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Chapter 054. Skin Manifestations of Internal Disease (Part 6)

Migratory erythema with erosions; favors lower extremities and girdle area In erythema gyratum repens, one sees numerous mobile concentric arcs and wavefronts that resemble the grain in wood. A search for an underlying malignancy is mandatory in a patient with this eruption. Erythema migrans is the cutaneous manifestation of Lyme disease, which is caused by the spirochete Borrelia burgdorferi. In the initial stage (3–30 days after tick bite), a single annular lesion is usually seen, which can expand to ≥10 cm in diameter. Within several days, approximately half the patients develop multiple smaller erythematous lesions at sites distant from the. | Chapter 054. Skin Manifestations of Internal Disease Part 6 Migratory erythema with erosions favors lower extremities and girdle area In erythema gyratum repens one sees numerous mobile concentric arcs and wavefronts that resemble the grain in wood. A search for an underlying malignancy is mandatory in a patient with this eruption. Erythema migrans is the cutaneous manifestation of Lyme disease which is caused by the spirochete Borrelia burgdorferi. In the initial stage 3-30 days after tick bite a single annular lesion is usually seen which can expand to 10 cm in diameter. Within several days approximately half the patients develop multiple smaller erythematous lesions at sites distant from the bite. Associated symptoms include fever headache photophobia myalgias arthralgias and malar rash. Erythema marginatum is seen in patients with rheumatic fever primarily on the trunk. Lesions are pink-red in color flat to mildly elevated and transient. There are additional cutaneous diseases that present as annular eruptions but lack an obvious migratory component. Examples include CTCL subacute cutaneous lupus secondary syphilis and sarcoidosis see Papulonodular Skin Lesions below . Acne Table 54-7 In addition to acne vulgaris and acne rosacea the two major forms of acne Chap. 53 there are drugs and systemic diseases that can lead to acneiform eruptions Table 54-7 . Table 54-7 Causes of Acneiform Eruptions I. Primary cutaneous disorders A. Acne vulgaris B. Acne rosacea II. Drugs e.g. anabolic steroids glucocorticoids lithium iodides EGFRa inhibitors III. Systemic diseases A. Increased androgen production 1. Adrenal origin e.g. Cushing s disease 21-hydroxylase deficiency 2. Ovarian origin e.g. polycystic ovary syndrome B. Cryptococcosis disseminated C. Dimorphic fungi D. Behçet s .