Dermoscopy of Annular Erythema in Secondary Sjögren Syndrome

Annular erythema, a distinct nonvasculitic manifestation of Sjögren syndrome (SS), is associated with positive anti-Ro antibodies and is generally reported in primary SS.[1] A 42-year-old female diagnosed with rheumatoid arthritis (RA) presented with an asymptomatic, doughnut-shaped erythematous rash with a raised border and a pale centre on her chest [Figure 1]. Dermoscopy revealed fixed, nonblanching erythema and arborising vessels having a foraging- root pattern as seen on the flanks of a stream [Figure 2]. Her detailed history suggested the possibility of an overlap syndrome, and laboratory examination revealed strongly positive anti-SSa, anti-Ro52, and anti-SSb antibodies. Hence, she was diagnosed as a case of secondary Sjögren syndrome. Histopathology demonstrated lymphocytic infiltration around blood vessels and appendages in a distinctive coat-sleeve-like arrangement. Secondary SS is associated with other underlying rheumatic diseases, such as systemic lupus erythematosus, RA, etc.Figure 1: Doughnut-shaped erythematous rash with a raised border and a pale center of annular erythema of Sjögren syndromeFigure 2: Dermoscopy showing fixed, nonblanching erythema and arborizing vessels having a foraging root pattern as seen on the flanks of a streamThree clinical types of annular erythema in SS have been recognised[2]: Type 1: Doughnut-ring-like erythema with a raised border mimicking Sweet’s disease, Type 2: Subacute cutaneous lupus erythematosus (SCLE)-like polycyclic erythema with marginal scales, and Type 3: Papular insect bite-like erythema. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Use of artificial intelligence (AI) The preparation of this manuscript was carried out entirely by the author without the use of artificial intelligence technologies.