Erythema gyratum repens is a

skin condition A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, nails, and related muscle and glands. The major function of this ...

that has a strong association with internal cancers. It characteristically presents with red wavy lines, generally in older adults. These regular whirly rings rapidly and repetitively appear within existing ones, giving the impression that the rash is moving. The resulting pattern is similar to

wood grain Wood grain is the longitudinal arrangement of wood fibers or the pattern resulting from such an arrangement. It has various derived terms refer to different aspects of the fibers or patterns. Wood grain is important in woodworking and it impacts ...

. There is often an intense

itch An itch (also known as pruritus) is a sensation that causes a strong desire or reflex to scratch. Itches have resisted many attempts to be classified as any one type of sensory experience. Itches have many similarities to pain, and while both ...

and scale over the leading edge, which may be slightly raised. The cause is believed to have an immunological base. 80% of cases have an underlying

cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...

, of which almost half have

lung cancer Lung cancer, also known as lung carcinoma, is a malignant tumor that begins in the lung. Lung cancer is caused by genetic damage to the DNA of cells in the airways, often caused by cigarette smoking or inhaling damaging chemicals. Damaged ...

. Sometimes no cause is found. Diagnosis is generally by its appearance, although tests may be required to exclude other conditions. These tests may include blood tests. A cancer may be located using

medical imaging Medical imaging is the technique and process of imaging the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs or tissues (physiology). Medical imaging seeks to revea ...

. Necrolytic migratory erythema and

erythema migrans Erythema migrans or erythema chronicum migrans is an expanding rash often seen in the early stage of Lyme disease, and can also (but less commonly) be caused by southern tick-associated rash illness (STARI). Page last reviewed: October 22, 2015 ...

are some of many other skin conditions that may appear similar. Treatment and outlook depend on the underlying cause.

Antihistamines Antihistamines are drugs which treat allergic rhinitis, common cold, influenza, and other allergies. Typically, people take antihistamines as an inexpensive, generic (not patented) drug that can be bought without a prescription and provides r ...

may help to reduce the itch. The rash typically resolves with successful cancer treatment. The condition is rare. Males are affected twice as frequently as females. J. A. Gammel first described the condition in 1952.

Signs and symptoms

Erythema gyratum repens characteristically presents as wavy

red Red is the color at the long wavelength end of the visible spectrum of light, next to orange and opposite violet. It has a dominant wavelength of approximately 625–750 nanometres. It is a primary color in the RGB color model and a seconda ...

lines on the

skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different ...

. These regular whirly rings rapidly and repetitively appear within existing ones, expanding outward at a rate of up to 1cm a day, giving the impression that the rash is moving. The resulting pattern is similar to

. There is typically an intense

and scale over the leading edge, which may be slightly raised. The trunk and limbs are most frequently affected. Thickening of the skin of the palms co-exists in around 10% of affected individuals, whatever the underlying cause. The skin may become extremely dry. Onset is generally in older adults; after the age of 60-years.

Cause

The cause of erythema gyratum repens is believed to have an immunological base. 80% of cases have an underlying cancer, of which almost half have

. Other cancers reported to be associated include cancers of the

oesophagus The esophagus (American English), oesophagus (British English), or œsophagus ( archaic spelling) ( see spelling difference) all ; : ((o)e)(œ)sophagi or ((o)e)(œ)sophaguses), colloquially known also as the food pipe, food tube, or gullet, ...

and

breast The breasts are two prominences located on the upper ventral region of the torso among humans and other primates. Both sexes develop breasts from the same embryology, embryological tissues. The relative size and development of the breasts is ...

, and less frequently

gastric cancer Stomach cancer, also known as gastric cancer, is a malignant tumor of the stomach. It is a cancer that develops in the lining of the stomach. Most cases of stomach cancers are gastric carcinomas, which can be divided into a number of subtypes ...

, uterine cancer,

throat cancer Head and neck cancer is a general term encompassing multiple cancers that can develop in the head and neck region. These include cancers of the mouth, tongue, gums and lips ( oral cancer), voice box ( laryngeal), throat ( nasopharyngeal, orophar ...

, pancreas cancer and

lymphoma Lymphoma is a group of blood and lymph tumors that develop from lymphocytes (a type of white blood cell). The name typically refers to just the cancerous versions rather than all such tumours. Signs and symptoms may include enlarged lymph node ...

. The rash generally precedes the cancer diagnosis by around 9-months. Less frequently, the cause may be tuberculosis of the lung, or no cause is found. Other rare reported associations have included

cryptogenic organizing pneumonia Cryptogenic organizing pneumonia (COP), formerly known as bronchiolitis obliterans organizing pneumonia (BOOP), is an inflammation of the bronchioles (bronchiolitis) and surrounding tissue in the lungs. It is a form of idiopathic interstitial pne ...

and

rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and h ...

Diagnosis

Diagnosis is generally by its appearance. Tests include blood tests such as a

complete blood count A complete blood count (CBC), also known as a full blood count (FBC) or full haemogram (FHG), is a set of medical laboratory tests that provide cytometry, information about the cells in a person's blood. The CBC indicates the counts of white blo ...

which may reveal raised eosinophils. Other blood tests include PSA, antinuclear antibodies and biochemistry. Medical imaging may locate a cancer;

chest X-ray A chest radiograph, chest X-ray (CXR), or chest film is a Projectional radiography, projection radiograph of the chest used to diagnose conditions affecting the chest, its contents, and nearby structures. Chest radiographs are the most common fi ...

mammogram Mammography (also called mastography; DICOM modality: MG) is the process of using low-energy X-rays (usually around 30 kVp) to examine the human breast for diagnosis and screening. The goal of mammography is the early detection of breast cancer ...

CT scan A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or ...

of pelvis and abdomen. If indicated then an

endoscopy An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are insert ...

may be required;

colonoscopy Colonoscopy () or coloscopy () is a medical procedure involving the Endoscopy, endoscopic examination of the large bowel (colon) and the distal portion of the small bowel. This examination is performed using either a Charge-coupled device, CCD ...

gastroscopy Esophagogastroduodenoscopy (EGD) or oesophagogastroduodenoscopy (OGD), also called by various other names, is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract down to the duodenum. It is considered ...

Differential diagnosis

Necrolytic migratory erythema,

tinea corporis Tinea corporis is a fungal infection of the body, similar to other forms of tinea. Specifically, it is a type of dermatophytosis (or ringworm) that appears on the arms and legs, especially on glabrous skin; however, it may occur on any superfici ...

, erythrokeratodermia variabilis, and subacute cutaneous lupus erythematosus are some of many other skin conditions that may appear similar.

Treatment

Treatment and outlook depend on the underlying cause. Antihistamines may help to reduce the itch, although the role of applying a steroid cream is unclear. The rash typically resolves with successful cancer treatment.

Epidemiology

The condition is rare. Males are affected twice as frequently as females.

History

J. A. Gammel first described the condition in 1952, in an individual who was later found to have breast cancer.

References

External links

{{Paraneoplastic syndromes Erythemas Paraneoplastic syndromes