Erythema Gyratum Repens

Key Points
One member of the group of skin disorders known as “gyrate erythemas” or “figurate erythemas”
Often associated with an underlying cancer, thus it is considered to be a paraneoplastic disease
Classically known to have a “wood-grain” appearance

Erythema gyratum repens (EGR) is a figurate erythema that is believed to be a paraneoplastic condition in most cases. Characteristic concentric erythematous bands forming a wood-grain appearance help distinguish Erythema gyratum repens from other similar dermatoses, such as Erythema annulare centrifugum. The appearance of Erythema gyratum repens often precedes the malignancy. The skin eruption is present an average of 9 months prior to the diagnosis of malignancy, with a range of 1-72 months. In some patients, Erythema gyratum repens occurred simultaneously with detection of the neoplasm.

Diagnosis:
Usually based on clinical findings
A skin biopsy may be helpful to rule out other disorders
A workup for malignancy is required when this diagnosis is being considered

The diagnosis in this case is often straightforward. Concentric circles with a wood grain appearance that grow and move rapidly across the skin are usually pathognomonic for the disorder. The next step usually involves a search for an underlying malignancy. This workup should include complete blood counts, urine analysis, and age appropriate cancer screening. CT scan of the chest, abdomen, and pelvis must also be considered if other tests are not diagnostic.

Treatment:

Therapy is directed at treating the underlying malignancy. Treatment of the rash itself is often disappointing. Topical steroids provide minimal relief in most cases. Systemic steroids can provide some relief, but correcting the underlying neoplasm provides the best chance of a cure.