Title: GZ / The Grenz Zone Season 2 / 26 Figurate (Gyrate) Erythemas
Tags: GZ DermnetNZ

Q: Erythema Annulare Centrifigum presents as erythematous annular lesions on the [body location] or proximal extremities that slowly progress about 2-3mm/day with "trailing scale"
A: trunk
Back Extra: Common triggers include:
Infections (e.g. tinea)
Medications (e.g. HCTZ, amitryptyline)
Foods (e.g. blue cheese)
Autoimmune conditions
Cancer (rare)

Q: On histology, erythema annulare centrifigum presents with parakeratosis, spongiosis, and [...] perivascular infiltrate
A: cuffing/coatsleeve
Back Extra: Cuffing/coatsleeve = tight lymphohistiocytic infiltrate surrounding superficial vessels

Q: Treatment of erythema annulare centrifigum includes addressing [...], topical steroid or calcineurin inhibitor, or UV or oral erythromycin
A: triggers

Q: Erythema Gyratum Repens is a [...] associated with internal cancer
A: paraneoplastic syndrome
Back Extra: Majority of rashes occur around 1 year prior to discovery of malignancy. Lung cancer is the most common (Breast/GI cancer also seen)
50% have peripheral eosinophilia

Q: Erythema Gyratum Repens presents clinically as multiple erythematous [morphology] rings with figurate wood grain appearance that develop rapidly/diffusely about 1cm/day
A: polycyclic

Q: Treatment of Erythema Gyratum Repens is [...]. The rash will resolve.
A: find & treat malignancy

Q: Erythema migrans is caused by [specific spirochete], which is carried by the deer tick, Ixodes scapularis
A: Borrelia burgdorferi
Back Extra: Seen in Lyme disease. Tick has to be attached >24hrs for transmission of Borrelia

Q: Clinically, erythema migrans presents as an erythematous, enlarging [...] lesion typically on the torso that appears a few days to 1 month after the initial bite.
A: targetoid
Back Extra: May have flu-like sxs at onset
Remember, if Lyme disease is untreated, it can progress to severe arthralgias, Bell's palsy, and 3rd degree AV Block

Q: Diagnosis of Lyme disease is with [2 answers] and H&P
A: ELISA/Western Blot

Q: Treatment of Lyme disease consists of [...] and a single 200mg dose of [specific antibiotic] for prophylaxis IF:
Attached tick = Ixodes scapularis
Attached > 36hrs
Med can be started within 72 hrs of removal
A: removal of the tick; doxycycline
Back Extra: For erythema migrans only: doxycycline 100mg BID for 2-3 weeks
If allergy or pregnant: amoxicillin 500mg q8 hrs for 2-3 weeks

Q: Erythema Marginatum is seen within 2-5 weeks following untreated [...]
A: Strep throat or Group A strep skin infections
Back Extra: Major JONES criteria: joint arthropathy, pancarditis, subQ extensor nodules, erythema marginatum, Syndeham's chorea
Minor JONES criteria: arthralgias, fevers, elevated ESR/CRP, prolonged PR interval

Q: Clinically, erythema marginatum presents as erythematous macules and papules in an [2 answers] arrangement on the trunk & proximal extremities
A: annular or polycyclic
Back Extra: Progress around 2-12 mm/day

Q: Diagnosis of Erythema Marginatum is with CBC, [antibody], ESR, and CRP
A: ASO-titer
Back Extra: Make sure to get a cardiac work-up (e.g. ECG, Echo)

Q: Treatment of Erythema Marginatum consists of [...], anti-inflammatories, and a Cardiology + Neurology consult
A: antibiotics
Back Extra: Antibiotics: penicillins, cephalosporins, azithromycin, clarithromycin, clindamycin
Anti-inflammatory: naproxen