Erythema Annulare Centrifugum as a Cutaneous Manifestation Associated with Diabetes Mellitus: A Review of Its Clinical and Pathogenic Relationship
DOI:
https://doi.org/10.63969/mwmr5z19Keywords:
Erythema annulare centrifugum, Type 2 Diabetes Mellitus, Dermatologic marker, Chronic dermatosis, Systemic associationAbstract
Erythema annulare centrifugum (EAC) is a rare figurate dermatosis characterized by annular or arciform erythematous lesions. Although considered a hypersensitivity reaction pattern, increasing evidence has associated EAC with various systemic conditions, notably Type 2 Diabetes Mellitus (T2DM). This integrative review analyzed 25 indexed publications to explore the clinical and pathophysiological relationship between EAC and T2DM. The review included case reports, series, and clinical analyses, comparing manifestations in diabetic and non-diabetic individuals. Findings show that EAC in patients with T2DM often presents as a chronic, recurrent eruption, sometimes resistant to conventional therapy, and typically linked to poor glycemic control. Histopathological features, particularly the perivascular lymphocytic “coat-sleeve” infiltrate, were consistent across cases. Drug-induced variants, such as those triggered by metformin or biologics, and paraneoplastic EAC were also discussed. The review emphasizes EAC as a potential dermatological marker of systemic imbalance. Older literature was included to contextualize and support emerging trends. Future research should aim to clarify the immunometabolic mechanisms linking EAC with chronic diseases. Early identification of EAC may provide an opportunity for clinicians to detect undiagnosed systemic conditions, particularly T2DM.
Downloads
References
Ali, Z., & Fried, J. (2021). Erythema annulare centrifugum associated with neuroendocrine tumor: A case report. Journal of Dermatological Case Reports, 15(2), 58–61. https://doi.org/10.1016/j.jdcr.2021.10.007
Borges, A. S., Brasileiro, A., Santos, S., & Saiote, J. (2018). Erythema annulare centrifugum in a patient with Budd-Chiari syndrome. Actas Dermo-Sifiliográficas (English Edition), 109(8), 755–757. https://doi.org/10.1016/j.adengl.2018.06.003
Cakir, A., Bostan, E., & Kaymaz, E. (2022). Erythema annulare centrifugum following SARS‑CoV‑2 infection in a pediatric patient. International Journal of Dermatology, 61(10), e408–e410. https://doi.org/10.1111/ijd.16249
Calderon, P., Ajmal, H., Brady, M., & Kartono, F. (2024). Refractory erythema annulare centrifugum treated with roflumilast. JAAD Case Reports, 47, 17–19. https://doi.org/10.1016/j.jdcr.2024.01.012
Chodkiewicz, H. M., & Cohen, P. R. (2012). Paraneoplastic erythema annulare centrifugum eruption: PEACE. American Journal of Clinical Dermatology, 13(4), 239–246. https://doi.org/10.2165/11598930-000000000-00000
De Aloe, G., Rubegni, P., Risulo, M., Sbano, P., et al. (2005). Erythema annulare centrifugum successfully treated with metronidazole. Clinical and Experimental Dermatology, 30(5), 583–584. https://doi.org/10.1111/j.1365-2230.2005.01841.x
Endocrine Practice. (2021). Erythema Annulare Centrifugum. Abstract S1530‑891X(21)00746‑1. https://doi.org/10.1016/j.eprac.2021.04.585
Ena, L., Mazzarello, V., Ferrari, M., & Ena, P. (2021). Recurrent erythema annulare centrifugum due to influenza type A. Case Reports in Dermatology, 13(1), 134–140. https://doi.org/10.1159/000515897
Fernandez‑Nieto, D., Ortega‑Quijano, D., & Jimenez‑Cauhe, J. (2021). Erythema annulare centrifugum associated with chronic amitriptyline intake. Anais Brasileiros de Dermatologia, 96(1), 114–116. https://doi.org/10.1016/j.abd.2020.09.010
Garrastegui‑Mercado, E., & Antony, S. (2023). Metformin Induced Erythema Annulare Centrifugum Mimicking Community‑Acquired MRSA Skin Infections [Poster]. Central & West Texas GME Research Day.
González‑Vela, M. C., et al. (2006). Erythema annulare centrifugum in an HIV‑positive patient. International Journal of Dermatology, 45(12), 1423–1425. https://doi.org/10.1111/j.1365-4632.2006.02638.x
Kim, K. J., Chang, S. E., Choi, J. H., Sung, K. J., & Moon, K. C. (2002). Clinicopathologic analysis of 66 cases of erythema annulare centrifugum. Journal of Dermatology, 29(2), 61–67. https://doi.org/10.1111/j.1346-8138.2002.tb00167.x
Kruse, L. L., Kenner‑Bell, B. M., & Mancini, A. J. (2016). Pediatric erythema annulare centrifugum treated with oral fluconazole: A retrospective series. Pediatric Dermatology, 33(5), 501–506. https://doi.org/10.1111/pde.12955
Lee, H. W., Lee, D. K., et al. (2005). Erythema annulare centrifugum following herpes zoster infection: Wolf’s isotopic response? British Journal of Dermatology, 153(6), 1241–1243. https://doi.org/10.1111/j.1365-2133.2005.06712.x
Mandel, V. D., Ferrari, B., Manfredini, M., Giusti, F., & Pellacani, G. (2015). Annually recurring erythema annulare centrifugum: a case report. Journal of Medical Case Reports, 9, 236. https://doi.org/10.1186/s13256-015-0718-1
Mendes‑Bastos, P., et al. (2014). Erythema annulare centrifugum during rituximab treatment for autoimmune haemolytic anaemia. Journal of the European Academy of Dermatology and Venereology, 28(8), 1125–1127. https://doi.org/10.1111/jdv.12396
Mohapatra, L., & Mangaraj, S. (2022). Erythema annulare centrifugum associated with insulin therapy: a case report. Practical Diabetes, 39(2), 38–40. https://doi.org/10.1002/pdi.2388
Ojeda‑Martín, M. J., Ferrándiz‑Pulido, L., & Moreno‑Ramírez, D. (2011). Approaches to the dermatopathologic diagnosis of figurate lesions. Actas Dermo-Sifiliográficas (English Edition), 102(5), 316–324. https://doi.org/10.1016/j.adengl.2011.01.005
Palwasha Jalil, S. M., & Fatima, S. (2020). Erythema annulare centrifugum: A rare skin manifestation of Hashimoto thyroiditis. Cureus, 12(8), e9987. https://doi.org/10.7759/cureus.9987
Sehgal, V. N., & Sharma, S. (2019). Insidious occurrence of erythema annulare centrifugum in non‑insulin dependent diabetes mellitus (NIDDM) type‑2/adult onset diabetes mellitus: An intractable bizarre cutaneous manifestation. Current Research in Diabetes & Obesity Journal, 9(5), 555771. https://doi.org/10.19080/CRDOJ.2019.09.555771
Sidiropoulou, P., et al. (2019). Nivolumab in non‑small cell lung cancer: A novel case of an erythema annulare centrifugum‑like eruption. JAAD Case Reports, 5(7), 572–575. https://doi.org/10.1016/j.jdcr.2019.05.024
StatPearls. (2024). Erythema annulare centrifugum. In NCBI Bookshelf. Recuperado de https://www.ncbi.nlm.nih.gov/books/NBK482494/
Weyers, W., Díaz‑Cascajo, C., & Weyers, I. (2003). Erythema annulare centrifugum: Results of a clinicopathologic study of 73 patients. American Journal of Dermatopathology, 25(6), 451–462. https://doi.org/10.1097/00000372-200312000-00001
Ziemer, M., Eisendle, K., & Zelger, B. (2009). New concepts on erythema annulare centrifugum: a clinical reaction pattern that does not represent a specific clinicopathological entity. British Journal of Dermatology, 160(1), 119–126. https://doi.org/10.1111/j.1365-2133.2008.08897.x
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Luis Alejandro Arellano Leyva, Emerson Alejandro Castro López, Jorge Angel Velasco Espinal, Ana Paula Calderón Aguirre, Alexa Fernanda Uriostegui Navarro (Autor/a)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Los artículos publicados en la revista se distribuyen bajo la licencia Creative Commons Atribución 4.0 Internacional (CC BY 4.0). Esta licencia permite a terceros descargar, copiar, distribuir, adaptar y reutilizar una obra, incluso con fines comerciales, siempre que se otorgue el crédito adecuado al autor original.
