Eosinophilic Annular Erythema: An Elusive Masquerader in A Leprosy-Endemic Country

Introduction: Eosinophilic annular erythema (EAE) is a rare eosinophilic dermatosis, originally described in children, characterized by multiple annular, erythematous plaques with centrifugal growth pattern. Its manifestations closely resemble other figurate erythemas and can mimic conditions like Hansen's disease (HD). We present a case exploring the diagnostic complexities in an elderly woman first suspected of having HD. Case: A 67-year-old female presented with a 2-month history of round, erythematous rash on the abdomen, neck, chest, and both lower limbs, initially considered to be HD. Physical examination revealed multiple annular erythematous plaques with hypoesthesia in some areas. Further tests did not reveal acid-fast bacilli or fungal elements. Total IgE levels were elevated. Serial skin biopsies showed mild spongiosis with predominantly eosinophilic infiltrates. Treatment with oral and topical corticosteroids resulted in clinical improvement. Conclusion: The clinicopathological correlation plays a vital role in confirming the diagnosis in this case. EAE should be suspected in patients with nonspecific annular lesions, and established based on eosinophilic dominance in histopathology.