Erythema anulare centrifugum associated with disseminated prostatic carcinoma.

Sir, Annular erythema is a reaction pattern to various agents, particularly drugs, infections and neoplasia (1). Shelley simpliŽ ed the classiŽ cation of annular erythemas into erythema anulare centrifugum (EAC), erythema chronicum migrans and erythema gyratum repens based on aetiology, morphology and clinical behaviour (2). EAC was Ž rst described by Darier in 1916 (3) and is characterized by the presence of annular lesions with induration, slight scaling and a slow change in appearance of the rash (as compared to erythema gyratum repens, which changes rapidly over days). Anecdotal reports have appeared in the literature over the years reporting the association of EAC and malignancy. Thus far, it has been described with non-small cell lung cancer, Fig. 1. Eruption on the back with peripheral erythema and trailing scale. breast cancer and haematological malignancies (4–6). We report the occurrence of EAC in association with prostatic carcinoma in an elderly man. The eruption initial treatment with radiotherapy to his thoracic spine, coincided with rising levels of prostate-speciŽ c antigen his disease was adequately controlled for nearly 5 years and responded to a course of oral steroids. Other with monthly subcutaneous injections of goserelin. reported cases of prostatic carcinoma with EAC Because of rising PSA levels 5 years later, he was tried and the literature regarding paraneoplastic erythema on oral androgen antagonists, all of which had to be annulare centrifugum are discussed. stopped owing to gastrointestinal adverse eVects. At the same time as he developed the skin rash, he developed painful wasting of both his hypothenar eminences, which CASE REPORT proved to be due to paraneoplastic ulnar neuropathy. Both of these problems were temporally associated with A 74-year-old Caucasian man was referred for dermatologic opinion. Several weeks previously he developed a a rising PSA level. Topical clobetasol propionate 0.05% (Dermovate ) red, itchy rash on his trunk. He was troubled by a burning sensation in the lesions along with nocturnal was prescribed. Owing to deterioration in his condition, he was commenced on prednisolone 10mg twice daily pruritus. The rash evolved gradually to involve his trunk, scalp and upper arms over several weeks, with as a third line agent to control his malignancy. Within a few days the skin rash started to clear and he reported no rapid change in borders. There was no family or personal history of dermatological problems nor was he an improvement in his upper limb pain. When seen in the dermatology clinic after 6 weeks, all of the plaques commenced on any new medication. Clinical examination of his skin showed widespread annular plaques with were  attened and scaling had disappeared. There was a mild residual erythema and postin ammatory hypera trailing scale involving most of his back, scalp and a few lesions on his chest wall and limbs (Fig. 1). pigmentation on the trunk. However, the serum PSA continued to rise and 4 months later measured 523mg/l. Mycological culture of scale was negative. Skin biopsy showed endothelial swelling of the dermal vessels with a perivascular lymphocytic inŽ ltrate; direct immunoDISCUSSION  uorescence was negative for immunoglobulin and complement. There were no histological features to suggest Although patients with coexistence of EAC and malignancy have been described, a causal association cutaneous lupus. Six years previously, he was diagnosed with disseminbetween them is by no means well established. Mahood followed-up 24 patients with EAC for a mean period of ated prostatic carcinoma with a serum prostatespeciŽ c antigen (PSA) measuring 5117 mg/l. He had 5.9 years and did not Ž nd any instances of malignancy (7). In an earlier study predating the current classiŽ caradiological and histological evidence of metastatic disease throughout his thoracolumbar spine. Following tion, White & Perry reported that no signiŽ cant increase