Erythema gyratum repens: Difference between revisions

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==Historical Perspective==
==Historical Perspective==
Erythema gyratum repens was first described by Dr. John A Gammel, a dermatologist, in 1952 in a patient with metastatic breast cancer. The patient was a 55 year old woman with skin eruption for nine months, associated with poorly differentiated adenocarcinoma of the breast. The skin lesions started in the face and neck as erythema and scales lesions that clear while other lesions flared.  
Erythema gyratum repens was first described in 1952 by a dermatologist, Dr. John A Gammel, in a patient with metastatic breast cancer. The patient was a 55 year old woman with skin eruption for nine months, associated with poorly differentiated adenocarcinoma of the breast. The skin lesions started in the face and neck as erythema and scales lesions that clear while other lesions flared.  


The association between [important risk factor/cause] and [disease name] was made in/during [year/event].
In the  twentieth century, Dr. Gammel has been trained that there is a possible association between atypical, bizarre, or recalcitrant skin lesions and internal/visceral malignancies.  


In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].
cases with EGR has been seen in patients with metastatic adenocarcinoma (61 year old woman, 6months history of generalized rash), and cholangiosarcoma (77 year old woman, 3 weeks history of lower limb rash).  
 
In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].
 
There have been several outbreaks of [disease name], including -----.
 
In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].


==Classification==
==Classification==
There is no established system for the classification of [disease name].
There is no established system for the classification of EGR.  
 
OR
 
[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
 
OR
 
[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
[Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
 
OR
 
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
 
OR
 
If the staging system involves specific and characteristic findings and features:
According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
 
OR
 
The staging of [malignancy name] is based on the [staging system].
 
OR
 
There is no established system for the staging of [malignancy name].


==Pathophysiology==
==Pathophysiology==
The cause of EGR has not been identified. However, there are theories that various immunologic mechanisms have been implicated in its pathogenesis. The first theory is that the tumor may induce antibodies that cross-react with the basement membrane of skin. The second theory is hat the tumor may produce polypeptides that bind skin antigens and render them immunogenic. Other researchers believe that deposition of tumor antigen-antibody complexes onto the basement membrane accounts for this reactive dermatitis.
The cause of EGR has not been identified. However, there are theories that various immunologic mechanisms have been implicated in its pathogenesis. The first theory is that the tumor may induce antibodies that cross-react with the basement membrane of skin. The second theory is hat the tumor may produce polypeptides that bind skin antigens and render them immunogenic. Other researchers believe that deposition of tumor antigen-antibody complexes onto the basement membrane accounts for this reactive dermatitis.
The exact pathogenesis of [disease name] is not fully understood.
OR
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
OR
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
OR
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
OR
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
OR
The progression to [disease name] usually involves the [molecular pathway].
OR
The pathophysiology of [disease/malignancy] depends on the histological subtype.


==Causes==
==Causes==
may be caused by [cause1], [cause2], or [cause3].
The cause of erythema gyratum repens has not been identified.  
 
OR
 
Common causes of [disease] include [cause1], [cause2], and [cause3].
 
OR
 
The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
 
OR
 
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].


==Differentiating ((Page name)) from Other Diseases==
==Differentiating ((Page name)) from Other Diseases==
EGR has a narrow differential diagnosis and given its distinctive appearance, it has to be differentiated from those with gyrate erythematous eruptions, such as, necrolytic migratory erythema (NME), erythema annulare centrifugum (EAC), and erythema migrans. Necrolytic migratory erythema (NME) is usually seen in association with pancreatic glucagonomas and favors the perioral and perianal areas. Erythema annulare centrifugum (EAC) has pruritic concentric lesions with central clearing and a trailing edge of scale but usually involves smaller areas of the trunk and extremities and it migrates at a much slower rate than the lesions of EGR. Erythema migrans is the lesion of Lyme disease, it has no scaling and is a more localized skin reaction.
EGR has a narrow differential diagnosis and given its distinctive appearance, it has to be differentiated from those with gyrate erythematous eruptions, such as, necrolytic migratory erythema (NME), erythema annulare centrifugum (EAC), and erythema migrans. Necrolytic migratory erythema (NME) is usually seen in association with pancreatic glucagonomas and favors the perioral and perianal areas. Erythema annulare centrifugum (EAC) has pruritic concentric lesions with central clearing and a trailing edge of scale but usually involves smaller areas of the trunk and extremities and it migrates at a much slower rate than the lesions of EGR. Erythema migrans is the lesion of Lyme disease, it has no scaling and is a more localized skin reaction.
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
OR
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].


==Epidemiology and Demographics==
==Epidemiology and Demographics==
EGR commonly affects Caucasians, with an average age of onset in the seventh decade of life, and the male to female ratio is 2:1. EGR is usually precedes the diagnosis of the associated cancer by several months. EGR is mainly seen in patients with paraneoplastic syndrome, it can rarely be seen in patients with nonneoplastic conditions such as tuberculosis, hypereosinophilic syndrome, bullous pemphigoid vulgaris, systemic lupus erythematosis, and ulcerative colitis.  
EGR commonly affects Caucasians, with an average age of onset in the seventh decade of life, and the male to female ratio is 2:1. EGR is usually precedes the diagnosis of the associated cancer by several months. EGR is mainly seen in patients with paraneoplastic syndrome, it can rarely be seen in patients with nonneoplastic conditions such as tuberculosis, hypereosinophilic syndrome, bullous pemphigoid vulgaris, systemic lupus erythematosis, and ulcerative colitis.
 
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
 
OR
 
In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
 
OR
 
In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.
 
 
 
Patients of all age groups may develop [disease name].
 
OR
 
The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.
 
OR
 
[Disease name] commonly affects individuals younger than/older than [number of years] years of age.
 
OR
 
[Chronic disease name] is usually first diagnosed among [age group].
 
OR
 
[Acute disease name] commonly affects [age group].
 
 
 
There is no racial predilection to [disease name].
 
OR
 
[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
 
 
 
[Disease name] affects men and women equally.
 
OR
 
[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.
 
 
 
The majority of [disease name] cases are reported in [geographical region].
 
OR
 
[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].


==Risk Factors==
==Risk Factors==
There are no established risk factors for [disease name].
There are no established risk factors for EGR.  
 
OR
 
The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].
 
OR
 
Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
 
OR
 
Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.


==Screening==
==Screening==
There is no screening tests for EGR but the skin rash shouldn't be missed in the the ED and patients should be referred for urgent evaluation and screening for internal malignancies.   
There is no screening tests for EGR but the skin rash shouldn't be missed in the the ED and patients should be referred for urgent evaluation and screening for internal malignancies.   
There is insufficient evidence to recommend routine screening for [disease/malignancy].
OR
According to the [guideline name], screening for [disease name] is not recommended.
OR
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
Patients with EGR usually presents with the severely pruritic rash few months prior to the diagnosis of the internal malignancy. The pruritus can be debilitating and it may persist to the time of death.   
Patients with EGR usually presents with the severely pruritic rash few months prior to the diagnosis of the internal malignancy. The pruritus can be debilitating and it may persist to the time of death.   
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
OR
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
OR
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.


==Diagnosis==
==Diagnosis==
===Diagnostic Study of Choice===
===Diagnostic Study of Choice===
EGR is mainly diagnosed clinically. Eosinophilia is observed in 60% of cases and immunofluorescence shows patterns of IgG, C3, and C4 at the basement membrane.   
EGR is mainly diagnosed clinically. Eosinophilia is observed in 60% of cases and immunofluorescence shows patterns of IgG, C3, and C4 at the basement membrane.   
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
OR
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
There are no established criteria for the diagnosis of [disease name].


===History and Symptoms===
===History and Symptoms===
The hallmark of EGR is skin rash  and pruritus is almost a universal symptom that can be extreme and debilitating. Patient may also complain of weight loss, anorexia, fatigue, and fever.         
The hallmark of EGR is skin rash  and pruritus is almost a universal symptom that can be extreme and debilitating. Patient may also complain of weight loss, anorexia, fatigue, and fever.         
The majority of patients with [disease name] are asymptomatic.
OR
The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].


===Physical Examination===
===Physical Examination===
Patients with EGR presents with a rash consisting of wavy erythematous concentric bands that can be figurate, gyrate, or annular. The bands are arranged in parallel rings and lined by a fine trailing edge of scale, a pattern often described as “wood grained. The rash typically involves large areas of the body but tends to spare the face, hands, and feet and it can expands as fast as a cm a day. Bullae can also form from within the areas of erythema.
Patients with EGR presents with a rash consisting of wavy erythematous concentric bands that can be figurate, gyrate, or annular. The bands are arranged in parallel rings and lined by a fine trailing edge of scale, a pattern often described as “wood grained. The rash typically involves large areas of the body but tends to spare the face, hands, and feet and it can expands as fast as a cm a day. Bullae can also form from within the areas of erythema.
by  usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
OR
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
OR
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Laboratory Findings===
===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
There are no diagnostic laboratory findings associated with EGR.
 
OR
 
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
 
OR
 
[Test] is usually normal among patients with [disease name].
 
OR
 
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
 
OR
 
There are no diagnostic laboratory findings associated with [disease name].


===Electrocardiogram===
===Electrocardiogram===
There are no ECG findings associated with [disease name].
There are no ECG findings associated with EGR.
 
OR
 
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===X-ray===
===X-ray===
There are no x-ray findings associated with [disease name].
There are no x-ray findings associated with EGR.
 
OR
 
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound  findings associated with [disease name].
There are no echocardiography/ultrasound  findings associated with EGR.
 
OR
 
Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===CT scan===
===CT scan===
There are no CT scan findings associated with [disease name].
CT findings could be seen in the associated visceral malignancy in EGR.  
 
OR
 
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===MRI===
===MRI===
There are no MRI findings associated with [disease name].
There are no MRI findings associated with EGR.
 
OR
 
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Other Imaging Findings===
===Other Imaging Findings===
Line 321: Line 72:
[[File:EGR1.jpg]]
[[File:EGR1.jpg]]


There are no other imaging findings associated with [disease name].
[[File:CT_Cholangiocarcinoma.jpg|403x403px]]
 
OR
 
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===Other Diagnostic Studies===
===Other Diagnostic Studies===
Although skin appearance is characteristic, EGR has nonspecific histopathologic features. Biopsy specimens display acanthosis, mild hyperkeratosis, focal parakeratosis, and spongiosis confined to the epidermis and superficial dermis. Mononuclear, lymphocytic, and histiocytic perivascular infiltrate in the superficial plexus can also be seen. Basement membrane deposits of IgG, C3, or C4 have been noted under direct immunofluorescence in some cases.   
Although skin appearance is characteristic, EGR has nonspecific histopathologic features. Biopsy specimens display acanthosis, mild hyperkeratosis, focal parakeratosis, and spongiosis confined to the epidermis and superficial dermis. Mononuclear, lymphocytic, and histiocytic perivascular infiltrate in the superficial plexus can also be seen. Basement membrane deposits of IgG, C3, or C4 have been noted under direct immunofluorescence in some cases.   
There are no other diagnostic studies associated with [disease name].
OR
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].


==Treatment==
==Treatment==
Line 344: Line 81:


===Medical Therapy===
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
There is no treatment for EGR]; the mainstay of therapy is underlying malignancy.
 
OR
 
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


===Surgery===
===Surgery===
Surgical intervention is not recommended for the management of [disease name].
Surgical intervention is not recommended for the management of EGR.
 
OR
 
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
 
OR
 
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
 
OR
 
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
 
OR
 
Surgery is the mainstay of treatment for [disease or malignancy].


===Primary Prevention===
===Primary Prevention===
There are no established measures for the primary prevention of [disease name].
There are no established measures for the primary prevention of EGR.
 
OR
 
There are no available vaccines against [disease name].
 
OR
 
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
 
OR
 
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].


===Secondary Prevention===
===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].
There are no established measures for the secondary prevention of EGR.
 
OR
 
Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].


==References==
==References==

Revision as of 14:26, 19 June 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Gammel's disease.


Overview

Erythema gyratum repens (EGR) is a rare dermatologic disorder associated with a variety of internal malignancies (paraneoplastic cutaneous syndrome). The most common malignancies EGR associated with are Lung, esophageal, and breast cancers. EGR is a systemic disease and it has a characteristic generalized rash [1]

Historical Perspective

Erythema gyratum repens was first described in 1952 by a dermatologist, Dr. John A Gammel, in a patient with metastatic breast cancer. The patient was a 55 year old woman with skin eruption for nine months, associated with poorly differentiated adenocarcinoma of the breast. The skin lesions started in the face and neck as erythema and scales lesions that clear while other lesions flared.

In the twentieth century, Dr. Gammel has been trained that there is a possible association between atypical, bizarre, or recalcitrant skin lesions and internal/visceral malignancies.

cases with EGR has been seen in patients with metastatic adenocarcinoma (61 year old woman, 6months history of generalized rash), and cholangiosarcoma (77 year old woman, 3 weeks history of lower limb rash).

Classification

There is no established system for the classification of EGR.

Pathophysiology

The cause of EGR has not been identified. However, there are theories that various immunologic mechanisms have been implicated in its pathogenesis. The first theory is that the tumor may induce antibodies that cross-react with the basement membrane of skin. The second theory is hat the tumor may produce polypeptides that bind skin antigens and render them immunogenic. Other researchers believe that deposition of tumor antigen-antibody complexes onto the basement membrane accounts for this reactive dermatitis.

Causes

The cause of erythema gyratum repens has not been identified.

Differentiating ((Page name)) from Other Diseases

EGR has a narrow differential diagnosis and given its distinctive appearance, it has to be differentiated from those with gyrate erythematous eruptions, such as, necrolytic migratory erythema (NME), erythema annulare centrifugum (EAC), and erythema migrans. Necrolytic migratory erythema (NME) is usually seen in association with pancreatic glucagonomas and favors the perioral and perianal areas. Erythema annulare centrifugum (EAC) has pruritic concentric lesions with central clearing and a trailing edge of scale but usually involves smaller areas of the trunk and extremities and it migrates at a much slower rate than the lesions of EGR. Erythema migrans is the lesion of Lyme disease, it has no scaling and is a more localized skin reaction.

Epidemiology and Demographics

EGR commonly affects Caucasians, with an average age of onset in the seventh decade of life, and the male to female ratio is 2:1. EGR is usually precedes the diagnosis of the associated cancer by several months. EGR is mainly seen in patients with paraneoplastic syndrome, it can rarely be seen in patients with nonneoplastic conditions such as tuberculosis, hypereosinophilic syndrome, bullous pemphigoid vulgaris, systemic lupus erythematosis, and ulcerative colitis.

Risk Factors

There are no established risk factors for EGR.

Screening

There is no screening tests for EGR but the skin rash shouldn't be missed in the the ED and patients should be referred for urgent evaluation and screening for internal malignancies.

Natural History, Complications, and Prognosis

Patients with EGR usually presents with the severely pruritic rash few months prior to the diagnosis of the internal malignancy. The pruritus can be debilitating and it may persist to the time of death.

Diagnosis

Diagnostic Study of Choice

EGR is mainly diagnosed clinically. Eosinophilia is observed in 60% of cases and immunofluorescence shows patterns of IgG, C3, and C4 at the basement membrane.

History and Symptoms

The hallmark of EGR is skin rash and pruritus is almost a universal symptom that can be extreme and debilitating. Patient may also complain of weight loss, anorexia, fatigue, and fever.

Physical Examination

Patients with EGR presents with a rash consisting of wavy erythematous concentric bands that can be figurate, gyrate, or annular. The bands are arranged in parallel rings and lined by a fine trailing edge of scale, a pattern often described as “wood grained. The rash typically involves large areas of the body but tends to spare the face, hands, and feet and it can expands as fast as a cm a day. Bullae can also form from within the areas of erythema.

Laboratory Findings

There are no diagnostic laboratory findings associated with EGR.

Electrocardiogram

There are no ECG findings associated with EGR.

X-ray

There are no x-ray findings associated with EGR.

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with EGR.

CT scan

CT findings could be seen in the associated visceral malignancy in EGR.

MRI

There are no MRI findings associated with EGR.

Other Imaging Findings

Other Diagnostic Studies

Although skin appearance is characteristic, EGR has nonspecific histopathologic features. Biopsy specimens display acanthosis, mild hyperkeratosis, focal parakeratosis, and spongiosis confined to the epidermis and superficial dermis. Mononuclear, lymphocytic, and histiocytic perivascular infiltrate in the superficial plexus can also be seen. Basement membrane deposits of IgG, C3, or C4 have been noted under direct immunofluorescence in some cases.

Treatment

Various dermatologic and immunosuppressive therapies have been used to treat EGR. Systemic steroids are frequently ineffective. Topical steroids, vitamin A, and azathioprine have also failed to relieve skin manifestations. Improvement or resolution of EGR, and its associated intense pruritus, depends on recognition and treatment of the underlying malignancy. In patients with widely metastatic disease, the response of EGR to chemotherapy is variable. In such cases, patients may not experience resolution of the rash until just before the time of death, a time of significant immunosuppression

Medical Therapy

There is no treatment for EGR]; the mainstay of therapy is underlying malignancy.

Surgery

Surgical intervention is not recommended for the management of EGR.

Primary Prevention

There are no established measures for the primary prevention of EGR.

Secondary Prevention

There are no established measures for the secondary prevention of EGR.

References

  1. ↑ Gore M, Winters ME (2011). "Erythema gyratum repens: a rare paraneoplastic rash". West J Emerg Med. 12 (4): 556–8. doi:10.5811/westjem.2010.11.2090. PMC 3236141. PMID 22224159 PMID: 22224159 Check |pmid= value (help).


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