Sunday, 17 October 2010

Erythema gyratum repens

Erythema gyratum repens. Greek: gyrate, a circle Latin: repens, to creep.

Clinically distinctive figurate reactive erythema. Regular waves of erythema spread over the body (the complete torso is frequently affected, often associated with severe pruritus) to produce a series of concentric, figurate bands in a pattern resembling the grain of wood. More striking is the relatively rapid rate at which lesions migrate (day-to-day migration of the leading edge: about 1 cm).

In the more common figurate erythemas, this concentric arrangement is lacking. About 80% of reported cases are associated with an internal tumour (paraneoplastic eruption). Lung cancer is present in about a third of these cases. Resection of the tumour often results in resolution of the eruption. Not all cases are paraneoplastic; it has been associated with e.g. tuberculosis. Drug hypersensitivity has also been implicated. Cases of apparent idiopathic erythema gyratum repens have been suggested to represent a stage in the evolution of pityriasis rubra pilaris. Fungal infection should be excluded, especially tinea imbricata.

Skin biopsy is important (though the histopathology of erythema gyratum repens is nonspecific) as a similar gyrate eruption may be a prodromal manifestation of pemphigoid, and similar but rather localized lesions have been reported due to vasculitis, especially in lupus erythematosus and in neutrophilic dermatoses. 

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Main Works of Reference List (The first eight are my top favourites)

  • British National Formulary
  • British National Formulary for Children
  • Guidelines (BAD - BASHH - BHIVA - Uroweb)
  • Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health
  • Oxford Handbook of Medical Dermatology
  • Rook's Textbook of Dermatology
  • Simple Skin Surgery
  • Weedon's Skin Pathology
  • A Concise Atlas of Dermatopathology (P Mckee)
  • Ackerman's Resolving Quandaries in Dermatology, Pathology and Dermatopathology
  • Andrews' Diseases of the Skin
  • Andrology (Nieschlag E FRCP, Behre M and Nieschlag S)
  • Bailey and Love's Short Practice of Surgery
  • Davidson's Essentials of Medicine
  • Davidson's Principles and Practice of Medicine
  • Fitzpatrick's Colour Atlas and Synopsis of Clinical Dermatology (Klaus Wolff FRCP and Richard Allen Johnson)
  • Fitzpatrick’s Dermatology in General Medicine
  • Ganong's Review of Medical Physiology
  • Gray's Anatomy
  • Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery
  • Hutchison's Clinical Methods
  • Lever's Histopathology of the Skin
  • Lever's Histopathology of the Skin (Atlas and Synopsis)
  • Macleod's Clinical Examination
  • Martindale: The Complete Drug Reference
  • Oxford Handbook of Clinical Examination and Practical Skills
  • Oxford Textbook of Medicine
  • Practical Dermatopathology (R Rapini)
  • Sexually Transmitted Diseases (Holmes K et al)
  • Statistics in Clinical Practice (D Coggon FRCP)
  • Stockley's Drug Interactions
  • Treatment of Skin Disease: Comprehensive Therapeutic Strategies
  • Yen & Jaffe's Reproductive Endocrinology