Erythema Gyratum Repens - A rare type of erythema
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A man in his 80's presented with a 2-year history of an asymptomatic, expanding eruption on the trunk and extremities. Physical examination revealed a serpiginous, erythematous eruption with a peripheral scale resembling wood grain. A workup for malignancy revealed a mass in the prostate with bilateral para-aortic and inguinal lymphadenopathy and an elevated level of prostate-specific antigen.

Erythema gyratum repens (EGR) is a rare type of figurate erythema. The rash has a characteristic appearance with erythematous concentric and parallel bands (wood grain pattern) and a collarette of scale. Advancement of the rash is usually rapid. The mean age at diagnosis is in the seventh decade of life, with a 2:1 male-to-female ratio. In approximately 70% of cases, EGR is considered a paraneoplastic condition. Figurate erythemas should be carefully considered in the differential diagnosis.

The exact pathogenesis of paraneoplastic EGR is still debated, but an immune response triggered by the malignant neoplasm is suspected. Patients should ensure that their routine cancer screening tests are updated and that appropriate symptoms are evaluated. If results of such studies are normal, thoracic imaging with chest radiography and computed tomography should be considered because of the association between EGR and thoracic malignant tumors. Patients should be advised to remain current with
future cancer screening tests if no malignant neoplasm is detected.

Neither immunosuppressive therapy nor retinoid treatment is
effective against EGR. Resolution requires successful treatment of the underlying disease.