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

• EGR (Erythema Gyratum Repens)
• Gammel's Disease

What is Erythema Gyratum Repens? (Definition/Background Information)

• Erythema Gyratum Repens (EGR) is an uncommon condition defining a type of skin lesion pattern, in which red skin rashes composed of concentric rings (annular erythema) moves to different parts of the body
• Erythema Gyratum Repens is mostly seen in adults. It is associated with an underlying malignancy, such as of the lung, breast, or cervix, in a majority of cases. However, the exact cause of development of EGR is unknown
• Any part of the body skin may be involved; but, in many cases, the skin lesions are observed on the face, arms, and legs. The lesions are very itchy (pruritic), which can result in scratching and bleeding
• The treatment of Erythema Gyratum Repens involves undertaking treatment of the underlying condition, which can help resolve the skin condition. The prognosis mainly depends upon the underlying condition causing EGR

It is important to note that Erythema Gyratum Repens is a benign condition. In a majority of cases, treating the underlying condition/disease resolves the symptoms of EGR. The overall prognosis of the individual is dependent upon the severity of the underlying condition/disease.

Who gets Erythema Gyratum Repens? (Age and Sex Distribution)

• Most cases of Erythema Gyratum Repens (EGR) are observed in adults. The age range is 16-77 years, and the average age of presentation is 63 years
• Both males and females may be affected
• Individuals of all racial and ethnic background may be affected, but EGR is more common in Caucasians

What are the Risk Factors for Erythema Gyratum Repens? (Predisposing Factors)

The risk factors for Erythema Gyratum Repens may include:

• A variety of cancers such as:
  • Lung cancer
  • Breast cancer
  • Urinary bladder cancer
  • Uterus cancer
  • Cervical cancer
  • Cancers of the gastrointestinal tract; esophageal and stomach cancers
  • Prostate cancer
• Tuberculosis (TB)
• Systemic lupus erythematosus (SLE)
• Calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia (CREST) syndrome
• Psoriasis
• Some forms of Erythema Gyratum Repens may be drug-induced

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 Erythema Gyratum Repens? (Etiology)

The exact cause of development of Erythema Gyratum Repens (EGR) is presently unknown. The condition may be caused by an abnormal immune system.

• Erythema Gyratum Repens is associated with an underlying malignancy in most of the cases
  • EGR can also occur before the detection of the malignancy
  • The average interval period between EGR and the detection of malignancy is about 9 months
  • In a few, it can be present at the time of the malignancy
• EGR is type of figurate erythema or gyrate erythema
• It is described as a type of paraneoplastic process (that occur due to changes in the immune system triggered by a malignant neoplasm, meaning cancer)

It is important to note that Erythema Gyratum Repens is non-contagious and it cannot be transmitted from one individual to another.

What are the Signs and Symptoms of Erythema Gyratum Repens?

The signs and symptoms of Erythema Gyratum Repens (EGR) include:

• Skin lesions that are red and consisting of ring-like pattern; multiple skin lesions are noted
• The concentric red bands appear like wood grain patterns
• The skin lesions can be very itchy, leading to bleeding from scratching
• The rashes may be observed as moving to other areas of the body, over a short time
• EGR usually involves the trunk and extremities, but may also cover the entire body surface

Besides the above, the signs and symptoms of the underlying condition causing EGR may be observed.

How is Erythema Gyratum Repens Diagnosed?

A diagnosis of Erythema Gyratum Repens may involve the following:

• A thorough medical history assessment and complete physical examination
• Assessment of the presenting signs and symptoms; the skin symptoms of the condition are generally distinctive and helpful in establishing its diagnosis
• 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
• Radiological studies, such as X-ray of the lung or a mammogram, to detect an underlying malignancy
• Blood test such as PSA level in men, liver function test
• Pap smear in women
• Endoscopy for gastrointestinal tract malignancies
• Skin biopsy: 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
• A differential diagnosis may be undertaken to rule out the following conditions that may present similar symptoms:
  • Bullous pemphigoid
  • Chronic urticaria
  • Erythema annulare centrifugum
  • Erythema marginatum
  • Erythema migrans
  • Lyme disease
  • Skin fungal infections such as tinea corporis

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 Erythema Gyratum Repens?

Erythema Gyratum Repens may lead to the following complications:

• The presence of large patches of skin lesions may result in cosmetic issues (especially when it involves the face or exposed skin areas)
• This may result in emotional stress
• Secondary bacterial and fungal infection due to scratching and bleeding
• Complications that arise from underlying cancers

How is Erythema Gyratum Repens Treated?

Treating the underlying cause of Erythema Gyratum Repens often improves the skin condition. Additionally, the following treatment measures may be considered to treat the skin symptoms:

• Use of topical applications and creams
• In some, corticosteroid therapy may be helpful
• Treating underlying conditions and disorders, if any
• Administration of antifungal or antibacterial medications for secondary infections
• Undertaking treatment for stress

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

How can Erythema Gyratum Repens be Prevented?

Currently, there are no known methods to prevent the occurrence of Erythema Gyratum Repens. However, one may lower the risk for the skin condition by considering the following factors:

• Stress management
• Treat any underlying infections/conditions early and adequately
• Inform your physician if you are allergic to certain drugs

What is the Prognosis of Erythema Gyratum Repens? (Outcomes/Resolutions)

• The prognosis for Erythema Gyratum Repens is usually dependent on the underlying cause and the severity of the symptoms presented
• If the underlying associated condition is a malignancy, then the prognosis depends upon the type of cancer, stage of the cancer, age and overall health of the individual, and the individual’s response to therapy

Additional and Relevant Useful Information for Erythema Gyratum Repens:

• 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