PRAGUE — Unexplained erythema should raise suspicion about a possible underlying malignancy, according to a review of cases at one Asian institution.
In an effort to determine the clinical implications of idiopathic erythema, Dr. Steven Thng and his colleagues at the National Skin Center in Singapore reviewed the records of patients evaluated for erythema from 2001 to 2005 and compared those patients with published case series as well as with data from the Singapore Cancer Registry.
Dr. Thng and colleagues identified 218 patients evaluated for erythema during the study period—108 cases (50%) were classified as idiopathic. Among patients with an identified cause of erythema, preexisting dermatoses (30%) and drug reaction (15%) were the most common diagnoses.
On follow-up, the researchers found idiopathic erythema was associated with visceral malignancy in 18% of patients and with cutaneous T-cell lymphoma in 5%.
“We recommend close follow-up with reevaluation for malignancy even if the initial investigation had been negative,” Dr. Thng and colleagues said in a poster presented at the International Congress of Dermatology.
Few investigators have attempted to examine the natural history and potential clinical consequences of unexplained erythema, the researchers wrote. Moreover, previous studies primarily involved white populations.
Analysis of patients with idiopathic erythema showed that most were men (73%) and that idiopathic erythema tended to occur at an older age (69 years) when compared with erythema of known cause (62 years). Patients with idiopathic erythema tended to experience a slow onset of disease, which had an average duration of 22 days. They also experienced more episodes of disease (average of 1.75 episodes), compared with patients who had erythema of known cause (average of 1.32 episodes).
When compared with age-standardized cases in the cancer registry, patients with idiopathic erythema had more than a threefold greater risk of visceral malignancy. The study findings came from a review of Asian patients and may not be applicable to patients in other regions, Dr. Thng and his colleagues noted. They reported no disclosures.