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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Erythema papulosa semicircularis recidivans &#40;EPSR&#41; is a recently described entity characterized by the appearance of semicircular erythematous plaques with a centrifugal extension and of a clearly seasonal nature&#44; starting in spring or summer and resolving spontaneously in colder seasons&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The principal differential diagnosis is established with figurate erythema&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> especially erythema annulare centrifugum &#40;EAC&#41; and&#44; specifically&#44; its annually recurring subtype &#40;AR EAC&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> We report the case of a patient with recurring annular lesions that oblige us to consider the differential diagnosis between these 2 entities&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 70-year-old woman with a history of ischemic heart disease&#44; hypothyroidism&#44; thromboembolic disease&#44; and chronic gastritis visited our department in the month of May with a large erythematous plaque in the abdominal region that had appeared 2 weeks earlier and had expanded centrifugally &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The patient stated that the lesion caused pruritus and moderate pain&#46; She had no fever&#44; joint pain&#44; or any other symptoms&#46; In total&#44; the patient had had 6 independent episodes of lesions in a similar location and of similar clinical characteristics&#46; The first episode had occurred 9 years earlier &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; All the episodes had begun in the spring or summer months and had resolved spontaneously in the early autumn&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination revealed a semicircular erythematous plaque measuring 20<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>cm&#44; located on the abdomen&#44; with a clearly demarcated papular margin and central lightening &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Histology showed only a perivascular inflammatory infiltrate composed mainly of lymphocytes&#44; which involved the superficial and middle dermis&#46; The epidermis and deep dermis showed no abnormalities &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Blood tests were performed with a full blood count and biochemistry&#44; and an antibody titer was performed&#59; results were normal&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Treatment with topical methylprednisolone and oral prednisone was prescribed &#40;maximum dosage&#44; 0&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#41; for 15 days&#44; with no clinical response&#46; After the summer&#44; the patient presented for a follow-up visit and showed complete spontaneous resolution of the lesions&#46; The course of the previous episodes was similar&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">EPSR was first described in 2012&#44; when Song et al<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> reported a series of 9 patients of Chinese nationality with papuloerythematous eruptions with a centrifugal growth pattern that typically recurred during the warm&#44; humid months&#46; Cases with similar seasonality were subsequently described in Western countries&#44; one of which showed a possible link to a primary pancreas B cell lymphoma&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> The most frequently involved areas are the torso and proximal extremities&#59; the face&#44; palms and soles are not usually involved&#46; Histology usually shows a perivascular lymphocytic inflammatory infiltrate and mild edema of the papillary dermis&#59; all of these finding suggest superficial perivascular dermatitis&#46; No leukocytoclasia or other vasculitic findings are observed&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">As mentioned&#44; the principal differential diagnosis is with EAC&#46; Both EAC and EPSR begin as plaques with centrifugal growth and central lightening&#46; Desquamation at the edge of the lesion can be observed in the superficial form of EAC&#44; whereas this phenomenon is not seen in EPSR&#46; Moreover&#44; the size of the plaques tends to be smaller in EAC than in EPSR&#46; Histology of EAC is characterized by the distribution of the perivascular inflammatory infiltrate in a shirt-sleeve pattern&#59; this pattern is not so clearly observed in EPSR&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Although EAC does not usually present as clearly seasonal&#44; descriptions exist of cases in which&#44; just like in EPSR&#44; the lesions appear in the warm months and resolve spontaneously with the arrival of cold temperatures&#46; This subtype is known as annually recurring EAC&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Although the etiology of EPSR and EAC is unknown&#44; both may be due to a hypersensitive reaction to different external or internal stimuli&#46; Infectious diseases&#44; hormone abnormalities or fluctuations&#44; some drugs and foods&#44; and even neoplasias have been linked to EAC lesions&#46; Annually recurring EAC may also involve seasonal environmental factors such as increased temperature or insect bites&#46; A clear causal agent&#44; however&#44; cannot be identified in most cases &#40;idiopathic EAC&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">With regard to treatment&#44; topical and systemic corticosteroids may alleviate the pruritus&#44; but they cannot halt the progress of the lesions&#44; which may involve the entire chest&#44; back or neck&#46; Characteristic of EPSR and annually recurring EAC is the gradual and spontaneous regression of the lesions with the arrival of cooler seasons&#46; Long-term follow-up has recorded recurrences in the first 2-5 years&#44; with subsequent definitive resolution&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Other publications&#44; however&#44; suggest a longer duration of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Although EPSR has been described and subsequently reported in high-impact scientific journals&#44; some authors question that it has sufficient clinical pathologic entity to be considered as an independent disease and they prefer to consider it as a peculiar variant of recurring figurate erythemas such as annually recurring EAC&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Case and Research Letters
Erythema Papulosa Semicircularis Recidivans: A New Entity or a Subtype of Erythema Annulare Centrifugum?
Eritema papular semicircular recidivante: ¿nueva entidad o subtipo de eritema anular centrífugo?
E. Bernia
Autor para correspondencia
eduardobernia@gmail.com

Corresponding author.
, C. Requena, B. Llombart
Servicio de Dermatología, Instituto Valenciano de Oncología (IVO), Valencia, Spain
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    "titulo" => "Erythema Papulosa Semicircularis Recidivans&#58; A New Entity or a Subtype of Erythema Annulare Centrifugum&#63;"
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        "titulo" => "Eritema papular semicircular recidivante&#58; &#191;nueva entidad o subtipo de eritema anular centr&#237;fugo&#63;"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The biopsy shows a perivascular inflammatory infiltrate composed mainly of lymphocytes&#44; which involves the superficial and middle dermis &#40;hematoxylin&#8211;eosin&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Erythema papulosa semicircularis recidivans &#40;EPSR&#41; is a recently described entity characterized by the appearance of semicircular erythematous plaques with a centrifugal extension and of a clearly seasonal nature&#44; starting in spring or summer and resolving spontaneously in colder seasons&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The principal differential diagnosis is established with figurate erythema&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> especially erythema annulare centrifugum &#40;EAC&#41; and&#44; specifically&#44; its annually recurring subtype &#40;AR EAC&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> We report the case of a patient with recurring annular lesions that oblige us to consider the differential diagnosis between these 2 entities&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 70-year-old woman with a history of ischemic heart disease&#44; hypothyroidism&#44; thromboembolic disease&#44; and chronic gastritis visited our department in the month of May with a large erythematous plaque in the abdominal region that had appeared 2 weeks earlier and had expanded centrifugally &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The patient stated that the lesion caused pruritus and moderate pain&#46; She had no fever&#44; joint pain&#44; or any other symptoms&#46; In total&#44; the patient had had 6 independent episodes of lesions in a similar location and of similar clinical characteristics&#46; The first episode had occurred 9 years earlier &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; All the episodes had begun in the spring or summer months and had resolved spontaneously in the early autumn&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination revealed a semicircular erythematous plaque measuring 20<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>cm&#44; located on the abdomen&#44; with a clearly demarcated papular margin and central lightening &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Histology showed only a perivascular inflammatory infiltrate composed mainly of lymphocytes&#44; which involved the superficial and middle dermis&#46; The epidermis and deep dermis showed no abnormalities &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Blood tests were performed with a full blood count and biochemistry&#44; and an antibody titer was performed&#59; results were normal&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Treatment with topical methylprednisolone and oral prednisone was prescribed &#40;maximum dosage&#44; 0&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#41; for 15 days&#44; with no clinical response&#46; After the summer&#44; the patient presented for a follow-up visit and showed complete spontaneous resolution of the lesions&#46; The course of the previous episodes was similar&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">EPSR was first described in 2012&#44; when Song et al<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> reported a series of 9 patients of Chinese nationality with papuloerythematous eruptions with a centrifugal growth pattern that typically recurred during the warm&#44; humid months&#46; Cases with similar seasonality were subsequently described in Western countries&#44; one of which showed a possible link to a primary pancreas B cell lymphoma&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> The most frequently involved areas are the torso and proximal extremities&#59; the face&#44; palms and soles are not usually involved&#46; Histology usually shows a perivascular lymphocytic inflammatory infiltrate and mild edema of the papillary dermis&#59; all of these finding suggest superficial perivascular dermatitis&#46; No leukocytoclasia or other vasculitic findings are observed&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">As mentioned&#44; the principal differential diagnosis is with EAC&#46; Both EAC and EPSR begin as plaques with centrifugal growth and central lightening&#46; Desquamation at the edge of the lesion can be observed in the superficial form of EAC&#44; whereas this phenomenon is not seen in EPSR&#46; Moreover&#44; the size of the plaques tends to be smaller in EAC than in EPSR&#46; Histology of EAC is characterized by the distribution of the perivascular inflammatory infiltrate in a shirt-sleeve pattern&#59; this pattern is not so clearly observed in EPSR&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Although EAC does not usually present as clearly seasonal&#44; descriptions exist of cases in which&#44; just like in EPSR&#44; the lesions appear in the warm months and resolve spontaneously with the arrival of cold temperatures&#46; This subtype is known as annually recurring EAC&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Although the etiology of EPSR and EAC is unknown&#44; both may be due to a hypersensitive reaction to different external or internal stimuli&#46; Infectious diseases&#44; hormone abnormalities or fluctuations&#44; some drugs and foods&#44; and even neoplasias have been linked to EAC lesions&#46; Annually recurring EAC may also involve seasonal environmental factors such as increased temperature or insect bites&#46; A clear causal agent&#44; however&#44; cannot be identified in most cases &#40;idiopathic EAC&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">With regard to treatment&#44; topical and systemic corticosteroids may alleviate the pruritus&#44; but they cannot halt the progress of the lesions&#44; which may involve the entire chest&#44; back or neck&#46; Characteristic of EPSR and annually recurring EAC is the gradual and spontaneous regression of the lesions with the arrival of cooler seasons&#46; Long-term follow-up has recorded recurrences in the first 2-5 years&#44; with subsequent definitive resolution&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Other publications&#44; however&#44; suggest a longer duration of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Although EPSR has been described and subsequently reported in high-impact scientific journals&#44; some authors question that it has sufficient clinical pathologic entity to be considered as an independent disease and they prefer to consider it as a peculiar variant of recurring figurate erythemas such as annually recurring EAC&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Bernia E&#44; Requena C&#44; Llombart B&#46; Eritema papular semicircular recidivante&#58; &#191;nueva entidad o subtipo de eritema anular centr&#237;fugo&#63; Actas Dermosifiliogr&#46; 2020&#46; <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.ad.2019.04.012">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1016&#47;j&#46;ad&#46;2019&#46;04&#46;012</span></p>"
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