Reactions 1704, p173 - 2 Jun 2018
Neutrophilic figurate erythema
A 35-year-old man developed neutrophilic figurate
erythema (NFE) following treatment with anti-oxidant herbal
medicine contacting ginkgo biloba [route and dosage not
The man presented with relapsing, reddish, mildly pruritic
and edematous swellings on the pre-sternal area, shoulders,
trunk and upper extremities for eight months. One month
prior to presentation, he received treatment with anti-oxidant
herbal pills containing ginkgo biloba on his own. The lesions
would aggravated after cold exposure and would resolve
spontaneously after rise in body temperature. Dermatological
examination demonstrated firm, erythematous, non-tender,
polimorphic plaques in annular and semi-annular or polycyclic
configurations, measuring in 0.5
2cm x 0.5
2cm size on his
shoulders, chest and back. Histopathological examination of
the punch biopsy showed a perivascular and interstitial
eosinophil, neutrophil and lymphocytic infiltration with
swelling and proliferation of the endothelial cells in the dermis.
Nuclear dusts were absent. Patch test with ginkgo biloba was
negative. Based on the findings, a diagnosis of NFE was made,
which was considered to be related to ginkgo biloba.
The man’s treatment with ginkgo biloba was discontinued
and he was treated with colchicine and levocetirizine for three
months. The lesions improved.
The man’s treatment with ginkgo biloba was restarted for
two weeks. However, ten days following reintroduction, he
again developed the same lesions. His treatment with ginkgo
biloba was discontinued and the lesions resolved. At one year
follow-up, he was asymptomatic.
Author comment: "We consider our case to represent a
figurate erythema with a dominant infiltration of neutrophils
that might be also induced by Ginkgo biloba."
Ustuner P, et al. Cold induced neutrophilic figurate erythema. Turkiye Klinikleri
Dermatoloji 27: 117-121, No. 3, 18 Dec 2017. Available from: URL: http://
doi.org/10.5336/dermato.2016-53745 - Turkey
Reactions 2 Jun 2018 No. 17040114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved