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Year : 2022  |  Volume : 67  |  Issue : 3  |  Page : 309-310
Arcuate erythematous plaques on the trunk


1 Department of Dermatology, Katihar Medical College, Katihar, Bihar, India
2 Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India

Date of Web Publication22-Sep-2022

Correspondence Address:
Anupam Das
Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.ijd_792_21

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How to cite this article:
Kumar P, Das A. Arcuate erythematous plaques on the trunk. Indian J Dermatol 2022;67:309-10

How to cite this URL:
Kumar P, Das A. Arcuate erythematous plaques on the trunk. Indian J Dermatol [serial online] 2022 [cited 2022 Sep 29];67:309-10. Available from: https://www.e-ijd.org/text.asp?2022/67/3/309/356759




A 75-year-old male presented with asymptomatic rashes recurring for 15 years. Each episode lasted for around 7–8 days. Cutaneous examination showed multiple arcuate erythematous plaques over the trunk, with central clearing and raised edematous borders, along with fine scaling on the inner side [Figure 1]a and [Figure 1]b. Skin scraping for potassium hydroxide mount did not reveal fungi. Histology showed basket weave hyperkeratosis, spongiosis, dermal perivascular infiltrate of lymphocytes and neutrophils, and extravasation of erythrocytes. Features of leukocytoclasia were not found [Figure 2]. Periodic acid Schiff stain was negative for fungi. Direct immunofluorescence test was non-contributory. Routine laboratory investigations including the serum biochemistry panel were within normal limits.
Figure 1: (a) Multiple arcuate and annular erythematous plaques on the trunk with central clearing and fine scaling at the inner margin. (b) Close up of the lesions

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Figure 2: Histopathology showing dermal oedema and perivascular infiltration consisting of lymphocytes and neutrophils (H and E x400)

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What is your diagnosis?

Answer: Neutrophilic figurate erythema.


   Discussion Top


Neutrophilic figurate erythema (NFE) is a rarely reported disease, presenting with annular rash over the trunk or limbs, and histology shows neutrophil predominant infiltrate.[1] The diagnosis of NFE relies on the fulfillment of certain criteria, which include (a) annular rash (without wheal) for more than 24 hours; (b) predominantly neutrophilic perivascular and interstitial infiltrate in the dermis in the absence of vasculitis; (c) exclusion of other entities presenting with annular lesions, such as tinea infection, syphilis, and cutaneous lupus erythematosus; and (d) exclusion of other neutrophil-predominant dermatitis, such as leukocytoclastic vasculitis and neutrophilic dermatoses, especially Sweet syndrome.[2] The histopathological features in the scaly type of NFE are similar to those of superficial fungal infection, which can be differentiated on the basis of periodic acid–Schiff stain. In neutrophilic urticaria and neutrophilic urticarial dermatosis, the rash usually subsides within 48 hours. The distribution of neutrophils in neutrophilic urticaria is predominantly perivascular, and leukocytoclasia is absent. Papillary dermal oedema is not a feature in neutrophilic urticarial dermatoses. Lupus erythematosus is diagnosed on the basis of interface dermatitis, mucin deposition, sub-epidermal separation, and direct immunofluorescence.[3] Rarely, the condition may be associated with underlying malignancies (Hodgkin lymphoma, juvenile myelomonocytic leukemia), and a meticulous systemic work-up needs to be done.[4],[5] Various therapeutic modalities have been tried, including topical steroids, systemic steroids, anti-histamines, dapsone, colchicine, and chemotherapy. The index case was prescribed dapsone, to which the lesions responded well.

Learning points

  1. Annular erythema is a common clinical presentation, observed in numerous conditions such as erythema annulare centrifugum, granuloma annulare, subacute cutaneous LE, annular erythema associated with Sjogren syndrome, and neutrophilic figurate erythema (NFE).
  2. Histological features of NFE include dermal oedema, perivascular and interstitial infiltrate of neutrophils, and the presence of leukocytoclasia superficially, but without vasculitis.
  3. It is essential to correlate complete clinical information and laboratory test results before arriving at a diagnosis of NFE.


Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Wu YH, Hsiao PF. Neutrophilic figurate erythema. Am J Dermatopathol 2017;39:344-50.  Back to cited text no. 1
    
2.
Ghosh SK, Bandyopadhyay D, Haldar S. Neutrophilic figurate erythema recurring on the same site in a middle-aged healthy woman. Indian J Dermatol Venereol Leprol 2012;78:505-8.  Back to cited text no. 2
  [Full text]  
3.
Alavi A, Sajic D, Cerci FB, Ghazarian D, Rosenbach M, Jorizzo J. Neutrophilic dermatoses: An update. Am J Clin Dermatol 2014;15:413-23.  Back to cited text no. 3
    
4.
Trébol I, González-Pérez R, García-Rio I, Arregui MA, Saracibar N, Carnero L, et al. Paraneoplastic neutrophilic figurate erythema. Br J Dermatol 2007;156:396-8.  Back to cited text no. 4
    
5.
Del Puerto Troncoso C, Curi Tuma M, Gonzalez Bombardiere S, Silva-Valenzuela S. Neutrophilic figurate erythema of infancy associated with juvenile myelomonocytic leukemia [in English, Spanish]. Actas Dermosifiliogr 2015;106:431-3.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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