M Chastagner1, J Shourik2, M Jachiet3, M Battistella4, G Lefevre5, J-B Gibier6, H Aubert7, M Musquer8, V Descamps9, L Deschamps10, O Chosidow11, N Ortonne12, M Groh13, M Bernier14, D Jullien1, F Chasset2, D Staumont-Salle15, J-D Bouaziz3, J Kanitakis1, A P Villani16. 1. Department of Dermatology, CHU Lyon, Université Claude Bernard Lyon I, 69000 Lyon, France. 2. Sorbonne université, Faculté de médecine, Service de Dermatologie et Allergologie, Hôpital Tenon, AP-HP, 75020 Paris, France. 3. Department of Dermatology, Hôpital Saint-Louis, AP-HP Université de Paris, 75010 Paris, France. 4. Pathology Department, Hôpital Saint-Louis, AP-HP, Université de Paris, Inserm U976, 75010 Paris, France. 5. CEREO (National reference center for Hypereosinophilic Syndromes), 75010 Paris, France; Department of Internal Medicine, CHU Lille, 59000 Lille, France. 6. Pathology Department, CHU Lille, 59000 Lille, France. 7. Dermatology Department, CHU Nantes, 44000 Nantes, France. 8. Pathology Department, CHU, 44000 Nantes, France. 9. Dermatology Department, Hôpital Bichat, 75018 Paris, France. 10. Pathology Department, Hôpital Bichat, 75018 Paris, France. 11. Faculté de Santé de Créteil et Service de Dermatologie, APHP, Hôpital Henri-Mondor, Université Paris-Est, Créteil, France and Research Group Dynamic, EA7380, Faculté de Santé de Créteil, Ecole Nationale Vétérinaire d'Alfort, USC ANSES, Université Paris-Est Créteil, 94010 Créteil, France. 12. Pathology Department, Hôpital Mondor, CHU Créteil, 94010 Créteil, France. 13. CEREO (National reference center for Hypereosinophilic Syndromes), 75010 Paris, France; Department of Internal Medicine, Hôpital Foch, 92150 Suresnes, France. 14. Pathology Department, Hôpital Foch, 92150 Suresnes, France. 15. Department of Dermatology, CHU Lille, Inserm U1286 INFINITE (Institute for Translational Research in Inflammation), University Lille, 59000 Lille, France. 16. Department of Dermatology, CHU Lyon, Université Claude Bernard Lyon I, 69000 Lyon, France. Electronic address: axel.villani@chu-lyon.fr.
Abstract
BACKGROUND: Eosinophilic annular erythema (EAE) is a rare eosinophil-related skin disease which typically manifests with annular erythematous plaques and severe pruritus. Besides the diagnosis, the treatment of EAE is challenging since relevant published data are sparse. METHODS: The aim of this study was to assess the underlying diseases, treatments and outcomes of patients with EAE. To this end, we conducted a retrospective multicenter study and a systematic review of the MEDLINE database. RESULTS: We included 18 patients with EAE followed in 8 centers. The MEDLINE database search yielded 37 relevant publications reporting 55 cases of EAE with 106 treatment sequences. The most common and efficient treatments included topical or systemic corticosteroids, hydroxychloroquine and dapsone. In refractory patients, a combination of systemic corticosteroids with hydroxychloroquine was associated with 88% of complete clinical response. DISCUSSION: To improve the management of EAE patients, we discuss the following treatment strategy: in topical steroid-resistant patients, hydroxychloroquine can be given as first-line systemic treatment. Dapsone, hydroxychloroquine or systemic corticosteroids are second-line options to consider. Last, monoclonal antibodies or JAK inhibitors targeting type 2 inflammation could represent promising last-resort options in refractory patients.
BACKGROUND: Eosinophilic annular erythema (EAE) is a rare eosinophil-related skin disease which typically manifests with annular erythematous plaques and severe pruritus. Besides the diagnosis, the treatment of EAE is challenging since relevant published data are sparse. METHODS: The aim of this study was to assess the underlying diseases, treatments and outcomes of patients with EAE. To this end, we conducted a retrospective multicenter study and a systematic review of the MEDLINE database. RESULTS: We included 18 patients with EAE followed in 8 centers. The MEDLINE database search yielded 37 relevant publications reporting 55 cases of EAE with 106 treatment sequences. The most common and efficient treatments included topical or systemic corticosteroids, hydroxychloroquine and dapsone. In refractory patients, a combination of systemic corticosteroids with hydroxychloroquine was associated with 88% of complete clinical response. DISCUSSION: To improve the management of EAE patients, we discuss the following treatment strategy: in topical steroid-resistant patients, hydroxychloroquine can be given as first-line systemic treatment. Dapsone, hydroxychloroquine or systemic corticosteroids are second-line options to consider. Last, monoclonal antibodies or JAK inhibitors targeting type 2 inflammation could represent promising last-resort options in refractory patients.