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

 ERYTHEMA GYRATUM REPENS, ANOTHER CUTANEOUS MARKER OF MALIGNANCY. ??

 
 ERITEMA GYRATUM REPENS, OTRO MARCADOR CUTÁNEO DE MALIGNIDAD.??

 

EDITORIAL ENGLISH 
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Hello friends of the network, DERMAGIC again with ANOTHER CUTANEOUS SIGN of MALIGNANCY. THE ERYTHEMA GYRATUM REPENS (EGR).

HISTORY AND CHRONOLOGY:

in most cases. THE ERYTHEMA GYRATUM REPENS or The GAMMEL syndrome. For the first time described in the year 1.952-1953 by JOHN A. GAMMEL in a female patient of 55 years with BREAST CANCER (ADENOCARCINOMA), 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 (112) 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). 

CLASSIFICATION:

Based on these findings, we can classify the ERYTHEMA GYRATUM REPENS in three variants: A.) ASSOCIATED WITH MALIGNITY (70-84%), in most cases, and the minority is B.) NOT ASSOCIATED with MALIGNANCY (16-30%). And another VARIANT: C.) CUTANEOUS ERUPTIONS MIMICKING (LIKE) ERITEMA GYRATUM REPENS. 

A.) MALIGNANCY ASSOCIATED WITH ERYTHEMA GYRATUM 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.) ERYTHEMA GYRATUM REPENS NOT ASSOCIATED WITH MALIGNANCY: 

1.) ICHTHYOSIS.

2.) PALMAR AND PLANTAR HYPERKERATOSIS.

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.) ERYTHEMA GYRATUM REPENS-LIKE ERUPTIONS: 

1.) LEPROSY.

2.) LEUKOCYTOCLASTIC 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 ERYTHEMA GYRATUM REPENS (EGR), moves rapidly across the surface of the skin, usually about 1 cm per day, That is why at the beginning in its first description it was called ERYTHEMA GYRATUM MIGRATORIUM, later it was changed to the definitive name used today, REPENS.

CONCLUSION:

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  references the facts, in the attached, classic ERYTHEMA GYRATUM REPENS 

Greetings to all. 

Dr José Lapenta.

Dr José M. Lapenta.

EDITORIAL ESPAÑOL
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Hola amigos de la red DERMAGIC de nuevo con ustedes OTRO SIGNO CUTÁNEO marcador de MALIGNIDAD, EL ERITEMA GYRATUM REPENS (EGR).

HISTORIA Y CRONOLOGÍA: 

En la mayoría de los casos. EL ERITEMA GYRATUM REPENS O síndrome de GAMMEL. Por primera vez descrito en el año de 1.952-1953 por JOHN A. GAMMEL en una paciente femenina de 55 años con cáncer de mama (ADENOCARCINOMA) con invasión axilar, el signo cutáneo apareció 9 meses antes de la malignidad, y desapareció 10 días después de la cirugía. 

-  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 habían reportado 3 casos NO ASOCIADOS A MALIGNIDAD. 

- Para el año de 1.985 se habían reportado 28 casos de ERITEMA GYRATUM REPENS, de los cuales 24 (85%) estaban asociados a malignidad. En 15 de los casos (68%) el SIGNO CUTÁNEO se presentó antes que la malignidad, en 6 casos (27%) apareció luego de detectada la malignidad, y en 1 caso (4 %) apareció al mismo tiempo que la malignidad. 

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

- En los últimos años se han descrito erupciones cutáneas "similares al ERITEMA GYRATUM REPENS en diferentes patologías, tipo LIKE-EGR.

Para el año 2.012 Ciento doce casos (112) 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 para-neoplásicos, y 29 casos fueron considerados como diferentes dermatosis simulando EGR en su presentación clínica (erupción tipo EGR). 

CLASIFICACIÓN:

En base a estos hallazgos podemos clasificar al ERITEMA GYRATUM REPENS en TRES variantes: A.) ASOCIADO A MALIGNIDAD, en la mayoría de los casos (70-84%), B.) NO ASOCIADO A MALIGNIDAD (16-30%), una minoría. y otra VARIANTE: C.) ERUPCIONES CUTÁNEAS QUE SIMULAN al ERITEMA GYRATUM REPENS. 

A.) MALIGNIDADES ASOCIADAS AL ERITEMA GYRATUM REPENS: 

1.) PULMÓN.

2.) ESÓFAGO.

3.) SENOS.

4.) ÚTERO.

5.) FARINGE.

6.) ESTÓMAGO.

7.) ANO.

8.) VEJIGA.

9.) INTESTINO.

10.) ENFERMEDAD DE HODGKIN

11.) LENGUA.

12.) PRÓSTATA.

13.) PANCREAS.

14.) MIELOMA.

15.) METASTASIS  

B.) ERYTHEMA GYRATUM REPENS NO ASOCIADO A MALIGNIDAD: 

1.) ICTIOSIS.

2.) HIPERQUERATOSIS PALMO PLANTAR.

3.) PITIRIASIS RUBRA PILAR.

4.) LESIONES PSORIASIFORMES.

5.) PENFIGOIDE BULOSO.

6.) PÉNFIGO VULGAR.

7.) ENFERMEDADES AMPOLLARES.

8.) LUPUS ERITEMATOSO DISCOIDEO CRÓNICO.

9.) NEUMONÍA.

10.) ARTRITIS REUMATOIDE.

11.) PERSONAS SANAS.

12.) HIPERTROFIA MAMARIA.

13.) TUBERCULOSIS.

14.) SÍNDROME HIPER-EOSINOFILICO.  

C.) ERYTHEMA GYRATUM REPENS-LIKE ERUPCIONES: 

1.) LEPRA.
 

2.) VASCULITIS LEUCOCITOCLASTICA.
 

3.) VASCULITIS URTICARIANA.
 

4.) PSORIASIS.
 

5.) EPIDERMOLISIS BULOSA ADQUIRIDA.
 

6.) MICOSIS FUNGOIDES.
 

7.) ERITROQUERATODERMIA VARIABILIS.
 

8.) SÍNDROME DE SJOGREN.
 

9.) LUPUS ERITEMATOSO SISTÉMICO.
 

10.) DROGAS (PENICILINA). 

CARACTERÍSTICAS CLÍNICAS:

"...El patrón del EGR se ha descrito como disposición 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 descamación está generalmente presente (ver fotos).

La erupción del ERITEMA GYRATUM REPENS (EGR), Se mueve rápidamente a través de la superficie de la piel, usualmente alrededor de 1 cm por día, por ello al comienzo en su primera descripción se le denomino ERITEMA GYRATUM MIGRATORIO, luego se le cambio a la definitiva que se usa hoy dia, REPENS.

CONCLUSIÓN:

De modo amigos y colegas dermatólogos, si se te presenta este SIGNO CUTÁNEO en alguno de sus pacientes, orientate con esta REVISIÓN BIBLIOGRÁFICA y realiza los exámenes adecuados, principalmente descartar MALIGNIDAD, pero recordemos que un porcentaje menor no está asociado a ella.

En las referencias, los hechos, en las fotos: ERITEMA GYRATUM REPENS CLÁSICO. 

Saludos a todos.
 

Dr José Lapenta.

Dr. Jose M. Lapenta. 

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REFERENCIAS BIBLIOGRÁFICAS / BIBLIOGRAPHICAL REFERENCES 
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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 

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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 

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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 present,14,20 and  trails the leading edge of the eruption,42. 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 

bullae,7, 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 cases,16,41  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 tuberculosis,28 and the 

CREST syndrome,36 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 

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% of      |  Affected  |   disorders  patients  | 

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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 lesions,10, 39,40 

6       Vesicles/bullae,7 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. 

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Table II. Underlying malignancies associated with erythema 

gyratum repens* 

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    %    |  Patients |     TyPe 

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32      Lung,4, 9, 10, 15-18, 21,26,37,39,41,43,44,45 

12      None,31,35,40,42,46 

8       Esophagus,27, 29,32, 33 

6       Breast,1, 3, 30 unknown metastatic neoplasm 4, 22, 25 

4       Cervix,5,7 pharynx,8,34 stomach,11,13 

2      Anus,24 bladder,20 bowel,23 Hodgkin's disease,38 myeloma,19                                               pancreas,41, prostate,20 tongue,6 uterus 12 

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*One patient each also had tuberculosis28 and CREST syndrome.36 

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HISTOPATHOLOGY 

EGR is classified among the superficial erythemas,50 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 lymphohistiocytic  infiltrate  with occasional  eosinophils.28, 37, 40, 43, 50 Mast cells may also be seen.28 The capillary endothelium may appear swollen,7 and vascular proliferation has been described.14,28 Frank vasculitis is absent. Pigmentary  incontinence,45 and papillary dermal edema,49 may also be seen. Subepidermal bullae with a sparse eosinophil infiltrate was described in a patient with EGR and bulbus pemphigoid.35 

Holt and Davies,26 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  immunofluorescence 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 inflammatory infiltrate in EGR demonstrated B cells and macrophages; no T cells were found.26 

DISCUSSION 

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Differential diagnosis of the figurate erythemas 

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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 slowly,48 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 

erythema,50,51 with a lymphohistiocytic "coat-sleeve" arrangement around blood vessels,50 mild spongiosis, and parakeratosis.49 

EAC may 2,48 or may not,2,52 be related to an underlying disease. It has been reported in association with malignancies,48 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 spreading, 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 tumors 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 Ouchterlony gel diffusion 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 immunofluorescence 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 necessarily 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 phytohemagglutinin, 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 afflicted 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 existing 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 Moore,62 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  cancer,63 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 vesiculobullous 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 Williamson,40 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, chemotherapy, or radiotherapy.1, 3,4,9, 10'25'38 After treatment of the cancer, additional therapy for the eruption includes topical,20, 46 and systemic steroids,25, 37,42 radiotherapy,24 and azathioprine.24 Failure of topical steroids 22,24 and vitamin A administration,42 has been reported. 

REFERENCES

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1. Gammel JA. Erythema gyratum repens. AMA Arch Derm Syph 1953;66:494-505. 

2. Harrison PM. The annular erythemas.  Int J Dermatol 1979;18:282-90. 

3. Purdy MJ. Erythema gyratum repens. Arch Dermatol 1 959;80:590- 1. 

4. Schneeweiss J, Goid SC. Erythema gyratum repens. Proc Roy Soc Med 1959;52:367-8.

5. Duperrat B, Guilaine J, Demay C. Erythema gvratum: en rapport avec un carcinome cervical métastatique. Bulí Soc Franc Derm Syph 1961;68:20-1. 

6. Duperrat B, Pringuet R, David V. Erythema gyratum repens. Bulí Soc Franc Derm Syph 1961;68:578-82. 

7. Van Dijk E. Erythema gyratum repens. Dermatologica 1961;123:301-10. 

8. Storck H, Schnyder UW, Schwarz K. Erythema gyratum repens bei  hypopharynx carcinom. Dermatologica 1962;124:289-93. 

9. Caldwell 1W. In discussion of Church RE. Bronchiolar carcinoma  presenfing as erythema gvratum perstans. Proc Roy Soc Med 1963;56:905. 

10. urch RE. Bronchiolar carcinoma presenting as erythema gyratum  perstans. Proc Roy Soc Med 1963;56:904-5. 

11. Woerdeman MJ. Erythema gyratum repens. Dermatolog-ica 1964;128:391-2. 

12. Le Coulant P, Texier L, Maleville J, et al. Erythema gyratum repens. Buil Soc Franc Derm Syph 1966;73:235-6. 

13. Pevny 1. Erythema gyratum repens. Z Raut Geschlecbtslcr 1 966;40:26~70. 

14. Leavelí UW, Winternitz WW, Black JR. Erythema gyratum repens and undifferentiated carcinoma. Arch Derma-tol 1967;95:69-72. 

15. Miguérés J, Jover A, Layssol M, et al. Un syndrome para-néoplasique rare: l'érythéme gyratum repens: Ses rapports avec le cancer bronchique. J Franc Med Chir Thor 1967;212:313-24.

16. Pokorny' M, Hilla M. Erythema gyratum repens. Cesk Dermatol 1969;44:200-3. 

17. Solomon R. Erythema gyratum repens [Letter]. Arch Dermatol 1969;lO0:639. 

18. Hochleitner H, Bartsch G, Zelger J. Erythema gyratum repens bei Bronchuscarcinom. Rautarzt 1970;21:1 16-9. 

19. Thivolet J, Gallois P, Perrot R. Une dermatose paranéc plasique  m6connue: l'érythema giratum repens. Rev Lyon Med 1970;19:789-95.  20. Thomson J, Stankler L. Erythema gyratum repens. Br J Dermatol 1970;82:406-1 1. 

21. Connor BL. Erythema gyratum repens: case presentation. Trans St Johns Hosp Dermatol Soc 1972;58:323-4. 2

2. Touraine R, Revaz J, Lepine J, et al. Syndrome paraneo-plasique associant ichtyose généralisé et érythéme annu-laire. Bulí Soc Fr Derm Syph 1972;79:623-6. 

23. Saika NK, MacKie RM, McQueen A. A case of bulbus pemphigoid and figurate erythema in association with metastatic spread of carcinoma.  Br J Dermatol 1973;88:33 1-4. 

24. Lukowska 1, Silny W. Erythema gyratum repens jako schorzenie 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 resolution 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. Erythema Gyratum Repens [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 repens de Gammel y enfermedad 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 Dermatol 1 964;90:54-8. 

54. Sniecinski 1, Haley J, Morgan-Byrne J, et al.Histocompatibility-antigen distribution in patients with cervical and endometrial carcinomas. Gynecol Oncol 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 Antigens 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 antigens. 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-diffusion system? [Lerter] Br J Der-matol 1982;107:723. 

63. Howel-Evans W, McConnell RB, Clarke DA, et al. Carcinoma 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 associated 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.  ============================================================= 

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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. 

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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. 

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

4.) Erythema gyratum repens: another case of a rare disorder but no new insight into pathogenesis. 

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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. 

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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. 

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6.) Erythema gyratum repens unassociated with underlying malignancy. 

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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. 

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7.) Erythema gyratum repens-like eruption in a patient with Sjogren syndrome. 

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Acta Derm Venereol 1995 Jul;75(4):327 Related Articles, Books 

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

Publication Types: 

Letter 

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

8.) Paraneoplastic bullous pemphigoid resembling erythema gyratum repens. 

Br J Dermatol 1999 Mar;140(3):550-2 Related Articles, Books, LinkOut 

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Hauschild A, Swensson O, Christophers E 

Publication Types: 

Letter 

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9.) Eruption resembling erythema gyratum repens in linear IgA dermatosis. 

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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. 

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10.) Erythema gyratum repens associated with hypereosinophilic syndrome. 

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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. 

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11.) Erythema gyratum repens. A case studied with immunofluorescence, 

immunoelectron microscopy and immunohistochemistry. 

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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. 

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12.) Erythema gyratum repens: direct immunofluorescence microscopic findings. 

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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. 

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13.) Erythema gyratum repens without underlying disease. 

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J Am Acad Dermatol 1993 Jan;28(1):132 Related Articles, Books, LinkOut 

Boyd AS, Neldner KH 

Publication Types: 

Comment 

Letter 

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

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 

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

15.) Subcorneal accumulation of Langerhans cells in erythema gyratum repens. 

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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. 

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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 

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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 

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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. 

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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. 

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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. 

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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. 

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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 1.) Erythema gyratum repens: A paraneoplastic eruption; Clinical review 
============================================================= 

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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