What are the other Names for this Condition? (Also known as/Synonyms)

• Drug-Induced EAC
• Medication-Induced EAC
• Medication-Induced Erythema Annulare Centrifugum

What is Drug-Induced Erythema Annulare Centrifugum? (Definition/Background Information)

• Erythema annulare centrifugum (EAC) is a chronic condition defining a pattern of red skin lesions that are in a ring form, spreading from the center. It may be caused by a variety of factors including infections, certain cancers, appendicitis, and other underlying conditions
• Drug-Induced Erythema Annulare Centrifugum is caused by the use of certain medications, such as antimalarial drugs, antibiotics, or certain antidepressants, among others. It may be considered as a reactive condition of the body to the drug
• The condition is seen in both children and adults. Any part of the body may be affected, but the legs are involved in many cases. The lesions are many in number and may be itchy (pruritic). They may present cosmetic concerns in some individuals
• A diagnosis of Drug-Induced Erythema Annulare Centrifugum is made by studying the presenting symptoms, assessing history of medication use, and a skin biopsy, if necessary
• Stopping or discontinuing the use of such medications may decrease progression of Drug-Induced Erythema Annulare Centrifugum, or may result in a cure. The prognosis is good in a majority of cases with adequate treatment

Who gets Drug-Induced Erythema Annulare Centrifugum? (Age and Sex Distribution)

• Drug-Induced Erythema Annulare Centrifugum is a skin condition caused by a variety of medications that are administered for other underlying conditions. Hence, any individual of any age may be at risk
• Both males and females are affected
• Individuals of all racial and ethnic background can be affected

What are the Risk Factors for Drug-Induced Erythema Annulare Centrifugum? (Predisposing Factors)

The key risk factor for Drug-Induced Erythema Annulare Centrifugum is the use of certain medications that cause the skin condition as a side effect. The medications observed to induce this abnormal skin growth include:

• Antimalarial drugs including chloroquine and hydroxychloroquine
• Antibiotics such as penicillin
• Antidepressants such as etizolam and amitriptyline
• Certain histamine H2 receptor antagonist such as cimetidine
• Diuretics that include spironolactone and hydrochlorothiazide
• Medications that contain gold
• Salicylates
• Non-steroidal anti-inflammatory drugs (NSAIDs) that include piroxicam
• Certain medications that are used to treat autoimmune disorders, prostate gland conditions, and psoriasis

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Drug-Induced Erythema Annulare Centrifugum? (Etiology)

• The exact cause of development of Drug-Induced Erythema Annulare Centrifugum is presently unknown
• The condition can be defined as an adverse reaction of the body to certain medications that are used for various health conditions. This results in the formation of lesions on the skin

What are the Signs and Symptoms of Drug-Induced Erythema Annulare Centrifugum?

The signs and symptoms of Drug-Induced Erythema Annulare Centrifugum include:

• Multiple skin lesions that are red and concentric in appearance
• They may range from 0.5 to 10 cm in size
• Erythema annulare centrifugum lesions usually involves the lower limbs, but the upper limbs can also be affected
• In rare cases, it may be present on the face and trunk (chest and back)
• The lesions may not always form as rings, but may be irregular in shape too
• The lesions may itch leading to scratching and bleeding

The severity of the signs and symptoms may be related to the type and usage of the drug. The onset of signs and symptoms may vary from one individual to another.

How is Drug-Induced Erythema Annulare Centrifugum Diagnosed?

A diagnosis of Drug-Induced Erythema Annulare Centrifugum may involve the following:

• A complete physical examination and a thorough medical history (which includes the use of any drugs and topical applications)
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy, if necessary: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Drug-Induced Erythema Annulare Centrifugum?

In many cases, Drug-Induced Erythema Annulare Centrifugum is a benign condition, and it does not cause any significant complications. However, the following factors may be a cause for concern in some individuals:

• The presence of large patches of skin lesions may result in cosmetic issues (especially when it involves the face or exposed skin areas), which may result in emotional stress
• Secondary bacterial and fungal infection due to scratching and bleeding

How is Drug-Induced Erythema Annulare Centrifugum Treated?

• Discontinuing the drug or topical cream responsible for the side effect may result in a cure, or in improvement of Drug-Induced Erythema Annulare Centrifugum
• Topical, or seldom, oral corticosteroid therapy may be administered
• Administration of antifungal or antibiotic medication, in case of any secondary infections

Follow-up care with regular screening and check-ups are important and encouraged.

How can Drug-Induced Erythema Annulare Centrifugum be Prevented?

Current medical research has not established a method of preventing Drug-Induced Erythema Annulare Centrifugum. However, the following may be observed:

• Drugs that cause erythema annulare centrifugum may be discontinued or alternative medications used
• Inform your physician if you are allergic to certain drugs
• Periodic monitoring or follow-up of the condition with the healthcare provider is recommended

What is the Prognosis of Drug-Induced Erythema Annulare Centrifugum? (Outcomes/Resolutions)

The prognosis for Drug-Induced Erythema Annulare Centrifugum is usually good in many cases, upon discontinuation of the medication and adequate treatment of the skin condition.

Additional and Relevant Useful Information for Drug-Induced Erythema Annulare Centrifugum:

• Do not pick or pop the blisters, for doing so can affect the healing process and may result in secondary infections
• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse