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

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.