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An Annular Eruption in a Young Child

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A young child presented to clinic with a 6-month history of an asymptomatic expanding erythematous eruption on the lower legs, abdomen, and buttocks (Figure, A). The eruption would wax and wane, with each episode lasting for approximately 1 week, without residual pigmentation. Clinical examination was significant for faint, nonscaling annular serpiginous, erythematous plaques with central clearing, and barely elevated borders. Test results for erythrocyte sedimentation rate, complete blood cell count, antinuclear antibodies, anti-Ro/SSA and anti-La/SSB antibodies, and Borrelia burgdorferi antibodies were within normal limits. There was no family history of autoimmune disease, and the child had not experienced any fevers or exposures to ticks or other arthropods. A punch biopsy specimen from the left thigh was obtained, and histopathological analysis was subsequently performed (Figure, B and C).

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C. Annular erythema of infancy

The analysis of the skin biopsy specimen revealed a superficial and deep, perivascular, and interstitial inflammatory infiltrate consisting of lymphocytes, histiocytes, neutrophils, and eosinophils. The recurrent and relapsing nature of the lesions, perivascular eosinophilic infiltrate, and lack of other systemic or serologic findings is consistent with a diagnosis of annular erythema of infancy (AEI).

Annular erythema of infancy is a benign, idiopathic disease characterized by the cyclic appearance of asymptomatic edematous papules. These enlarge peripherally, forming arcuate, annular plaques with urticarial borders. Lesions are typically several centimeters in diameter, and patients can have multiple confluent lesions that create a polycyclic appearance. The lesions are usually evanescent and last several days but tend to reappear in a cyclic fashion during the first year of life.1

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Article Information

Corresponding Author: Nirali Patel, MS, Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 200 Medical Plaza, Ste 450, Los Angeles, CA 90035 (niralipatel@mednet.ucla.edu).

Published Online: July 3, 2018. doi:10.1001/jamadermatol.2018.1174

Conflict of Interest Disclosures: None reported.

Additional Contributions: Chandra Smart, MD (Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles), assisted with the pathology images. There was no financial compensation.

References
1.
Peterson  AO  Jr, Jarratt  M.  Annular erythema of infancy.  Arch Dermatol. 1981;117(3):145-148.PubMedGoogle ScholarCrossref
2.
Stachowitz  S, Abeck  D, Schmidt  T, Ring  J.  Persistent annular erythema of infancy associated with intestinal Candida colonization.  Clin Exp Dermatol. 2000;25(5):404-405.PubMedGoogle ScholarCrossref
3.
Pfingstler  LF, Miller  KP, Pride  H.  Recurring diffuse annular erythematous plaques in a newborn.  JAMA Dermatol. 2014;150(5):565-566.PubMedGoogle ScholarCrossref
4.
Helm  TN, Bass  J, Chang  LW, Bergfeld  WF.  Persistent annular erythema of infancy.  Pediatr Dermatol. 1993;10(1):46-48.PubMedGoogle ScholarCrossref
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Wong  LC, Kakakios  A, Rogers  M.  Congenital annular erythema persisting in a 15-year-old girl.  Australas J Dermatol. 2002;43(1):55-61.PubMedGoogle ScholarCrossref
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Patrizi  A, Savoia  F, Varotti  E, Gaspari  V, Passarini  B, Neri  I.  Neutrophilic figurate erythema of infancy.  Pediatr Dermatol. 2008;25(2):255-260.PubMedGoogle ScholarCrossref
7.
Toledo-Alberola  F, Betlloch-Mas  I.  Eritemas anulares en la infancia.  Actas Dermosifiliogr. 2010;101(6):473-484.PubMedGoogle ScholarCrossref
8.
Kettler  AH, Stone  MS, Bruce  S, Tschen  JA.  Annular eruptions of infancy and neonatal lupus erythematosus.  Arch Dermatol. 1987;123(3):298-299.PubMedGoogle ScholarCrossref
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