Erythema gyratum repens is not an obligate paraneoplastic disease: a systematic review of the literature and personal experience.

BACKGROUND: Erythema gyratum repens (EGR) is a rare clinical entity that is considered to be an obligatory paraneoplastic disease. According to the literature, an underlying neoplasm can be detected in 82% of the cases.

OBJECTIVES: The aim of this systemic review was to evaluate the association of EGR with malignancies or other non-neoplastic conditions.

METHODS: The medical records of patients seen at the Section of Dermatology, University of Genoa between 1990 and 2010, in whom a diagnosis of EGR had been made, were reviewed for evidence of systemic associations. A systematic search of the Cochrane library, EMBASE, Pubmed and MEDLINE databases was also conducted. Key search term used in the review was 'erythema gyratum repens'.

RESULTS: Four patients with a diagnosis of EGR have been retrieved from our medical records. One case was idiopathic, one was associated with a bronchial carcinoma and two were associated with drug-intake. One hundred and twelve original cases of EGR were selected from the literature for detailed review. Among these, 58 cases (70%) were associated with an underlying neoplasm, 25 cases (30%) were non-paraneoplastic and 29 cases have been considered as different dermatoses mimicking EGR in their clinical presentation ('EGR-like' eruption).

CONCLUSION: EGR should no longer be considered as an obligate paraneoplastic syndrome as the cases that are not associated with neoplasm are more than expected. In addition to searching an underlying neoplasm, dermatologists should be aware about the possibility of other associations including also drug-intake.