Makindo Medical Notes

Erythema Gyratum Repens (EGR) is a rare, paraneoplastic dermatological condition characterized by rapidly migrating, erythematous, concentric bands that resemble wood grain patterns. It is often associated with internal malignancies, particularly lung cancer, and serves as a clinical marker indicating an underlying neoplastic process.

About

• Definition: Erythema Gyratum Repens is a distinctive skin disorder marked by the presence of swiftly moving, red, ring-like lesions that form intricate, wood-grain-like patterns on the skin.
• Epidemiology: EGR is exceedingly rare, with fewer than 100 cases reported in medical literature. It predominantly affects middle-aged to older adults and has a slight male predominance.

Clinical Features

• Lesion Appearance: Well-defined, erythematous bands that migrate rapidly across the skin, typically covering large body areas such as the trunk and extremities.
• Pattern: The lesions form concentric rings with a wood-grain-like or gyrate pattern, often with a clear central area.
• Symptomatology: Patients may experience pruritus (itching) and a burning sensation, but systemic symptoms are generally related to the underlying malignancy.
• Course: The rash progresses rapidly, with bands advancing at a rate of several centimeters per week.

Causes

• Paraneoplastic Syndrome: EGR is most commonly associated with internal malignancies, especially:
  • Lung carcinoma (particularly squamous cell carcinoma)
  • Esophageal cancer
  • Breast cancer
  • Ovarian cancer
  • Unknown primary tumours
• Non-Malignant Associations: Rarely, EGR has been linked to infections, autoimmune diseases, and inflammatory conditions, though these associations are uncommon.

Investigations

• Clinical Examination: Detailed dermatological assessment to identify the characteristic rash patterns.
• Imaging Studies:
  • Chest X-ray or CT scan to screen for lung malignancies.
  • Abdominal ultrasound or CT scan if abdominal malignancies are suspected.
• Biopsy: Skin biopsy may be performed to rule out other dermatological conditions but is not specific for EGR.
• Laboratory Tests: Routine blood tests may help identify underlying malignancies, such as elevated tumour markers.
• Endoscopy: If esophageal cancer is suspected, upper GI endoscopy may be indicated.

Management

• Treat Underlying Malignancy: The primary approach to managing EGR is to identify and treat the associated cancer, which may lead to the resolution of the rash.
• Symptomatic Treatment:
  • Topical corticosteroids or antihistamines can be used to alleviate pruritus and inflammation.
  • Emollients to maintain skin hydration.
• Regular Monitoring: Continuous surveillance for the development of internal malignancies in patients presenting with EGR without an initially identifiable cancer.

Prognosis

• EGR typically indicates an advanced stage of the associated malignancy, often correlating with a poorer prognosis.
• Early detection and treatment of the underlying cancer can improve outcomes and may lead to the regression of the skin lesions.

References

• Erythema Gyratum Repens: A Case Report and Review of the Literature
• DermNet NZ - Erythema Gyratum Repens
• Merck Manuals - Erythema Gyratum Repens
• American Family Physician - Paraneoplastic Syndromes