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Dermatopathology: Practical & Conceptual January - March 2008
6. New Heights: Erythema annulare centrifugum (deep type), palpable migratory and arciform erythema, erythema figuratum, and lymphocytic infiltration of Jessner and Kanof: pattern or disease?
Almut Böer, M.D.
Mihaela Costache, M.D.
erythema annulare centrifugum
tumid lupus erythematosus
Criteria for diagnosis of erythema annulare centrifugum (EAC) (deep type), palpable migratory and arciform erythema (PMAE), erythema figuratum, and lymphocytic infiltration (Jessner Kanof) (LIS) overlap, and the relationships of each of these conditions to tumid lupus erythematosus (TLE) is controversial.
To clarify the relationship of these conditions to each other.
Review of articles and paragraphs in textbooks about these conditions.
1) TLE is generally accepted as a distinctive clinicopathologic variant of LE typified by superficial and deep lymphocytic infiltrates accompanied by deposits of mucin in the reticular dermis. 2) LIS is TLE because criteria for diagnosis as they were set forth by Jessner, Kanof, and Clark et al. are indistinguishable from those of TLE. 3) What today is called EAC is a distinctive disease characterized by a spongiotic dermatitis similar to pityriasis rosea, and it is completely unrelated to the condition long referred to as "EAC (Darier)deep type." 4) EAC (Darier)deep type has been referred to by different names (deep gyrate erythema, deep figurate erythema, PMAE, erythema figuratum). It has been considered to be a distinctive disease, but criteria for diagnosis of it consist only of moderately dense superficial and deep infiltrates of lymphocytes.
Such an infiltrate often cannot be diagnosed with specificity. It may be observed in a variety of conditions including lupus erythematosus tumidus, erythema migrans, herpetic infection, polymorphous light eruption, and specific infiltrates of chronic lymphocytic leukemia. It is merely a pattern, not a distinctive clinicopathologic entity.
Almut Böer, M.D., is a dermatopathologist at the Dermatologikum Hamburg, Germany. Mihaela Costache, M.D., practices dermatology in Timisoara, Romania. This article was reviewed by Muna Shuweiter, M.D., and Masoud Asgari, M.D. Contact corresponding author via e-mail:
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