Medical condition
Erythema gyratum repens is a skin condition that has a strong association with internal cancers.[1] It characteristically presents with red wavy lines, generally in older adults.[1] These regular whirly rings rapidly and repetitively appear within existing ones, giving the impression that the rash is moving.[3] The resulting pattern is similar to wood grain.[1] There is often an intense itch and scale over the leading edge, which may be slightly raised.[2]
The cause is believed to have an immunological base.[4] 80% of cases have an underlying cancer, of which almost half have lung cancer.[1] Sometimes no cause is found.[3]
Diagnosis is generally by its appearance, although tests may be required to exclude other conditions.[3] These tests may include blood tests.[1] A cancer may be located using medical imaging.[1] Necrolytic migratory erythema and erythema migrans are some of many other skin conditions that may appear similar.[1]
Treatment and outlook depend on the underlying cause.[1] Antihistamines may help to reduce the itch.[2][5] The rash typically resolves with successful cancer treatment.[3]
The condition is rare.[1] Males are affected twice as frequently as females.[1] J. A. Gammel first described the condition in 1952.[6][7]
Signs and symptoms
Erythema gyratum repens characteristically presents as wavy red lines on the skin.[1] These regular whirly rings rapidly and repetitively appear within existing ones, expanding outward at a rate of up to 1cm a day, giving the impression that the rash is moving.[3] The resulting pattern is similar to wood grain.[1] There is typically an intense itch and scale over the leading edge, which may be slightly raised.[2] The trunk and limbs are most frequently affected.[5] Thickening of the skin of the palms co-exists in around 10% of affected individuals, whatever the underlying cause.[1] The skin may become extremely dry.[3] Onset is generally in older adults; after the age of 60-years.[1]
Cause
The cause is believed to have an immunological base.[4] 80% of cases have an underlying cancer, of which almost half have lung cancer.[1] Other cancers reported to be associated include cancers of the oesophagus and breast, and less frequently gastric cancer, uterine cancer, throat cancer, pancreas cancer and lymphoma.[1] The rash generally precedes the cancer diagnosis by around 9-months.[2] Less frequently, the cause may be tuberculosis of the lung, or no cause is found.[3] Other rare reported associations have included cryptogenic organizing pneumonia and rheumatoid arthritis.[2]
Diagnosis
Diagnosis is generally by its appearance.[3] Tests include blood tests such as a complete blood count which may reveal raised eosinophils.[2] Other blood tests include PSA, antinuclear antibodies and biochemistry.[1] Medical imaging may locate a cancer; chest X-ray, mammogram, CT scan of pelvis and abdomen.[1] If indicated then an endoscopy may be required; colonoscopy, gastroscopy.[1]
Differential diagnosis
Necrolytic migratory erythema, erythema migrans, tinea corporis, erythrokeratodermia variabilis, and subacute cutaneous lupus erythematosus are some of many other skin conditions that may appear similar.[1]
Treatment
Treatment and outlook depend on the underlying cause.[1] Antihistamines may help to reduce the itch, although the role of applying a steroid cream is unclear.[2][5] The rash typically resolves with successful cancer treatment.[3]
Epidemiology
The condition is rare.[1] Males are affected twice as frequently as females.[1]
History
J. A. Gammel first described the condition in 1952, in an individual who was later found to have breast cancer.[6][7]
