A woman, who presented in a dermatology clinic, had no idea that the tie-dye rash all over her body was already a clinical sign of anal cancer.
The case of the 73-year-old Kansas woman was documented in the New England Journal of Medicine.
"After colonoscopy and imaging, stage IIA anal squamous-cell carcinoma was diagnosed," the authors wrote.
Patient Experience Leading To The Diagnosis
The woman suffered for 11 months from itchy and reddish rash on her thighs, buttocks, trunk, and armpit areas. At first, the rash was just itchy lesions with dark-colored center found in the anal area. She underwent treatment with anti-allergy medications and a type of steroid called prednisone, but these treatments did not provide relief.
The rash then progressed to repeated cycles of reddish plaques in the following four months. At this point, she also manifested abdominal pain, vomiting, and diarrhea.
Treatment And Diagnosis
After diagnostic testings, the woman was diagnosed with erythema gyratum repens by a dermatologist. She then started treatment of glucocorticoids, which is a type of steroid hormones, and a trial therapy of gabapentin for the itchiness.
The patient started chemotherapy and radiation, and after three months, the rash lessened. After eight months, the patient was declared to have no evidence of disease and the rash did not come back.
What Is Erythema Gyratum Repens?
Erythema gyratum repens is a rare type of cancerous rash, mostly commonly linked to breast, lung, and esophageal cancers.
Most patients with this disease first present to the emergency department with chief complaint of rashes. Majority of cases are not cancerous, and improve with ointments or creams directly applied to the body. A number of EGR, however, might signal more serious disease.
Although EGR is not referred to as a dermatological emergency because it does not necessitate immediate treatment, it is still a condition that must not be overlooked.
EGR usually precedes malignant diseases by a couple of months, but with prompt diagnosis in the emergency department, patients can be referred for immediate diagnostic assessment.