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Annular skin lesions in infancy

      Abstract

      Annular skin lesions have a unique morphology, and the dramatic appearance of these skin eruptions in infants can cause concern for parents and clinicians. Annular lesions appearing during infancy (defined here as birth to 1 year of age) lend to a broad differential, ranging from benign cutaneous disorders to severe systemic diseases. This review summarizes the pathogenesis, clinical and histopathologic findings, and management options of possible etiologies for annular skin lesions in infants, including annular erythema of infancy, neonatal lupus erythematosus, dermatophyte infections, hemorrhagic edema of infancy, and urticaria multiforme.
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      References

        • Hsu S
        • Le EH
        • Khoshevis MR.
        Differential diagnosis of annular lesions.
        Am Fam Physician. 2001; 64: 289-296
        • Warren LJ
        • Tilakaratne D
        • Seth R.
        Neonatal tinea corporis.
        Med J Aust. 2017; 207: 324
        • Harper J
        • Oranje AP
        • Bodemer C
        • et al.
        Harper's Textbook of Pediatric Dermatology E-Book.
        John Wiley & Sons, Hoboken, New Jersey2011
        • Eichenfield LF
        • Frieden IJ
        • Zaenglein A
        • et al.
        Neonatal and Infant Dermatology E-Book.
        Elsevier Health Sciences, London2014
        • Peterson AO
        • Jarratt M.
        Annular erythema of infancy.
        Arch Dermatol. 1981; 117: 145-148
        • Hebert AA
        • Esterly NB.
        Annular erythema of infancy.
        J Am Acad Dermatol. 1986; 14: 339-343
        • Cox NH
        • McQueen A
        • Evans TJ
        • et al.
        An annular erythema of infancy.
        Arch Dermatol. 1987; 123: 510-511
        • Stachowitz S
        • Abeck D
        • Schmidt T
        • et al.
        Persistent annular erythema of infancy associated with intestinal Candida colonization.
        Clin Exp Dermatol. 2000; 25: 404-405
        • Helm TN
        • Bass J
        • Chang LW
        • et al.
        Persistent annular erythema of infancy.
        Pediatr Dermatol. 1993; 10: 46-48
        • Wong LC
        • Kakakios A
        • Rogers M.
        Congenital annular erythema persisting in a 15-year-old girl.
        Australas J Dermatol. 2002; 43: 55-61
        • Pfingstler LF
        • Miller KP
        • Pride H.
        Recurring diffuse annular erythematous plaques in a newborn.
        JAMA Dermatol. 2014; 150: 565-566
        • Patrizi A
        • Savoia F
        • Varotti E
        • et al.
        Neutrophilic figurate erythema of infancy.
        Pediatr Dermatol. 2008; 25: 255-260
        • Miller A
        • Johnson M
        • Allen P.
        Annular erythema of infancy.
        J Am Acad Dermatol. 2014; 70: AB143
        • Vanoni F
        • Lava SA
        • Fossali EF
        • et al.
        Neonatal systemic lupus erythematosus syndrome: a comprehensive review.
        Clin Rev Allergy Immunol. 2017; 53: 469-476
        • Lynn Cheng C
        • Galbraith S
        • Holland K
        Congenital lupus erythematosus presenting at birth with widespread erosions, pancytopenia, and subsequent hepatobiliary disease.
        Pediatr Dermatol. 2010; 27: 109-111
        • Hon KL
        • Leung AK.
        Neonatal lupus erythematosus.
        Autoimmune Dis. 2012; 2012301274
        • Watson RM
        • Lane AT
        • Barnett NK
        • et al.
        Neonatal lupus erythematosus: a clinical, serological and immunogenetic study with review of the literature.
        Medicine. 1984; 63: 362-378
        • Inzinger M
        • Salmhofer W
        • Binder B.
        Neonatal lupus erythematosus and its clinical variability.
        J Dtsch Dermatol Ges. 2012; 10: 407-411
        • Admani S
        • Krakowski AC.
        Neonatal lupus erythematosus presenting as atypical targetoid-like lesions involving genitals and soles of feet following brief sun exposure.
        J Clin Aesthet Dermatol. 2013; 6: 19-23
        • Silverman E
        • Jaeggi E.
        Non-cardiac manifestations of neonatal lupus erythematosus.
        Scand J Immunol. 2010; 72: 223-225
        • Crowley E
        • Frieden IJ.
        Neonatal lupus erythematosus: an unusual congenital presentation with cutaneous atrophy, erosions, alopecia, and pancytopenia.
        Pediatr Dermatol. 1998; 15: 38-42
        • Miyagawa S.
        Neonatal lupus erythematosus: a review of the racial differences and similarities in clinical, serological and immunogenetic features of Japanese versus Caucasian patients.
        J Dermatol. 2005; 32: 514-522
        • Nitta Y
        Lupus erythematosus profundus associated with neonatal lupus erythematosus.
        Br J Dermatol. 1997; 136: 112-114
        • Lee LA.
        Neonatal lupus: clinical features, therapy, and pathogenesis.
        Curr Rheumatol Rep. 2001; 3: 391-395
        • Cimaz R
        • Biggioggero M
        • Catelli L
        • et al.
        Ultraviolet light exposure is not a requirement for the development of cutaneous neonatal lupus.
        Lupus. 2002; 11: 257-260
        • Neiman A
        • Lee L
        • Weston W
        • et al.
        Cutaneous manifestations of neonatal lupus without heart block: characteristics of mothers and children enrolled in a national registry.
        J Pediatr. 2000; 137: 674-680
        • Izmirly P
        • Saxena A
        • Buyon JP.
        Progress in the pathogenesis and treatment of cardiac manifestations of neonatal lupus.
        Curr Opin Rheumatol. 2017; 29: 467-472
        • Penate Y
        • Guillermo N
        • Rodriguez J
        • et al.
        Histopathologic characteristics of neonatal cutaneous lupus erythematosus: description of five cases and literature review.
        J Cutan Pathol. 2009; 36: 660-667
        • Sitthinamsuwan P
        • Nitiyarom R
        • Chairatchaneeboon M
        • et al.
        Histiocytoid neutrophilic dermatitis, an unusual histopathology in neonatal lupus erythematosus.
        J Cutan Pathol. 2015; 42: 996-999
        • Sommer L
        • Manders S.
        Seeing double: annular diaper rash in twins.
        Pediatr Dermatol. 2015; 32: 410-413
        • Morales-Conde M
        • Feito-Rodríguez M
        • de Lucas-Laguna R.
        Dermatophytosis of the diaper area: case report and literature review.
        Pediatr Dermatol. 2018; 35: e368-e370
        • Metkar A
        • Joshi A
        • Vishalakshi V
        • et al.
        Extensive neonatal dermatophytoses.
        Pediatr Dermatol. 2010; 27: 189-191
        • Alkeswani A
        • Duncan JR
        • Theos A.
        Tinea faciei starting at day two of life.
        Pediatr Dermatol. 2019; 36: e20-e22
        • Drake LA
        • Dinehart SM
        • Farmer ER
        • et al.
        Guidelines of care for superficial mycotic infections of the skin: tinea corporis, tinea cruris, tinea faciei, tinea manuum, and tinea pedis. Guidelines/Outcomes Committee. American Academy of Dermatology.
        J Am Acad Dermatol. 1996; 34: 282-286
        • Weitzman I
        • Summerbell RC.
        The dermatophytes.
        Clin Microbiol Rev. 1995; 8: 240-259
        • Gupta AK
        • Chaudhry M
        • Elewski B.
        Tinea corporis, tinea cruris, tinea nigra, and piedra.
        Dermatol Clin. 2003; 21: 395-400
        • Fu M
        • Ge Y
        • Chen W
        • et al.
        Tinea faciei in a newborn due to Trichophyton tonsurans.
        J Biomed Res. 2013; 27: 71-74
        • Bonifaz A
        • Rojas R
        • Tirado-Sánchez A
        • et al.
        Superficial mycoses associated with diaper dermatitis.
        Mycopathologia. 2016; 181: 671-679
        • Michaels BD
        • Del Rosso JQ.
        Tinea capitis in infants: recognition, evaluation, and management suggestions.
        J Clin Aesthet Dermatol. 2012; 5: 49-59
        • Zampella JG
        • Kwatra SG
        • Blanck J
        • et al.
        Tinea in tots: cases and literature review of oral antifungal treatment of Tinea capitis in children under 2 years of age.
        J Pediatr. 2017; 183: 12-18
        • Kakourou T
        • Uksal U.
        Guidelines for the management of tinea capitis in children.
        Pediatr Dermatol. 2010; 27: 226-228
        • Tey HL
        • Tan AS
        • Chan YC.
        Meta-analysis of randomized, controlled trials comparing griseofulvin and terbinafine in the treatment of tinea capitis.
        J Am Acad Dermatol. 2011; 64: 663-670
        • Veraldi S
        • Giorgi R
        • Pontini P
        • et al.
        Tinea imbricata in an Italian child and review of the literature.
        Mycopathologia. 2015; 180: 353-357
        • Bonifaz A
        • Vázquez-González D.
        Tinea imbricata in the Americas.
        Curr Opin Infect Dis. 2011; 24: 106-111
        • Fiore E
        • Rizzi M
        • Ragazzi M
        • et al.
        Acute hemorrhagic edema of young children (cockade purpura and edema): a case series and systematic review.
        J Am Acad Dermatol. 2008; 59: 684-695
        • Saraclar Y
        • Tinaztepe K
        • Adalioğlu G
        • Tuncer A.
        Acute hemorrhagic edema of infancy (AHEI)—a variant of Henoch-Schönlein purpura or a distinct clinical entity?.
        J Allergy Clin Immunol. 1990; 86: 473-483
        • Legrain V
        • Lejean S
        • Taïeb A
        • Guillard JM
        • Battin J
        • Maleville J.
        Infantile acute hemorrhagic edema of the skin: study of ten cases.
        J Am Acad Dermatol. 1991; 24: 17-22
        • Krause I
        • Lazarov A
        • Rachmel A
        • et al.
        Acute haemorrhagic oedema of infancy, a benign variant of leucocytoclastic vasculitis.
        Acta Paediatrica. 1996; 85: 114-117
        • Rohr BR
        • Manalo IF
        • Mowad C.
        Acute hemorrhagic edema of infancy: guide to prevent misdiagnosis.
        Cutis. 2018; 102: 359-362
        • Cunningham BB
        • Caro WA
        • Eramo LR.
        Neonatal acute hemorrhagic edema of childhood: case report and review of the English-language literature.
        Pediatr Dermatol. 1996; 13: 39-44
        • Larregue M
        • Lorette G
        • Prigent F
        • et al.
        Oedeme aigu hemorragique du nourrisson avec complication lethale digestive [Acute haemorrhagic edema of the skin of the new-born with lethal intestinal complication (author’s transl)].
        Ann Dermatol Venereol. 1980; 107 ([in French]): 901-905
        • da Silva Manzoni AP
        • Viecili JB
        • de Andrade CB
        • et al.
        Acute hemorrhagic edema of infancy: a case report.
        Int J Dermatol. 2004; 43: 48-51
        • Shah KN
        • Honig PJ
        • Yan AC.
        “Urticaria multiforme”: a case series and review of acute annular urticarial hypersensitivity syndromes in children.
        Pediatrics. 2007; 119: e1177-e1183
        • Emer JJ
        • Bernardo SG
        • Kovalerchik O
        • et al.
        Urticaria multiforme.
        J Clin Aesthet Dermatol. 2013; 6: 34-39
        • Tamayo-Sanchez L
        • Ruiz-Maldonado R
        • Laterza A.
        Acute annular urticaria in infants and children.
        Pediatr Dermatol. 1997; 14: 231-234
        • Borghesi A
        • Cipelletti P
        • Maragliano R
        • et al.
        Human herpesvirus-6 associated neonatal urticaria multiforme.
        Arch Dis Child Fetal Neonatal Ed. 2013; 98: F450
        • Mortureux P
        • Leaute-Labreze C
        • Legrain-Lifermann V
        • et al.
        Acute urticaria in infancy and early childhood: a prospective study.
        Arch Dermatol. 1998; 134: 319-323
        • Legrain V
        • Taïeb A
        • Sage T
        • Maleville J.
        Urticaria in infants: a study of forty patients.
        Pediatr Dermatol. 1990; 7: 101-107
        • Starnes L
        • Patel T
        • Skinner RB.
        Urticaria multiforme—a case report.
        Pediatr Dermatol. 2011; 28: 436-438
        • Sempau L
        • Martín-Sáez E
        • Gutiérrez-Rodríguez C
        • et al.
        Urticaria multiforme: a report of 5 cases and a review of the literature.
        Actas Dermosifiliogr. 2016; 107: e1-e5
        • Samorano LP
        • Fernandez VV
        • Valente NY
        • et al.
        Urticaria multiforme: two cases with histopathological findings.
        Allergol Int. 2017; 66: 154-155
        • Zoghaib S
        • Kechichian E
        • Souaid K
        • Soutou B
        • Helou J
        • Tomb R.
        Triggers, clinical manifestations, and management of pediatric erythema multiforme: a systematic review.
        J Am Acad Dermatol. 2019; 81: 813-822
        • Patel S
        • Mancini AJ.
        Serum sickness–like reaction in children: a retrospective review.
        J Am Acad Dermatol. 2009; 60: AB6