At a Glance - Eythema Annulare vs Lymphoma

Contributed by Dr Jean Watkins, a retired GP in Hampshire

ERYTHEMA ANNULARE CENTRIFUGUM


Aetiology

  • Occurs at any age.
  • May be related to: infections; parasites; drugs (antimalarials, penicillin, salicylates, cimetidine, amitriptyline); foods; cholestatic liver disease; or hyperthyroidism.

Clinical features

  • Common on lower limbs but may occur on face, trunk and arms.
  • Small inflammatory spot gradually spreads to form a ring. Central area flattens and clears.
  • Generally no symptoms but may be slightly itchy.

Management

  • Skin scraping to exclude tinea or candida.
  • Treat underlying cause or wait for spontaneous resolution.
  • Topical steroid may reduce inflammation and itching.

PRIMARY CUTANEOUS T-CELL LYMPHOMA

Aetiology

  • Lymphoma of the skin with no evidence of disease elsewhere in the body.
  • May be cutaneous T-cell lymphoma (65 per cent) or cutaneous B-cell lymphoma.
  • Uncommon skin condition. More common in men, rare in children.
  • Cause unknown but possible persistent antigen leading to gene mutations.

Clinical features

  • Patch stage: oval or annular dry, pink patches. Patches may slowly enlarge or disappear spontaneously. May be itchy and have atrophic appearance.
  • Plaque stage: thickened, itchy patches.
  • Tumour stage: plaque thickens into large nodules or tumours. May ulcerate.

Management

  • Skin biopsy to confirm diagnosis.
  • CT or MRI scan in advanced cases to check if other organs involved.
  • Depending on severity, use: topical steroids; phototherapy; topical nitrogen mustard; chemotherapy; radiotherapy; interferons; oral retinoids; or photopheresis.

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