients with an underlying 
malignancy. To date oflly 49 cases have appearcd in the literature, 41 of 
which (84%) were associated with a neoplasm, most commonly of the lung. 
Several patients also had pruritus, palmoplantar keratoderma, ichthyosis, 
vesiculobulbus lesions, and/ or eosinophilia. Histopathologic findings are 
nonspecific. The skin findings usually disappear with therapy for the 
underlying malignancy. (J AM ACAD DERMATOL 1992;26:757-62.) 
 

The skin may be the first organ to heraLd {he presence of a visceral 
malignancy. Paraneoplastic eruptions seen with cancer include acanthosis 
nigricans, acquired ichthyosis, pancreatic fat necrosis, migratory 
thrombophlebitis, Sweet's syndrome, hypertrichosis lanuginosa acquisita, 
and others, but one of the most specific dermatoses associated with 
underlying neoplasia is that of erythema gyratum repens (EGR). We discuss 
this dermatosis and review the literature. 

HISTORY 
======= 
Gammel1 described the first case of EGR in 1953. His patient, a 
55-year-old woman, developed a scaling, pruritic eruption on her trunk and 
extremities reminiscent of "knotty cypress wood grain." The eruptions was 
noted to extend about 1 cm per day. A palpable axillary lymph node revealed 
metastatic adenocarcinoma of the breast. A radical mastectomy was 
performed that led to fading of the eruption within 48 hours and complete 
clearing by 6 weeks. Neither the eruption nor the tumor recurred. The 
author believed this distinctive eruption had been caused by a carcinotoxin 
to which the host was allergic. He named it "erythema gyratum repens" 
(repens from the Latin meaning to crawl or creep).2 
Since this initial description, at least 48 additional patients have been 
reported.3-46 With a few exceptions,28, 31,35,36,40,42,46 all have been afflicted with an underlying malignancy, most commonly of the lung. Figurate erythemas have been known to occur With neoplasia,47 but EGR is the most specific and may be the most distinctive. 

CLINICAL FINDINGS 
================= 

EGR displays concentric erythematous bands48 predominantly on the trunk and 
extremities. The hands, feet, and face are usually spared.2'49 
The pattern of EGR has been described as wood-grained,17' 25, 28, 35, 43 
serpiginous,25 zebralike,2' 20 cypress rings,22 gyrate,43 whorled,43 and 
swirls of rope25 (Fig. 1, B). The expanding borders are usually macular 
but may occasionally be palpable.20 Scale is usually present14,20 and 
trails the leading edge of the eruption42. The eruption of EGR 
moves rapidly across the surface of the skin, usually about 1 cm per day.14 
EGR may involve the entire body.12'20'25'26'40 Saika et al.23 reported a 
patient in whom solely right-sided truncal lesions developed with 
underlying intrahepatic metastases from an adenocarcinoma of the colon. An 
overlying solitary flank lesion in a patient with ipsilateral 
hypernephroma has also been observed by one of us (A. M.). 

Table 1 lists the associated skin findings in these patients. Most patients 
experienced some degree of pruritus.20 Ichthyosis and palmar/plantar 
hyperkeratosis were also noted in 16% (8 of 49) and 10% (5 of 49) of the 
patients, respectively. Three patients also had bullous pemphigoid,23,35,44 
one had pemphigus vulgaris,30 and three had unspecified vesicles and 
bullae7, 13, 14 during the course of the disorder. 

An approximately 2:1 male-to-female ratio was observed. The average age was 
63 years and thus far alL patients have been white. Most patients (25) had 
the onset of their eruption an average of 9 months before their malignancy 
was diagnosed (range 1 to 72 months). Four patients developed EGR an 
average of 9 months after their tumor was detected and in two cases16,41 
the eruption and neoplasm occurred simultaneously. 

Table II outlines the underlying malignancies (if any) in these patients. 
Lung cancer was the most common (16 patients [32%]), followed distantly by 
esophagus (4 patients [8%]) and breast (3 patients 
[6%]). In three patients a metastatic malignancy was detected but the 
primary site could not be identified.14,22,25  Lymphoreticular  cancers 
were rare.19,37 Six patients did not have an underlying malignancy,31,35,40,42,46 and in two other cases tuberculosis28 and the 
CREST syndrome36 were believed to be the cause. 

Laboratory evaluations were performed in some cases. Many patients had 
peripheral eosinophilia as high as 59%.29 Eosinophilia of the bone marrow 
has also been described.7,46 Decreased T-ce1126'30 and increased 
B-ce1126 populations have been reported, as have normal percentages for 
both.31 Stankler31 demonstrated normal T-cell function in a patient with EGR but no underlying malignancy. Decreased serum levels of C3 and increased luteinizing hormone and follicle-stimulating hormone were reported in one patient.26 

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Table 1. Skin findings in 49 patients with erythema gyratum repens 
============================================================= 
% of      | 
Affected  |         disordes 
patients  | 
------------------------------------------------------------- 
50          Pruritus* 
16       Ichthyosis 22' 26, 29, 40,41,43,45,46 
lo       Palmar/plantar hyperkeratosis 6,42,45,46 
8       Pityriasis rubra pilaris 20, 40 
6       Psoriasiform lesions10, 39,40 
6       Vesicles/bullae7' 13, 14 
6       Bulbus pemphigoid 23,35'44 
2       Pemphigus vulgaris 30 
2       Discoid lupus erythematosus 40 

*References 1,3-7, 10, 12, 14, 17,21,22,25,27-29,37, 38,40,41,43, 45, 46, 48. 
------------------------------------------------------------- 

============================================================= 
Table II. Underlying malignancies associated with erythema 
gyratum repens* 
============================================================= 
    %    | 
Patients |            TyPe 
------------------------------------------------------------- 
32       Lung4, 9, 10, 15-18, 21,26,37,39,41,43,44,45 
12       None31,35,40,42,46 
8       Esophagus27, 29,32, 33 
6       Breast,1, 3, 30 unknown metastatic neoplasm 4, 22, 25 
4       Cervix,5,7 pharynx,8,34 stomach11,13 
2       Anus,24 bladder,20 bowel,23 Hodgkins disease,38 myeloma,19                                               pancreas,41, prostate,20 tongue,6 uterus 12 
-------------------------------------------------------------- 
*One patient each also had tuberculosis28 and CREST syndrome.36 
-------------------------------------------------------------- 

HISTOPATHOLOGY 

EGR is classified among the superficial erythemas50 and as such tends to 
demonstrate generally nonspecific histopathologic features. Mild to 
moderate hyperkeratosis, parakeratosis, and spongiosis are seen.43,49, 
50 Acanthosis, follicular plugging, liquefactive epidermal celLs, and 
epidermopoiesis of neutrophils and eosinophils have been described.7 
The dermal vessels are surrounded by a lympho-histiocytic  infiltrate  with 
occasional  eosinophils.28, 37, 40, 43, 50 Mast cells may also be seen.28 
The capillary endothelium may appear swollen7 and vascular proliferation 
has been described.14,28 Frank vasculitis is absent. Pigmentary 
incontinence45 and papillary dermal edema49 may also be seen. Subepidermal 
bullae with a sparse eosinophil infiltrate was described in a patient with 
EGR and bulbus pemphigoid.35 
Holt and Davies26 described a patient with bronchogenic carcinoma who had 
IgG and C3 deposits at the basement membrane zone detected by direct 
immunofluorescence of both lesional and uninvolved skin. Indirect 
immunofluorescence and immunofluorescence of metastatic nodal deposits 
were negative. Other investigators have found negative direct and indirect 
immunofiuorescence in biopsy specimens of EGR.39,46 Levine et al.43 
described a patient Erythema gyratum repens  with no immune deposits at the basement membrane zone but IgM deposition on epidermal nuclei. Phenotyping of the infiammatory infiltrate in EGR demonstrated B celís and macrophages; no T celís were found.26 

DISCUSSION 
=========== 
Differential diagnosis of the figurate erythemas 
------------------------------------------------ 
Erythema annulare centrifugum (EAC) is morphologically similar to EGR and 
some authors believe a close relation exists between the two disorders.7 
EAC usually is manifested by arcuate, polycyclic erythematous lesions that 
expand slowly48 and clear centrally; it may be pruritic.49 EAC differs from 
EGR in that the former is slightly palpable and "moves" much more slowly.20 
Histopathologic examination shows that EAC is a deep and superficial 
erythema50,51 with a lymphohistiocytic "coat-sleeve" arrangement around 
blood vessels,50 mild spongiosis, and parakeratosis.49 
EAC may 2,48 or may not2,52 be related to an underlying disease. It has 
been reported in association with malignancies48 but also with infections 
and drug intake.2,48,53 Lesions may persist indefinitely or resolve within 
a few days. 
Erythema chronicum migrans (ECM) is an annular eruption precipitated by 
the bite of an Ixodes tick and caused by infection with Borrelia 
burgdorferi.2,48,49 The lesions begin as erythematous papules that enlarge 
in a circular, expansile pattern to form a red, raised, scaleless eruption 
several centimeters in width.48 This usually begins several days to weeks 
after the tick bite. Serum antibodies directed against Borrelia antigens 
may be found. 
Erythema marginatum rheumaticum is usually associated with rheumatic fever in children and is rarely seen today.2 This eruption shows swift spread-irng, erythema, and minimal induration. However, it displays no scaling, has no symptoms, is evanescent, and demonstrates a neutrophilic infiltrate on histologic examination 49,51 Patients with glucagon-producing islet cell tu-mors of the pancreas may have necrolytic migratory erythema. Lesions usually begin on dependant parts of the body, periorally and perigenitally. Arcuate and circinate red plaques with erosions, vesicles, necrosis, and desquamation are present.48 Additional diseases that may occasionally enter the differential diagnosis include subacute cutaneous discoid lupus erythematosus, tinea corporis (especially tinea imbricata), psoriasis, pityriasis rubra pilaris, familial annular erythema, and keratolytic winter erythema. 

Etiology 
======== 

The cause of EGR is unclear. Gammel1 believed that the underlying tumor 
altered organ proteins, thereby producing endogenous allergens and creating 
a state of hypersensitivity to specific tumor antigens. Church10 injected 
suspensions of his patient's tumor (lung), unaffected pulmonary tissue, and 
skin intradermally into a recovered patient. In a similar experiment 
Leavelí et al.14 performed an Ouchter-lony gel ditfusion with their 
patient's serum and a homogenate of his tumor (undifferentiated 
adenocarcinoma-type unknown). Both produced negative results. Holt and Davies,26 the only investigators to demonstrate positive immunofiuorescence 
of the basement membrane in skin biopsy specimens of EGR, proposed three 
possibilities: tumor neoantigens may invoke antibody production that 
cross-react with endogenous skin antigens, the tumor products may alter 
certain skin antigens rendering it susceptible to immunologic attack, and 
tumor antigen-antibody complexes may form with subsequent cutaneous 
deposition. Barber et al.28 agreed that immune complex deposition may be 
operative but not neeessarily involve tumor antigens exclusively. 
Evaluations of the cellular arm of the immune system in EGR have been 
sparse. Investigators do not believe these lymphocyte subsets play a 
significant etiologic role in the eruption.26 Jacobs et al.30 noted a 
peripheral T-cell deficiency in their patient and postulated that a 
compensatory B-cell hyperactivity existed. Peripheral blood lymphocytes in 
one patient were not stimulated by phytohemagglutimn, tumor extract (lung), or involved skin extract.26 
It seems clear that whatever factors are involved in the production of 
this eruption emanate from the underlying tumor. These factors may be 
produced from solid as well as hematopoietic tumors. Inherent in patients 
who develop EGR is a predisposition to react in such a manner when 
affiicted with cancer. Such a susceptibility could involve the human 
lymphocyte antigen (HLA) system, tumoral antigen production, and/or ground 
substance alterations. Specific HLA antigens have been reported to occur to a significantly greater extent in patients with malignancies of the cervix,54 testis,55 and thyroid,56 as well as in non-Hodgkin's lymphoma,57 Burkitt's lymphoma,58 and multiple myeloma.59 An interesting feature of the HLA antigens is their close relation to tumor antigens.60 These two groups of polypeptides are believed to be structurally similar with an association 
existiing between the genes expressing both. Specific alleles among 
patients with cancer may render them more susceptible to the development 
of EGR. Second, the pathogenesis of EGR may involve a localized ground substance adaptive phenomenon. In this model granulocytes release connective 
tissue active peptides, which, in turn, stimulate fibroblast proliferation 
to produce ground substance with increased viscosity. 61 Thus inflammatory 
mediators are impeded from tissue spread and "walled off." EGR might result 
from a similar phenomenon involving spread of the erythematous rings 
through stroma, which is unable to "wall off,' the attendant inflammation. 
Clearing of the eruption results from a subsequent halt of this process 
and clearance of the inflammatory mediators.61 Moore62 noted that the 
morphologic features of EGR were similar to the patterns of aggregating 
slime mould and the Belousez-Zhabotinskii chemical reaction, processes in 
which reaction or diffusion systems are also operative. 

Additional findings 
-------------------- 

Five patients with EGR (10%) also had palmo-plantar keratoderma. In three, 
no underlying malignancy was detected,42,46 one had lung cancer,45 and one 
patient had a tongue carcinoma.6 Keratotic involvement of the palms and 
soles has been described previously in association with esophageal 
cancer63 and Bazex syndrome.64 Therefore it is not surprising that hyperkeratotic activity should appear in a subset of patients with a paraneoplastic eruption. These findings may be purely coincidental, but the high prevalence of palmoplantar thickening would make an association seem plausible. 
Three patients had associated bullous pemphigoid,23,35,44 one had pemphigus 
vulgaris,30 and three had vesiculobulbus eruptions not otherwise 
specified.7,13, 14 All but one of these had an underlying malignancy,35 
and no specific cancer was represented more than once. The association 
between cancer and pemphigoid/pemphigus has been speculated on for many 
years, however, it is currently believed that a link probably does not 
exist.65,66 Because virtually all patients with EGR have had an underlying malignancy, the question arises, what of those who do not? Barber et al.28 published the first case of a patient with this eruption and pulmonary tuberculosis. Although their photograph fails to show the classic "knotty cypress" pattern, the patient's course appears consistent with EGR. Shortly 
thereafter, Stankler31 described a healthy man with a 17-month history of 
a gyrate erythema believed to be consistent with EGR that subsequently 
resolved. Examination did not reveal a malignant process. No photographs 
were provided. Ingber et al.36 and Juhlin et al.46 described patients with 
the CREST syndrome and palmoplantar hyperkeratosis, respectively; however, 
their photographic documentation is questionable for EGR. In 1985 Langlois 
et al. 42 reported a patient with the classic eruption of EGR with a 
negative evaluation and lack of malignancy at autopsy. The patient had had 
an unexplained 30-pound weight loss. Risk factors for neoplasia in this 
patient were not discussed. Finally, Cheesbrough and Williamson40 present 
the best evidence for EGR unassociated with a malignancy. Their two 
patients had a characteristic eruption, exhaustive work-ups, lengthy 
follow-up (12 and 60 months), and, importantly, no signs or symptoms 
referable to an underlying cancer. Therefore it seems clear that a few 
patients with EGR and no underlying malignancy do exist. However, patients 
who develop the typical eruption of this disorder should be assumed to have 
an underlying cancer until proven otherwise. 

TREATMENT 
========= 

The most effective therapy for EGR is an exhaustive search for an 
underlying malignancy with treatment of the primary cause. Resolution of the 
Erythema gyratum repens eruption has been noted after surgery, chemother-apy, or radiotherapy.1, 3,4,9, 10'25'38 After treatment of the cancer, additional therapy for the 
eruption includes topical20, 46 and systemic steroids,25, 37,42 
radiotherapy,24 and azathioprine.24 Failure of topical steroids 22,24 and 
vitamin A administration42 has been reported. 

REFERENCES 
========== 
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paranowotworowe. Przegl Dermatol 1974; 61:785-9. 
25. Skolnick M, Mainman BR. Erythema gyratum repens with metastatic 
adenocarcinoma. Arch Dermatol  1975; 111:227-9. 
26. Holt PJA, Davies MG. Erythema gyratum repens an ímmunologically 
mediated dermatosis? Br J Dermatol 1 977;96:343-7. 
27. Verret JL, Pierrin B, Bertrand G, et al. Erythema gyratum repens: 011 
syndrome paranéoplasique de Gammel. Ann Dermatol Venereol 1 977;104:403-6. 
28. Barber PV, Doyle L, Vickers DM, et al. Erythema gyratum repens with 
pulmonary tuberculosis. Br J Dermatol 1978; 98:465-8. 
29. Barriére H, Litoux P, Bureau B, et al. Erythema gyratum repens de 
Gammel et ichtyose acquise associés a un cancer de l'oesophage. Ann 
Dermatol Venereol 1978;105:3 19-21. 
30. Jacobs R, Eng AM, Solomon LM. Carcinoma of the breast, pemphigus 
vulgaris and gyrate erythema. mt J Dermatol 1978;17:221-4. 
31. Stankler L. Erythema gyratum repens: spontaneous reso-lution in a 
healthy man (Lerter]. Br J Dermatol 1978;99: 461. 
32. Tenailleau JP. Erythema gyratum repens [Lerter]. 
Ann Dermatol Vénéreol 1978;105:765. 
33. ChristensenjD. Erythemagyratumrepens [Letter] . 
Ugeskr Laeger 1979;141:3532. 
34. Ressa PG, Colombo R. Erythema gyratum repens. 
G Ital Dermatol Venereol 1980;115:301-2. 
35. Breathnach SM, Wilkinson JD, Black MM. Erythema gy-ratum repens-like 
figurate eruption in bulbus pemphigoid. Clin Exp Dermatol 1982;7:401-6. 
36. Ingber A, Pullmann H, Nowel C. CRSET Syndrom: assoziation mit erythema 
figuratum. Z Hautkr 1983;58:1298-306. 
37. Larrouy JC, Apter J, Baréty M, et al. Erythema gyratum repens et cancer bronchique primitif: disparition de la dermatose sous corticothérapie 
gégérale. Ann Dermatol V~ néréol 1983;l 10:329-34. 
38. Yebra SI, Garciá BB, Camacho MF. Eritema gyratum re-pens de Gammel y 
enfirmedad de Hodgkin. Med Cutan Ibero Lat Am 1983;11:281-6. 
39. Olsen TG, Milroy SK, Jones-Olsen 5. Erythema gyratum repens with 
associated squamous celí carcinoma of the lung. Cutis 1 984;34:35 1-5. 
40. Cheesbrough MJ, Williamson DM. Erythema gyratum repens, a stage in the 
res~ution of pityriasis rubra pilaris? Clin Exp Dermatol 1985;l0:466-71. 
41. Karalitski EM. Erythema gyratum repen~paraneoplas-ticheski dermatoz. 
Vestn Dermatol Venereol 1985;8:49-51. 
42. Langlois JC, Shaw JM, Odland GF. Erythema gyratum repens unassociated 
with internal malignancy. J AM ACAD DERMATOL 1985;12:911-3. 
43. Levine LE, Morgan NF, Fretzin D, et al. Erythema gyratum repens. 
Arch Dermatol 1985;121:170-1. 
44. Graham-Brown RAC. Bullous pemphigoid with figurate erythema associated 
with carcinoma of the bronchus. Br J Dermatol 1987;l 17:385-8. 
45. Appell ML, Ward WQ, Tyring SK. Erythema gyratum repens: a cutaneous 
marker of malignancy. Cancer 1988; 62:548-50. 
46. Juhlin L, Lacour LP, Larrouy JC, et al. Episodic erythema gyratum 
repens witll ichthyosis and palmoplantar hyocrk-eratosis without sigus of 
internal malignancy. Clin Exp Dermatol 1 989;14:223-6. 
47. Summerly R. The figurate erythemas and neoplasia. 
Br J Dermatol 1964;76:370-3. 
48. Burgdorf WRC, Goltz RW. Figurate erythemas. In: Fita-patnck TB, Bisen 
AZ, Wolff K, et al, eds. Dermatology in general medicine. New York: 
McGraw-Hrn, 1987:1010-8. 
49. White JW. Gyrate erythema. 
Dermatol Clin 1985;3:l29-39. 
50. Lever WF, Schaumburg-Lever G. Histopathology of the skin. Philadelphia: JB Lippincott, 1983:137-8. 
51. White JW. Hypersensitivity and miscellaneous inflammatory disorders. 
In: Moschella SL, Hurley HJ, eds. Dermatology. Philadelphia: WB Saunders, 
l985:46-98. 
52. White JW, Perry HO. Erythema perstans. 
Br J Dermatol 1969;81:641-5l. 
53. Sheliey WB. Erythema annulare centrifugum. 
Arch Der-matol 1 964;90:54-8. 
54. Sniecinski 1, Haley J, Morgan-Byrne J, et al.Histocom-patibility-antigen distribution in patients with cervical and endometrial carcinomas. Gynecol Onool 1981; 11:68-74. 
55. DeWolf WC, Lange PH, Binarson ME, et al. HLA and testicular cancer. 
Nature 1 979;277:21 6-7. 
56. Panza N, Del Veechio L, Maio M, et al. Strong association between an 
HLA-DR anfigen and thyroid carcinoma. Tissue Antigens 1982.20:155-8. 
57. van den Tweel JG, Dugas DJ, Loon J, et al. HLA typing in non-Hodgkin's 
lymphomas. Comparative study in caucasoids, Mexican-Americans and negroids. Tissue Anti-gens 1 982;20:364-7 1. 
58. Jones EH, Biggar RJ, Nkrumah FK, et al. Study of the HLA system in 
Burkitt's lymphoma. Hum Immunol 1980;3:207-l0. 
59. Ludwig H, Mayr W. Genetic aspects of susceptibility to multiple 
myeloma. Blood 1982;59:1286-91. 
60. Gupta RK, Morton DL. Tumor antigeos. In: Ray PK, ed. Immunobiology of 
transpíantation, cancer and pregnancy. 
New York: Pergamon Press, 1983:113-47. 
61. Stone OJ. A mechanism of peripheral spread or localization of 
inflammatory reactions-role of the localized ground substance adaptive 
phenomenon. Med Hypotheses 1989; 29:167-9. 
62. Moore HJ. Does the pattern of erythema gyratum repens depend on a 
reaction-dilfusion system? [Lerter] Br J Der-matol 1982;107:723. 
63. Howel-Evans W, McConnell RB, Clarke DA, et al. Carci-noma of the 
esophagus with keratosis palmaris et plantaris (tylosis). Q J Med 
1958;27:413-29. 
64. Richard M, Giroux J-M. Acrokeratosis paraneoplastic (Bazex syndrome). JAM ACAD DERMATOL 1987;16:178-83. 
65. Stone SP, Schrocter AL. Bulbus pemphigoid and associ-ated malignant 
neoplasms. Arch Dermatol 1 975;1 11:991-4. 
66. Kaplan RP, Callen JP. Pemphigus-associated diseases and induced 
pemphigus. Clin Dermatol 1983; 1:42-71. 
============================================================= 

============================================================= 
2.) Cutaneous manifestations of cancer. 
============================================================= 
Curr Opin Oncol 1999 Mar;11(2):139-44 Related Articles, Books 

Sabir S, James WD, Schuchter LM 

Hematology-Oncology Division, Hospital of the University of Pennsylvania, 
Philadelphia 19104, USA. 

The appearance of skin lesions in patients with occult or obvious 
malignancy may be of extreme value in the detection and management of 
cancer because the skin is readily accessible to examination and biopsy. 
Examination of the skin of our patients can provide important insights into 
underlying malignant processes or possible complications from cancer 
treatment. The range of cutaneous abnormalities is wide, and include 
cutaneous paraneoplastic syndromes such as xanthomas, acanthosis nigricans, 
carcinoid syndrome, unusual erythematous eruptions such as erythema gyratum 
repens, and a number of genetic syndromes associated with malignancies and 
inherited dermatoses. 

============================================================= 
3.) Erythema gyratum repens in association with renal cell carcinoma. 
============================================================= 
J Urol 1998 Jun;159(6):2077 Related Articles, Books, LinkOut 

Kwatra A, McDonald RE, Corriere JN Jr 

Department of Surgery, University of Texas Medical School, Houston, USA. 
============================================================= 

============================================================= 
4.) Erythema gyratum repens: another case of a rare disorder but no new insight into pathogenesis. 
============================================================= 
Dermatology 1996;193(4):336-7 Related Articles, Books 

Rojo Sanchez S, Suarez Fernandez R, de Eusebio Murillo E, Lopez Bran E, 
Sanchez de Paz F, Robledo Aguilar A 

Department of Dermatology, Hospital Universitario San Carlos, Madrid, Spain. 

Erythema gyratum repens (EGR) is an uncommon but distinctive dermatosis 
characterized by marble-like swirls of erythema and a thin covering scale 
over the trunk, axillae and groins which has been associated with 
malignancy. Bronchial carcinoma has been the most frequent neoplasm 
associated. A case of EGR in a 50-year-old man with carcinoma of the lung 
is reported. The onset of dermatosis preceded the discovery of the neoplasm 
by 9 months. Oral corticosteroids induced the disappearance of the skin 
lesions. No recurrence was observed after discontinuation of the treatment. 
The patient died 1 year after the onset of dermatosis. 

============================================================= 
5.) Cutaneous paraneoplastic syndromes in solid tumors. 
============================================================= 
Am J Med 1995 Dec;99(6):662-71 Related Articles, Books 

Kurzrock R, Cohen PR 

Department of Clinical Investigation, University of Texas M.D. Anderson 
Cancer Center, Houston 77030, USA. 

OBJECTIVE: To provide an overview of the clinical manifestations, 
pathophysiology, and oncologic implications of the cutaneous paraneoplastic 
syndromes that occur predominantly in patients with solid tumors. METHODS: 
A review was performed of the literature identified by a comprehensive 
MEDLINE search. RESULTS: Diverse cutaneous paraneoplastic syndromes may be 
associated with underlying tumors. They include musculoskeletal disorders 
(clubbing, hypertrophic osteoarthropathy, dermatomyositis, and multicentric 
reticulohistiocytosis), reactive erythemas (erythema gyratum repens and 
necrolytic migratory erythema), vascular dermatoses (Trousseau's syndrome), 
papulosquamous disorders (acanthosis nigricans, tripe palms, palmar 
hyperkeratosis, acquired ichthyosis, pityriasis rotunda, Bazex's syndrome, 
florid cutaneous papillomatosis, the sign of Leser-Trelat, and extramammary 
Paget's disease), and disorders of hair growth (hypertrichosis lanuginosa 
acquisita). The clinical manifestations of these dermatoses may precede, 
coincide with, or follow the diagnosis of cancer. The presence of a 
cutaneous paraneoplastic syndrome is often associated with a poor 
prognosis. CONCLUSIONS: Cutaneous paraneoplastic syndromes are specific 
constellations of mucous membrane and/or skin abnormalities that are caused 
by an underlying tumor. Since they may be the presenting sign of an occult 
cancer, cognizance of their features and clinical implications are of 
considerable importance. Individuals with these syndromes should have a 
thorough workup for an associated malignancy. 

============================================================= 
6.) Erythema gyratum repens unassociated with underlying malignancy. 
============================================================= 
J Dermatol 1995 Aug;22(8):587-9 Related Articles, Books 

Kawakami T, Saito R 

Second Department of Dermatology, Toho University School of Medicine, 
Tokyo, Japan. 

A case of erythema gyratum repens occurring in a 62-year-old woman is 
presented together with a review of the literature. Evaluation and 
follow-up for the development of malignancy over a 32-month period failed 
to reveal any evidence of malignancy. Formerly, all cases of erythema 
gyratum repens were evaluated in terms of an association with an underlying 
malignant disorder. To date, only sixty cases have been reported in the 
literature; 14 (23%) were not found to be associated with any neoplasm. 
Therefore, this term is now also used for cases unassociated with 
malignancy. Erythema gyratum repens is a cutaneous eruption with a 
characteristic diagnostic morphology resembling a wood grain pattern. 

============================================================= 
7.) Erythema gyratum repens-like eruption in a patient with Sjogren syndrome. 
============================================================= 
Acta Derm Venereol 1995 Jul;75(4):327 Related Articles, Books 

Matsumura T, Kumakiri M, Sato-Matsumura KC, Ohkawara A 

Publication Types: 
Letter 
============================================================= 
============================================================= 
8.) Paraneoplastic bullous pemphigoid resembling erythema gyratum repens. 
Br J Dermatol 1999 Mar;140(3):550-2 Related Articles, Books, LinkOut 
============================================================= 
Hauschild A, Swensson O, Christophers E 

Publication Types: 
Letter 
============================================================= 
============================================================= 
9.) Eruption resembling erythema gyratum repens in linear IgA dermatosis. 
============================================================= 
Dermatology 1995;190(3):235-7 Related Articles, Books 

Caputo R, Bencini PL, Vigo GP, Berti E, Veraldi S 

Istituto di Scienze Dermatologiche, Universita di Milano, Ospedale 
Policlinico IRCCS, Italia. 

We report a case of linear IgA dermatosis associated with eruptions 
resembling erythema gyratum repens in a 62-year-old man. The patient 
revealed no clinical and laboratory evidence of an underlying malignancy. 
The presence of eruptions similar to erythema gyratum repens during the 
course of bullous dermatoses has been described in only eight reports. 

============================================================= 
10.) Erythema gyratum repens associated with hypereosinophilic syndrome. 
============================================================= 
J Dermatol 1994 Aug;21(8):612-4 Related Articles, Books 

Morita A, Sakakibara N, Tsuji T 

Department of Dermatology, Nagoya City University Medical School, Japan. 

We report a case of typical erythema gyratum repens lesions observed as a 
manifestation of idiopathic hypereosinophilic syndrome in a 63-year-old 
man. While erythema gyratum repens is usually associated with malignancy, 
an intensive search over a 30-month period failed to reveal any evidence of 
neoplasm. With administration of dapsone, the typical gyrate lesions 
disappeared as the subject's hypereosinophilia improved. 

============================================================= 
11.) Erythema gyratum repens. A case studied with immunofluorescence, 
immunoelectron microscopy and immunohistochemistry. 
============================================================= 
Br J Dermatol 1994 Jul;131(1):102-7 Related Articles, Books 

Caux F, Lebbe C, Thomine E, Benyahia B, Flageul B, Joly P, Rybojad M, Morel P 

Service de Dermatologie, Hopital Saint-Louis, Paris, France. 

We report a patient with erythema gyratum repens (EGR), in whom a bronchial 
carcinoma was found. Direct immunofluorescence revealed granular deposits 
of immunoglobulins at the basement membrane zone (BMZ) in the skin, and in 
the lung tumour. Direct immunoelectron microscopy showed that the immune 
deposits were localized just beneath the lamina densa. Indirect 
immunofluorescence revealed circulating anti-BMZ antibodies. 
Immunohistochemical staining, using anti-transforming growth factor-beta, 
anti-epidermal growth factor receptor, anti-vimentin and anti-alpha-actin, 
was found to be more intense in the lesional skin and the lung tumour than 
in normal tissues. Possible mechanisms in the pathogenesis of EGR are 
discussed. 

============================================================= 
12.) Erythema gyratum repens: direct immunofluorescence microscopic findings. 
============================================================= 
J Am Acad Dermatol 1993 Sep;29(3):493-4 Related Articles, Books, 
LinkOut 

Albers SE, Fenske NA, Glass LF 

Department of Internal Medicine, University of South Florida, College of 
Medicine. 
============================================================= 
============================================================= 
13.) Erythema gyratum repens without underlying disease. 
============================================================= 
J Am Acad Dermatol 1993 Jan;28(1):132 Related Articles, Books, LinkOut 

Boyd AS, Neldner KH 
Publication Types: 
Comment 
Letter 
============================================================= 
============================================================= 
14.)Reactive erythemas: erythema annulare centrifugum and erythema gyratum 
repens. 
============================================================= 
Clin Dermatol 1993 Jan-Mar;11(1):135-9 Related Articles, Books 
Tyring SK 

Department of Dermatology, University of Texas Medical Branch, Galveston. 

Publication Types: 
Review 
Review, tutorial 
============================================================= 
============================================================= 
15.) Subcorneal accumulation of Langerhans cells in erythema gyratum repens. 
============================================================= 
Br J Dermatol 1992 Feb;126(2):189-92 Related Articles, Books 

Wakeel RA, Ormerod AD, Sewell HF, White MI 

Department of Dermatology, Aberdeen Royal Infirmary, U.K. 

Erythema gyratum repens (EGR) is a cutaneous manifestation of malignant 
disease. We report an unusual accumulation of activated epidermal 
Langerhans cells in the upper layer of the epidermis and propose that these 
cells play an important immunopathological role. 

============================================================= 
16.) Erythema gyratum repens in a healthy woman. 
============================================================= 
J Am Acad Dermatol 1992 Jan;26(1):121-2 Related Articles, Books 

Garrett SJ, Roenigk HH Jr 

Department of Dermatology, Northwestern University Medical School, Chicago, 
IL 60611. 

Comments: 
Comment in: J Am Acad Dermatol 1993 Jan;28(1):132 
============================================================= 

============================================================= 
17.)[Gammel's non-paraneoplastic erythema gyratum repens]. 
============================================================= 
Ann Dermatol Venereol 1991;118(6-7):469 Related Articles, Books 

[Article in French] 

Bazex J, Marguery MC 

Service de Dermatologie, Allergologie et Venereologie, Hopital Purpan, 
Toulouse. 

Publication Types: 
Review 
Review of reported cases 
============================================================= 
============================================================= 
18.) [Erythema gyratum repens type eruption]. 
============================================================= 
Ann Dermatol Venereol 1991;118(11):897-9 Related Articles, Books 

Goettmann S, Lazareth I, Crickx B, Lemaire V, Belaich S 

Service de Dermatologie, Hopital Bichat, Paris. 
============================================================= 
============================================================= 
19.) A mechanism of peripheral spread or localization of inflammatory 
reactions--role of the localized ground substance adaptive phenomenon. 
============================================================= 
Med Hypotheses 1989 Jul;29(3):167-9 Related Articles, Books 

Stone OJ 

It is known that connective tissue-active peptides (CTAP) are released at 
sites of inflammation. Some of this material diffuses to immediately 
adjacent tissue and increases ground substance viscosity and fibroblast 
proliferation. This contributes to host protection against spread of 
infections and tumors. In a person with normal inflammatory reactivity, it 
should prevent spread of mediators and products of local inflammation. 
However, the host with an increased reactivity in sites of increased ground 
substance viscosity or who is highly reactive to dilution of tissue fluid 
would respond with more inflammation. A non-infectious, non-malignant 
process in a host with a highly reactive inflammatory or immune response 
could end up with peripheral spread. This could occur in any tissue but it 
occurs with great vigor in the skin. It could present as a peripheral 
extension of a local disease process, such as psoriasis, or the migration 
of cyclic lesions with clearing of the central area. There are over a dozen 
variants of peripherally spreading, ringed lesions described in the 
dermatologic literature. This includes erythema marginatum of rheumatic 
fever, erythema gyratum repens associated with cancer, and erythema 
annulare centrificum associated with allergic reactions to fungi. Many of 
the ringed dermatologic lesions have an immunologic component. They tend to 
be associated with inflammatory immune reactions at distant sites. 
Dermatologists have been gathering information on the ringed phenomenon at 
least since Hebra in 1854. The acute localized ground substance adaptive 
phenomenon is a broadly beneficial biologic response. 

============================================================= 
20.) Episodic erythema gyratum repens with ichthyosis and palmoplantar 
hyperkeratosis without signs of internal malignancy. 
============================================================= 
Clin Exp Dermatol 1989 May;14(3):223-6 Related Articles, Books 

Juhlin L, Lacour JP, Larrouy JC, Baze PE, Ortonne JP 

Two patients with typical lesions of erythema gyratum repens, peripheral 
ichthyosis, palmoplantar hyperkeratosis and nail changes are described. A 
non-specific erythrodermic eruption of several weeks' duration had preceded 
the typical lesions. No signs of internal malignancy were found and the 
typical gyrate lesions disappeared within some weeks with full restitution 
of all skin lesions within 6-8 months. 

============================================================= 
21.) Erythema gyratum repens. A cutaneous marker of malignancy. 
============================================================= 
Cancer 1988 Aug 1;62(3):548-50 Related Articles, Books 
Appell ML, Ward WQ, Tyring SK 

Department of Dermatology, University of Alabama, Birmingham. 

A patient with erythema gyratum repens in whom a bronchogenic carcinoma was 
found is described. Erythema gyratum repens is a cutaneous eruption with a 
unique morphology resembling a wood grain pattern. Its presence is almost 
always associated with serious systemic pathology, usually neoplastic, and 
thus should be considered a cutaneous marker of internal malignancy. 

============================================================= 
22.) Bullous pemphigoid with figurate erythema associated with carcinoma of the bronchus. 
============================================================= 
Br J Dermatol 1987 Sep;117(3):385-8 Related Articles, Books 

Graham-Brown RA 
Department of Dermatology, Leicester Royal Infirmary, Infirmary Square, U.K. 

A patient with bullous pemphigoid (BP), a figurate erythema resembling 
erythema gyratum repens and a bronchial carcinoma is reported. It is 
suggested that this is a genuine association and that when a figurate 
erythema occurs with BP, an underlying carcinoma should be excluded. 

============================================================= 
23.) Erythema figuratum versus erythema gyratum repens. 
============================================================= 
J Am Acad Dermatol 1986 Jul;15(1):111-2 Related Articles, Books 

Ingber A, Sandbank M 

Publication Types: 
Letter 
============================================================= 
============================================================= 
24.) Erythema gyratum repens, a stage in the resolution of pityriasis rubra 
pilaris? 
============================================================= 
Clin Exp Dermatol 1985 Sep;10(5):466-71 Related Articles, Books 

Cheesbrough MJ, Williamson DM 
============================================================= 
============================================================= 
25.)[Erythema gyratum repens--a paraneoplastic dermatosis]. 
============================================================= 
Vestn Dermatol Venerol 1985 Aug;(8):49-51 Related Articles, Books 

[Article in Russian] 

Karalitskii EM 
============================================================= 
============================================================= 
26.)Erythema gyratum repens unassociated with internal malignancy. 
============================================================= 
J Am Acad Dermatol 1985 May;12(5 Pt 2):911-3 Related Articles, Books 

Langlois JC, Shaw JM, Odland GF 

A case report of erythema gyratum repens occurring in a 68-year-old man is 
presented. Evaluation and follow-up for development of malignancy over a 
39-month period failed to reveal evidence of malignancy. The patient died 
of an unrelated cause. Autopsy did not demonstrate any evidence of malignancy. 

============================================================= 
27.) Erythema gyratum repens. 
============================================================= 
Arch Dermatol 1985 Feb;121(2):170-1 Related Articles, Books 

Levine LE, Morgan NE, Fretzin D, Rubenstein D 

Publication Types: 
Letter 
============================================================= 
============================================================= 
28.) Gyrate erythema. 
============================================================= 
Dermatol Clin 1985 Jan;3(1):129-39 Related Articles, Books 

White JW Jr 

The gyrate erythemas consist of a nonspecific group (often called erythema 
annulare centrifugum) for which the cause is usually unknown, and three 
specific types (erythema marginatum rheumaticum, erythema chronicum migrans 
[Lyme disease], and erythema gyratum repens). The first specific type, 
erythema marginatum rheumaticum, has become extremely rare with the decline 
of its associated disease, rheumatic fever. The second specific type, 
erythema chronicum migrans, is caused by a spirochete transmitted by the I. 
ricinus complex of ticks. The third specific type, erythema gyratum repens, 
is uncommon, morphologically distinctive, and an indicator of serious 
disease, usually internal malignancy, in almost every instance. 

============================================================= 
29.) Infantile epidermodysplastic erythema gyratum responsive to imidazoles. A new entity? 
============================================================= 
Arch Dermatol 1984 Dec;120(12):1601-3 Related Articles, Books 

Saurat JH, Janin-Mercier A 

A 3 1/2-year-old girl had a three-year history of chronic annular erythema 
that more closely mimicked erythema gyratum repens of adults than other 
annular erythemas of infancy. Histopathologic study revealed bowenoid 
characteristics in the epidermis. No fungi were ever demonstrated in this 
patient's skin lesions, but they consistently responded to treatment with 
ketoconazole and flared immediately after cessation of treatment with that 
drug. 

============================================================= 
30.) Erythema gyratum repens with associated squamous cell carcinoma of the lung. 
============================================================= 
Cutis 1984 Oct;34(4):351-3, 355 Related Articles, Books 

Olsen TG, Milroy SK, Jones-Olsen S 

A 63-year-old man with erythema gyratum repens (EGR) was found to have an 
underlying squamous cell carcinoma of the lung. Neither radiation nor 
chemotherapy had any effect on the extensive eruption. EGR is the most 
distinctive of the figurate erythemas, and continues to be one of the most 
consistent cutaneous signs of an associated visceral malignancy. 

============================================================= 
31.) [Cutaneous paraneoplastic syndromes]. 
============================================================= 
Ann Med Interne (Paris) 1984;135(8):662-8 Related Articles, Books 

Barriere H 

The authors list the really significant paraneoplastic cutaneous syndromes: 
acanthosis nigricans, paraneoplastic acrokeratosis, acquired ichthyosis 
(and eventually the "explosive" onset of seborrheic warts) and a special 
type of desquamative circinate erythema (erythema gyratum repens). The 
possible paraneoplastic character of other conditions is also discussed: 
dermatomyositis, necrosing vasculitis, autoimmune bullous conditions and 
pruritus "sine materia". 

============================================================= 
32.) [Erythema gyratum repens and primary bronchial cancer. Disappearance of the dermatosis under general corticoid therapy]. 
============================================================= 
Ann Dermatol Venereol 1983;110(4):329-34 Related Articles, Books 

[Article in French] 

Larrouy JC, Apter J, Barety M, Ortonne JP 

A case of Erythema Gyratum Repens in a 76 year old man with bronchiolar 
carcinoma is reported. The onset of the dermatosis preceded the discovery 
of the neoplasm. Oral corticosteroids induced the disappearance of the skin 
lesions. No recurrence was observed after discontinuation of the treatment. 
The patient died 7 months after the onset of the dermatosis. 

============================================================= 
33.) [Erythema gyratum repens of Gammel and Hodgkin's disease]. 
============================================================= 
Med Cutan Ibero Lat Am 1983;11(4):281-6 Related Articles, Books 

[Article in Spanish] 

Yebra Sotillo I, Garcia Bravo B, Camacho Martinez F 

A 65 year old male with Hodgkins disease, and generalised figurate 
Erythema, which during his period of hospitalisation migrated and became 
much more evident, disappearing after initial therapy. Diagnosed as 
"Erythema gyratum repens" reported by Gammel, an uncommon form of 
paraneoplasic migrant figurate Erythema, we review the 33 previous cases of 
this process, and find that, although 30 were related to other processes. 

============================================================= 
34.) Erythema gyratum repens-like figurate eruption in bullous pemphigoid. 
============================================================= 
Clin Exp Dermatol 1982 Jul;7(4):401-6 Related Articles, Books 

Breathnach SM, Wilkinson JD, Black MM 

============================================================= 
============================================================= 
35.) [Erythema gyratum repens]. 
============================================================= 
Ugeskr Laeger 1979 Dec 17;141(51):3532 Related Articles, Books 

[Article in Danish] 

Christensen JD 
============================================================= 
============================================================= 
36.) [Erythema gyratum repens]. 
============================================================= 
Hautarzt 1979 Apr;30(4):213-5 Related Articles, Books 

[Article in German] 

Verret JL, Schnitzler L, Schubert B, Alain YM, Bertrand G 

A case of erythema gyratum repens is reported in 78 year old woman. The 
particularly typical eruption, mainly affecting the trunk, was associated 
with a squamous cell carcinoma of the esophagus. The paraneoplastic 
dermatosis cleared after radiotherapy of the cancer. 

============================================================= 
37.) Erythema gyratum repens: spontaneous resolution in a healthy man. 
============================================================= 
Br J Dermatol 1978 Oct;99(4):461 Related Articles, Books 

Stankler L 

Publication Types: 
Letter 
============================================================= 
============================================================= 
38.) Erythema gyratum repens with pulmonary tuberculosis. 
============================================================= 
Br J Dermatol 1978 Apr;98(4):465-8 Related Articles, Books 

Barber PV, Doyle L, Vickers DM, Hubbard H 

A 63-year-old man presented with erythema gyratum repens of 7 months' 
duration. A cavitating mass at the right lung apex was resected and proved 
to be tuberculous. Following the resection, the skin lesions cleared within 
a few days. Erythema gyratum repens has not previously been described in 
association with non-malignant visceral pathology. The pathogenesis remains 
obscure but cannot be related specifically to a response to tumour cells or 
their products in view of the association reported here. The condition 
bears no resemblance to any known tuberculide. 

============================================================= 
39.) [Gammel's erythema gyratum repens and acquired ichthyosis associated with esophageal carcinoma]. 
============================================================= 
Ann Dermatol Venereol 1978 Mar;105(3):319-21 Related Articles, Books 

Barriere H, Litoux P, Bureau B, Preel JL, Thebaud Y 
============================================================= 

============================================================= 
40.) [Erythema gyratum repens or Gammel paraneoplastic syndrome. A case with 
epidermoid carcinoma developed on a megaesophagus]. 
============================================================= 
 Ann Dermatol Venereol 1977 May;104(5):403-6 Related Articles, Books 

[Article in French] 

Verret JL, Pierrin B, Bertrand G, Dubin J, Allain YM, Schnitzler L 

============================================================= 

============================================================= 
41.) Erythema gyratum repens--an immunologically mediated dermatosis? 
============================================================= 
 Br J Dermatol 1977 Apr;96(4):343-7 Related Articles, Books 

Holt PJ, Davies MG 
============================================================= 

============================================================= 
42.) Erythema gyratum repens with metastatic adenocarcinoma. 
============================================================= 
Arch Dermatol 1975 Feb;111(2):227-9 Related Articles, Books 

Skolnick M, Mainman ER 

A patient with Erythema Gyratum Repens (EGR) had a marked increase of his 
eruption, with uncontrollable pruritus that was unresponsive to steriod 
therapy. This culminated in an exfoliative dermatitis. A metastatic, 
undifferentiated adenocarcinoma was removed following a right-sided 
craniotomy. The patient then had complete cessation of his pruritus, with 
moderate improvement of his eruption. All the reported cases of EGR were 
reviewed in terms of the source of the malignant disorder. The relationship 
between the time of onset of the EGR and the discovery of the malignant 
disorder, as well as the effect of treatment of the malignant condition on 
the course of the EGR, was studied. The data suggest a highly probable 
relationship between the two. 

============================================================= 
43.) [Erythema gyratum repens (Gammel's syndrome)] 
============================================================= 
SO  - Hautarzt  1979 Apr;30(4):213-5 
AU  - Verret JL; Schnitzler L; Schubert B; Alain YM; Bertrand G 
PT  - JOURNAL ARTICLE 
AB  - A case of erythema gyratum repens is reported in 78 year old woman. 
The particularly typical eruption, mainly affecting the trunk, was 
associated with a squamous cell carcinoma of the esophagus. The 
paraneoplastic dermatosis cleared after radiotherapy of the cancer. 

============================================================= 
44.) Figurate and bullous eruption in association with breast carcinoma. 
============================================================= 

SO  - Arch Dermatol  1990 May;126(5):649-52 
AU  - Watsky KL; Orlow SJ; Bolognia JL 
PT  - JOURNAL ARTICLE; REVIEW (16 references); REVIEW OF REPORTED CASES 
AB  - We describe a patient with two coexistent cutaneous eruptions: (1) 
trauma-induced bullae of the distal extremities and elbows and (2) multiple 
concentric gyrate lesions on the trunk and extremities, some of which 
became bullous. The gyrate lesions were stationary and nonpruritic. Biopsy 
of both types of lesions showed a subepidermal blister and a minimal 
inflammatory infiltrate. Direct immunofluorescence revealed linear 
deposition of IgG and C3 at the dermoepidermal junction and indirect 
immunofluorescence was negative. By immunoelectron microscopy, these immune 
deposits were localized to the lower lamina lucida. The eruption was not 
controlled despite high-dose (80 mg/d) oral administration of prednisone 
and required the addition of an oral administration of methotrexate (20 mg 
weekly). On further evaluation, an intraductal mammary carcinoma was 
detected. Following radiation therapy, the methotrexate and prednisone 
therapy were tapered without recurrence of the eruption during a follow-up 
period of 18 months. 

============================================================= 
45.) [Erythema gyratum repens associated with bronchial carcinoma] 
============================================================= 
SO  - Hautarzt  1970 Mar;21(3):116-9 
AU  - Hochleitner H; Bartsch G; Zelger J 
PT  - JOURNAL ARTICLE 
============================================================= 
============================================================= 
46.) Erythema gyratum repens. Reports of two further cases associated with 
carcinoma. 
============================================================= 
SO  - Br J Dermatol  1970 Apr;82(4):406-11 
AU  - Thomson J; Stankler L 
PT  - JOURNAL ARTICLE 
============================================================= 
============================================================= 
47.) Carcinoma of the breast, pemphigus vulgaris and gyrate erythema. 
============================================================= 
SO  - Int J Dermatol  1978 Apr;17(3):221-4 
AU  - Jacobs R; Eng AM; Solomon LM 
PT  - JOURNAL ARTICLE 
============================================================= 

============================================================= 
48.) [Premycotic erythema simulating erythema gyratum repens]. 
============================================================= 
Bull Soc Fr Dermatol Syphiligr 1969;76(1):12 Related Articles, Books 

[Article in French] 

Duperrat B, Puissant A, Cherif-Cheikh JL, Pringuet R, David V, Blanchet P 
============================================================= 
============================================================= 

============================================================= 
49.) An unusual paraneoplastic syndrome: erythema "gyratum repens" or Gammel's syndrome]. 
============================================================= 
Presse Med 1967 May 20;75(24):1239-42 Related Articles, Books 

[Article in French] 

Migueres J, Jover A, Layssol M, Ranfaing J 

============================================================= 
============================================================= 
50.) [An unusual paraneoplastic syndrome: erythema gyratum repens. Its relation with bronchial cancer]. 
============================================================= 
J Fr Med Chir Thorac 1967 Apr;21(3):313-24 Related Articles, Books 

[Article in French] 

Migueres J, Jover A, Layssol M, Ranfaing J 

=====================================
51.) Cutaneous manifestations of lung cancer.
=====================================
Owen CE1.
Author information

1University of Louisville, Division of Dermatology, Louisville, KY. Electronic address: ceowen01@louisville.edu.

Abstract

Skin findings can serve as a clue to internal disease. In this article, cutaneous manifestations of underlying lung malignancy are reviewed. Paraneoplastic dermatoses are rare, but when recognized early, can lead to early diagnosis of an underlying neoplasm. Malignancy-associated dermatoses comprise a broad group of hyperproliferative and inflammatory disorders, disorders caused by tumor production of hormonal or metabolic factors, autoimmune connective tissue diseases, among others. In this review, paraneoplastic syndromes associated with lung malignancy are discussed, including ectopic ACTH syndrome, bronchial carcinoid variant syndrome, secondary hypertrophic osteoarthropathy/digital clubbing, erythema gyratum repens, malignant acanthosis nigricans, sign of Leser-Trélat, tripe palms, hypertrichosis lanuginosa, acrokeratosis paraneoplastica, and dermatomyositis.
=========================================
52.) Cutaneous manifestations of breast cancer.
========================================
Semin Oncol. 2016 Jun;43(3):331-4. doi: 10.1053/j.seminoncol.2016.02.030. Epub 2016 Feb 23.

Tan AR1.
Author information

1Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC. Electronic address: Antoinette.Tan@CarolinasHealthcare.org.

Abstract

Breast cancer may present with cutaneous symptoms. The skin manifestations of breast cancer are varied. Some of the more common clinical presentations of metastatic cutaneous lesions from breast cancer will be described. Paraneoplastic cutaneous dermatoses have been reported as markers of breast malignancy and include erythema gyratum repens, acquired ichthyosis, dermatomyositis, multicentric reticulohistiocytosis, and hypertrichosis lanuginosa acquisita. Mammary Paget's disease, often associated with an underlying breast cancer, and Cowden syndrome, which has an increased risk of breast malignancy, each have specific dermatologic findings. Recognition of these distinct cutaneous signs is important in the investigation of either newly diagnosed or recurrent breast cancer.
=========================================
53.) Erythema gyratum repens.
========================================
Eubanks LE1, McBurney E, Reed R.
Author information

1Department of Dermatology, Tulane University School of Medicine, New Orleans, LA 70112, USA.

Abstract
BACKGROUND:

Erythema gyratum repens is a rare, clinically specific, and distinctive paraneoplastic syndrome. It is associated with internal malignancy in 82% of patients.
OBJECTIVE:

A 58-year-old man with erythema gyratum repens is described. On diagnosis of his eruption, a malignancy work-up revealed a 9-mm pulmonary adenocarcinoma. Removal of the carcinoma resulted in clearing of the erythema.
RESULTS:

Erythema gyratum repens is most commonly associated with bronchial, esophageal, and breast cancer. It has also rarely been reported in patients without evidence of malignancy. The histopathologic findings are nonspecific. Direct immunofluorescence has sometimes revealed C3, C4, or immunoglobulin G at the basement membrane zone.
CONCLUSION:

The etiology of erythema gyratum repens is unknown, although an immune response is postulated. Treatment involves treating the underlying malignancy.
=============================================
54.) Erythema gyratum repens unassociated with underlying malignancy.
============================================
J Dermatol. 1995 Aug;22(8):587-9.
Kawakami T1, Saito R.
Author information

1Second Department of Dermatology, Toho University School of Medicine, Tokyo, Japan.

Abstract

A case of erythema gyratum repens occurring in a 62-year-old woman is presented together with a review of the literature. Evaluation and follow-up for the development of malignancy over a 32-month period failed to reveal any evidence of malignancy. Formerly, all cases of erythema gyratum repens were evaluated in terms of an association with an underlying malignant disorder. To date, only sixty cases have been reported in the literature; 14 (23%) were not found to be associated with any neoplasm. Therefore, this term is now also used for cases unassociated with malignancy. Erythema gyratum repens is a cutaneous eruption with a characteristic diagnostic morphology resembling a wood grain pattern.
============================================
55.) Erythema gyratum repens unassociated with internal malignancy.
============================================
J Am Acad Dermatol. 1985 May;12(5 Pt 2):911-3.

Langlois JC, Shaw JM, Odland GF.
Abstract

A case report of erythema gyratum repens occurring in a 68-year-old man is presented. Evaluation and follow-up for development of malignancy over a 39-month period failed to reveal evidence of malignancy. The patient died of an unrelated cause. Autopsy did not demonstrate any evidence of malignancy.
===========================================
56.) Erythema gyratum repens associated with cryptogenic organizing pneumonia.
==========================================
Indian J Dermatol Venereol Leprol. 2016 Mar-Apr;82(2):212-3. doi: 10.4103/0378-6323.173594.

Samotij D, Szczech J, Bencal-Kusinska M, Reich A1.
Author information

1Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland.
============================================
57.) Erythema gyratum repens preceding the onset of rheumatoid arthritis.
===========================================
Eur J Dermatol. 2013 May-Jun;23(3):399-400. doi: 10.1684/ejd.2013.2049.

Endo Y1, Fujisawa A1, Tanioka M1, Miyachi Y1.
Author information

1Department of Dermatology, Kyoto University, 54 Shogoin-Kawara-cho, Sakyo, Kyoto 606-8507, Japan.

=============================================
58.) Erythema gyratum repens associated with hypereosinophilic syndrome.
=============================================
J Dermatol. 1994 Aug;21(8):612-4.

Morita A1, Sakakibara N, Tsuji T.
Author information
Abstract

We report a case of typical erythema gyratum repens lesions observed as a manifestation of idiopathic hypereosinophilic syndrome in a 63-year-old man. While erythema gyratum repens is usually associated with malignancy, an intensive search over a 30-month period failed to reveal any evidence of neoplasm. With administration of dapsone, the typical gyrate lesions disappeared as the subject's hypereosinophilia improved.
==============================================
59.) [Erythema gyratum repens of Gammel and Hodgkin's disease].
===============================================
Med Cutan Ibero Lat Am. 1983;11(4):281-6.

[Article in Spanish]
Yebra Sotillo I, Garciá Bravo B, Camacho Martínez F.
Abstract

A 65 year old male with Hodgkins disease, and generalised figurate Erythema, which during his period of hospitalisation migrated and became much more evident, disappearing after initial therapy. Diagnosed as "Erythema gyratum repens" reported by Gammel, an uncommon form of paraneoplasic migrant figurate Erythema, we review the 33 previous cases of this process, and find that, although 30 were related to other processes.

=============================================
60.) Erythema gyratum repens is not an obligate paraneoplastic disease: a systematic review of the literature and personal experience.
=============================================
J Eur Acad Dermatol Venereol. 2014 Jan;28(1):112-5. doi: 10.1111/j.1468-3083.2012.04663.x. Epub 2012 Jul 25.

Rongioletti F1, Fausti V, Parodi A.
Author information

1Section of Dermatology, DISSAL, University of Genoa, Genoa, Italy.

Abstract
BACKGROUND:

Erythema gyratum repens (EGR) is a rare clinical entity that is considered to be an obligatory paraneoplastic disease. According to the literature, an underlying neoplasm can be detected in 82% of the cases.
OBJECTIVES:

The aim of this systemic review was to evaluate the association of EGR with malignancies or other non-neoplastic conditions.
METHODS:

The medical records of patients seen at the Section of Dermatology, University of Genoa between 1990 and 2010, in whom a diagnosis of EGR had been made, were reviewed for evidence of systemic associations. A systematic search of the Cochrane library, EMBASE, Pubmed and MEDLINE databases was also conducted. Key search term used in the review was 'erythema gyratum repens'.
RESULTS:

Four patients with a diagnosis of EGR have been retrieved from our medical records. One case was idiopathic, one was associated with a bronchial carcinoma and two were associated with drug-intake. One hundred and twelve original cases of EGR were selected from the literature for detailed review. Among these, 58 cases (70%) were associated with an underlying neoplasm, 25 cases (30%) were non-paraneoplastic and 29 cases have been considered as different dermatoses mimicking EGR in their clinical presentation ('EGR-like' eruption).
CONCLUSION:

EGR should no longer be considered as an obligate paraneoplastic syndrome as the cases that are not associated with neoplasm are more than expected. In addition to searching an underlying neoplasm, dermatologists should be aware about the possibility of other associations including also drug-intake.
=============================================
61.) Novel presentation of lepromatous leprosy in an erythema gyratum repens-like pattern.
=============================================
Int J Dermatol. 2014 Feb;53(2):210-2. doi: 10.1111/ijd.12237. Epub 2013 Dec 10.

Mohanan S1, Devi AS, Kumari R, Thappa DM, Ganesh RN.
Author information

1Department of Skin and Sexually Transmitted Diseases, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Abstract
OBJECTIVES:

Leprosy can have diverse cutaneous and occasionally perplexing presentations. We report an unusual case of lepromatous leprosy (LL) with annular lesions resembling erythema gyratum repens.
REPORT:

A 55-year-old man presented with a symmetrical, hypopigmented, and erythematous rash of bizarre appearance over the lateral aspect of the upper arm, and anterior and posterior aspects of the trunk of two months' duration. He gave a history of self-resolving episodes of bilateral pedal edema, and numbness and pricking sensations in both the hands and feet, which had occurred intermittently over the previous six years. An ulcer measuring 2 cm in size was present over the adjacent surface of the right first and second toes. The bilateral ulnar and radial cutaneous nerves were symmetrically thickened.
RESULTS:

Slit-skin smears revealed numerous acid-fast bacilli. Skin biopsy from the trunk showed collections of histiocytes, lymphocytes, and plasma cells in the dermis and around the blood vessels. The patient was diagnosed with LL and started on multibacillary multi-drug therapy.
CONCLUSIONS:

Lepromatous leprosy can have varied clinical manifestations and is often a great imitator. However, the skin smear positivity, even in normal skin, symmetrical cutaneous and peripheral nerve involvement, and histopathology in the present patient were indicative of LL. This report highlights a rare presentation of leprosy. Clinicians should be aware of these rare manifestations as lepromatous cases still occur in certain regions.
==============================================
62.) Leucocytoclastic vasculitis presenting as an erythema gyratum repens-like eruption.
==============================================
Clin Exp Dermatol. 2016 Apr;41(3):320-2. doi: 10.1111/ced.12749. Epub 2015 Sep 3.

Spierings NM1, Natkunarajah J2.
Author information

1Dermatology Department, Ground Floor, Lanesborough Wing, St. George's Hospital NHS Trust, Blackshaw Road, London, SW17 0QT, UK. nspierings@doctors.org.uk.
2Dermatology Department, Kingston Hospital NHS Trust, London, UK.
==================================================
63.) Urticarial vasculitis presenting as erythema gyratum repens-like eruption.
=================================================
Noda S, Takekoshi T, Tamaki Z, Asano Y, Sugaya M, Sato S.

J Eur Acad Dermatol Venereol. 2011 Apr;25(4):493-5. doi: 10.1111/j.1468-3083.2010.03747.x.

===================================================
64.) Erythema gyratum repens-like eruption occuring in resolving psoriasis during methotrexate therapy.
====================================================
Int J Dermatol. 2010 Mar;49(3):306-7. doi: 10.1111/j.1365-4632.2009.04256.x.

Singal A1, Sonthalia S, Pandhi D.
Author information

1Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, University of Delhi, New Delhi, India.
===================================================
65.) Erythema gyratum repens-like eruption in a patient with epidermolysis bullosa acquisita
associated with ulcerative colitis.
==================================================
Br J Dermatol. 2007 Apr;156(4):773-5. Epub 2007 Jan 30.

España A, Sitaru C, Pretel M, Aguado L, Jimenez J.
====================================================
66.) Erythema gyratum repens-like eruption in mycosis fungoides: is dermatophyte superinfection
underdiagnosed in cutaneous T-cell lymphomas?
====================================================
J Eur Acad Dermatol Venereol. 2008 Nov;22(10):1276-8. doi: 10.1111/j.1468-3083.2008.02628.x. Epub 2008 Mar 7.

Jouary T, Lalanne N, Stanislas S, Vergier B, Delaunay M, Taieb A.
=====================================================
67.) Erythrokeratodermia variabilis with erythema gyratum repens-like lesions.
====================================================
Landau M1, Cohen-Bar-Dayan M, Hohl D, Ophir J, Wolf CR, Gat A, Mevorah B.
Author information

1Dermatology Unit, Edith Wolfson Medical Center, Holon, Israel, Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel. landau@post.tau.ac.il

Abstract

A large pedigree with erythrokeratodermia variabilis (EKV) and erythema gyratum repens-like lesions is described. Clinical, laboratory, and histologic findings of this family are presented. The differential diagnoses of the following dermatoses with an erythematous and a hyperkeratotic component are discussed: erythrokeratodermia variabilis (Mendes da Costa), progressive symmetric erythrokeratoderma (Gottron), loricrin keratoderma, erythrokeratoderma en cocardes (Degos), Netherton syndrome, keratitis-ichthyosis-deafness (KID) syndrome, erythrokeratolysis hiemalis (Oudtshoorn disease), and nonbullous congenital ichthyosiform erythroderma.
==================================================
68.) Erythema gyratum repens-like eruption in a patient with Sjögren syndrome.
====================================================
Acta Derm Venereol. 1995 Jul;75(4):327.

Matsumura T, Kumakiri M, Sato-Matsumura KC, Ohkawara A.
===============================================
69.) Neutrophilic dermatosis with an erythema gyratum repens-like pattern in systemic lupus erythematosus.
================================================
Acta Derm Venereol. 2005;85(5):455-6.

Khan Durani B, Andrassy K, Hartschuh W.
=================================================
70.) Penicillin-induced anti-p200 pemphigoid: an unusual morphology.
=================================================
Acta Derm Venereol. 2006;86(5):443-6.

Wozniak K1, Kowalewski C, Hashimoto T, Ishii N, Glinska-Wielochowska M, Schwartz RA.
Author information

1Department of Dermatology, Medical University of Warsaw, PL-02008 Warsaw, Poland. kwoznia@amwaw.edu.pl

Abstract

We report here a case of a 52-year-old woman with erythema gyratum repens-like lesions appearing during anti-p200 pemphigoid, probably induced by oral penicillin. The diagnosis of anti-p200 pemphigoid was made by the presence of in vivo bound and circulating IgG anti-basement membrane zone auto-antibody reactive with the dermal side of salt-split skin and with 200 kDa protein in dermal extract on Western immunoblot. Laser scanning confocal microscopic study disclosed the localization of IgG at the lamina lucida-lamina densa border. Skin lesions responded poorly to high dose of prednisone and the combination of prednisone and dapsone. When methotrexate was added, skin lesions healed within 3 weeks. To our knowledge, erythema gyratum repens-like lesions have not been described previously in this disorder. Thus, we have expanded the clinical morphological spectrum of patients with anti-p200 pemphigoid and first described a patient whose disorder was probably drug-induced.

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