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JAMA Dermatology Clinicopathological Challenge
November 2018

An Atypical Figurate Erythema With Seasonal Recurrences

Author Affiliations
  • 1Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
JAMA Dermatol. 2018;154(11):1340-1341. doi:10.1001/jamadermatol.2018.1438

A healthy woman in her 50s presented with a large annular erythematous plaque on her lower back that had appeared in June (1 month previously) and had centrifugally expanded. She complained about mild pruritus that had not responded to conventional antihistamine therapy or topical steroids. She could not recall an arthropod bite prior to the skin eruption and denied having traveled outside Spain in the past few years. She reported a 20-year history of the same annular plaques recurring on the trunk every single year by the beginning of summer and spontaneously resolving by the beginning of autumn. Such lesions had never appeared on the face, hands, or feet. She did not relate these lesions to any particular hobby or application of any skin care product. Physical examination revealed a large, 35-cm semicircular erythematous plaque on her lower back with central clearing and a distinctive, well-demarcated papular border (Figure, A and B). After obtaining informed consent, 2 biopsy specimens were taken from the papular border of the plaque for both hematoxylin-eosin stain and direct immunofluorescence (Figure, C).