Case Reports

Eosinophilic annular erythema: four additional cases and a review of the literature on therapeutic options

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Published: 16 January 2026
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Eosinophilic annular erythema (EAE) is a rare, benign dermatosis characterized by recurrent erythematous-urticarial plaques and tissue eosinophilia. Its cause is unknown, though it may involve hypersensitivity to an unidentified antigen. EAE typically follows a chronic, relapsing course, affecting the trunk and extremities. Treatment guidelines are lacking, and therapy responses vary. This study presents four new cases and reviews current treatment options. Four patients with EAE, aged 20 to 72, were treated at Galliera Hospital (Genova, Italy). They exhibited erythematous, annular lesions on the trunk or extremities with variable pruritus. Histology confirmed eosinophilic inflammation without flame figures. Previous systemic steroid treatments provided partial improvement but resulted in relapse. Topical clobetasol improved symptoms in two of three patients, while systemic methylprednisolone also showed benefit. However, one patient on topical clobetasol and another on systemic methylprednisolone were lost to follow-up. A search in PubMed until July 2024 identified English-language articles with histologically confirmed EAE and clear treatment outcomes. Antimalarial drugs, dapsone, and corticosteroids were the most frequently prescribed nonbiological therapies leading to disease control. Other effective treatments in individual cases included nicotinamide, doxycycline, and narrow-band ultraviolet-B (UV-B) phototherapy. Biological drugs such as dupilumab, benralizumab, and mepolizumab showed promising results. The treatment of EAE remains challenging, with many cases resistant to antimalarials, dapsone, and corticosteroids. Further research is necessary to identify more effective treatments. Targeting T-helper 2 (Th2)-type cytokines with specific antibodies may offer a promising approach for refractory EAE, potentially providing a rapid and sustained clinical response.

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1. Fania L, Provini A, Rota L, et al. Eosinophilic annular erythema: Report of four cases. Dermatol Ther 2020;33:e14369. DOI: https://doi.org/10.1111/dth.14369
2. El-Khalawany M, Al-Mutairi N, Sultan M, Shaaban D. Eosinophilic annular erythema is a peculiar subtype in the spectrum of Wells syndrome: a multicentre long-term follow-up study. J Eur Acad Dermatol Venereol 2013;27:973-9. DOI: https://doi.org/10.1111/j.1468-3083.2012.04616.x
3. Rongioletti F, Fausti V, Kempf W, et al. Eosinophilic annular erythema: an expression of the clinical and pathological polymorphism of Wells syndrome. J Am Acad Dermatol 2011;65:e135-7. DOI: https://doi.org/10.1016/j.jaad.2011.05.049
4. Thomas L, Fatah S, Nagarajan S, Natarajan S. Eosinophilic annular erythema: successful response to ultraviolet B therapy. Clin Exp Dermatol 2015;40:883-6. DOI: https://doi.org/10.1111/ced.12668
5. Nakazato S, Fujita Y, Shinkuma S, et al. Eosinophilic annular erythema is clinically characterized by central pigmentation reflecting basal melanosis: a clinicopathological study of 10 cases. J Eur Acad Dermatol Venereol 2017;31:1916-23. DOI: https://doi.org/10.1111/jdv.14350
6. Chastagner M, Shourik J, Jachiet M, et al. Treatment of Eosinophilic Annular Erythema: Retrospective multicenter study and literature review. Ann Dermatol Venereol 2022;149:123-7. DOI: https://doi.org/10.1016/j.annder.2021.07.007
7. Prajapati V, Cheung-Lee M, Schloss E, Salopek TG. Spontaneously resolving eosinophilic annular erythema. J Am Acad Dermatol 2012;67:e75-7. DOI: https://doi.org/10.1016/j.jaad.2011.08.027
8. Żychowska M, Tutka K, Reich A. Mepolizumab Therapy for Recalcitrant Eosinophilic Annular Erythema in an Adult: A Case Report and Review of Treatment Options. Dermatol Ther (Heidelb) 2020;10:893-9. DOI: https://doi.org/10.1007/s13555-020-00412-9
9. Ciccarese G, Facciorusso A, Mastrolonardo M, et al. Atypical Manifestations of Syphilis: A 10-Year Retrospective Study. J Clin Med 2024;13:1603. DOI: https://doi.org/10.3390/jcm13061603
10. Kazandjieva J, Bogdanov G, Bogdanov I, Tsankov N. Figurate annulare erythemas. Clin Dermatol 2023;41:368-75. DOI: https://doi.org/10.1016/j.clindermatol.2023.07.005
11. Hsu S, Le EH, Khoshevis MR. Differential diagnosis of annular lesions. Am Fam Physician 2001;64:289-96.
12. Trayes KP, Savage K, Studdiford JS. Annular Lesions: Diagnosis and Treatment. Am Fam Physician 2018;98:283-91.
13. Moro-Bolado F, Martínez-Montalvo L, Al-Wattar-Ceballos O, et al. Treatment of Eosinophilic Annular Erythema With Benralizumab. JAMA Dermatol 2023;159:564-6. DOI: https://doi.org/10.1001/jamadermatol.2023.0314
14. Karataş Toğral A, Seçkin D. Eosinophilic annular erythema: A late but complete response to hydroxychloroquine. Australas J Dermatol 2017;58:228-30. DOI: https://doi.org/10.1111/ajd.12445
15. Chaabani M, Litaiem N, Bacha T, et al. Eosinophilic annular erythema in adults: a new case of this rare entity. Int J Dermatol 2020;59:e380-1. DOI: https://doi.org/10.1111/ijd.15115
16. Eljazouly M, Chahboun F, Alj M, et al. Eosinophilic Annular Erythema: A New Entity of Eosinophilic Dermatosis. Cureus 2022;14:e22657. DOI: https://doi.org/10.7759/cureus.22657
17. Howes R, Girgis L, Kossard S. Eosinophilic annular erythema: a subset of Wells' syndrome or a distinct entity? Australas J Dermatol 2008;49:159-63. DOI: https://doi.org/10.1111/j.1440-0960.2008.00456.x
18. Kahofer P, Grabmaier E, Aberer E. Treatment of eosinophilic annular erythema with chloroquine. Acta Derm Venereol 2000;80:70-1. DOI: https://doi.org/10.1080/000155500750012685
19. Ljubojević Hadžavdić S, Bartolić L, Bradamante M. Prolonged Treatment of Eosinophilic Erythema Annulare with Chloroquine. Acta Dermatovenerol Croat 2018;26:262-3.
20. Mebazaa A, Kenani N, Ghariani N, et al. Eosinophilic annular erythema responsive to chloroquin. Eur J Dermatol 2009;19:84-5. DOI: https://doi.org/10.1684/ejd.2008.0558
21. Lachance M, Vallée S, Gagné É. Vesiculobullous eosinophilic annular erythema: A case report. SAGE Open Med Case Rep 2023;11:2050313X231181024. DOI: https://doi.org/10.1177/2050313X231181024
22. Manriquez J, Berroeta-Mauriziano D, Andino-Navarrete R, Vera-Kellet C. Eosinophilic annular erythema: complete clinical response with dapsone. Int J Dermatol 2015;54:e96-8. DOI: https://doi.org/10.1111/ijd.12736
23. Alharbi R, Peric J, Wolff H, Wollenberg A. Dapsone treatment for eosinophilic anular erythema. J Eur Acad Dermatol Venereol 2017;31:e153-4. DOI: https://doi.org/10.1111/jdv.13890
24. Gordon SC, Robinson SN, Abudu M, et al. Eosinophilic annular erythema treated with dupilumab. Pediatr Dermatol 2018;35:e255-6. DOI: https://doi.org/10.1111/pde.13533
25. Okazaki T, Takahashi T, Asano Y. Eosinophilic annular erythema successfully treated with dupilumab: A case report. J Dermatol 2024;51:e249-50. DOI: https://doi.org/10.1111/1346-8138.17158
26. Maione V, Caravello S, Cozzi C, et al. Refractory eosinophilic annular erythema treated successfully with dupilumab. J Dtsch Dermatol Ges 2020;18:1031-2. DOI: https://doi.org/10.1111/ddg.14254
27. Ikutama R, Ogawa T, Takeno K, Ikeda S. A Case of Eosinophilic Annular Erythema (EAE) Concomitant with Autoimmune Hypothyroidism. Indian Dermatol Online J 2023;14:882-3. DOI: https://doi.org/10.4103/idoj.idoj_558_22
28. Kim YS, Song YM, Seo HM, et al. Eosinophilic Annular Erythema Associated with Churg-Strauss Syndrome. Ann Dermatol 2017;29:813-4. DOI: https://doi.org/10.5021/ad.2017.29.6.813
29. Masaki K, Ueki S, Tanese K, et al. Eosinophilic annular erythema showing eosinophil cytolytic ETosis successfully treated with benralizumab. Asia Pac Allergy 2021;11:e28. DOI: https://doi.org/10.5415/apallergy.2021.11.e28
30. Ogawa K, Fukumoto T, Yoshida M, et al. Eosinophilic annular erythema in a patient with autoimmune pancreatitis: Nicotinamide therapy may be beneficial for achieving remission. J Dermatol 2016;43:1380-1. DOI: https://doi.org/10.1111/1346-8138.13411
31. Young JN, Chung J, Fett N. Eosinophilic Annular Erythema Responding to Doxycycline. Cureus 2023;15:e47478. DOI: https://doi.org/10.7759/cureus.47478
32. Awosika O, Totoraitis K, Eleryan M, et al. A case of eosinophilic annular erythema as a presenting sign for autoimmune hepatitis. JAAD Case Rep 2017;4:84-6. DOI: https://doi.org/10.1016/j.jdcr.2017.01.007
33. Iga N, Otsuka A, Kaku Y, et al. Eosinophilic annular erythema limited on the palms and the soles and possibly associated with thymoma. J Eur Acad Dermatol Venereol 2016;30:1213-4. DOI: https://doi.org/10.1111/jdv.13139
34. Rosenberg HF, Dyer KD, Foster PS. Eosinophils: changing perspectives in health and disease. Nat Rev Immunol 2013;13:9-22. DOI: https://doi.org/10.1038/nri3341
35. Fyles F, Nuttall A, Joplin H, Burhan H. Long-Term Real-World Outcomes of Mepolizumab and Benralizumab Among Biologic-Naive Patients With Severe Eosinophilic Asthma: Experience of 3 Years' Therapy. J Allergy Clin Immunol Pract 2023;11:2715-23. DOI: https://doi.org/10.1016/j.jaip.2023.05.025
36. Chersi F, Zelin E, Mazzoletti V, et al. Mepolizumab therapy for eosinophilic pustular folliculitis (Ofuji disease). J Eur Acad Dermatol Venereol 2024;38:e993-6. DOI: https://doi.org/10.1111/jdv.20047
37. Sato M, Yatomi M, Wakamatsu I, et al. Effective treatment with mepolizumab in a patient with severe eosinophilic granulomatosis with polyangiitis complicated with small intestine perforation. Respir Med Case Rep 2023;43:101818. DOI: https://doi.org/10.1016/j.rmcr.2023.101818
38. Sanchez-Melendez SN, Shaw KS, Pan CX, et al. Mepolizumab for refractory eosinophilic fasciitis: a retrospective analysis from two tertiary care centres. Clin Exp Rheumatol 2023;41:1721-2. DOI: https://doi.org/10.55563/clinexprheumatol/j7gexb
39. Bosma AL, de Wijs LEM, Hof MH, et al. Long-term effectiveness and safety of treatment with dupilumab in patients with atopic dermatitis: Results of the TREAT NL (TREatment of ATopic eczema, the Netherlands) registry. J Am Acad Dermatol 2020;83:1375-84. DOI: https://doi.org/10.1016/j.jaad.2020.05.128
40. Khatri S, Moore W, Gibson PG, et al. Assessment of the long-term safety of mepolizumab and durability of clinical response in patients with severe eosinophilic asthma. J Allergy Clin Immunol 2019;143:1742-51.e7. DOI: https://doi.org/10.1016/j.jaci.2018.09.033
41. Korn S, Bourdin A, Chupp G, et al. Integrated Safety and Efficacy Among Patients Receiving Benralizumab for Up to 5 Years. J Allergy Clin Immunol Pract 2021;9:4381-92.e4. DOI: https://doi.org/10.1016/j.jaip.2021.07.058

How to Cite



1.
Corio A, Sola S, Zalaudek I, Massone C. Eosinophilic annular erythema: four additional cases and a review of the literature on therapeutic options. Dermatol Reports [Internet]. 2026 Jan. 16 [cited 2026 Apr. 18];. Available from: https://journals.pagepress.net/dr/article/view/10168