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Annular erythema associated with Sjögren’s syndrome: review of the literature on the management and clinical analysis of skin lesions

  • Review Article
  • Published:
Modern Rheumatology

Abstract

Annular erythema has been recognized to be a specific, cutaneous manifestation associated with Sjögren’s syndrome. Based on a search of the literature up to 2007, annular erythema with Sjögren’s syndrome (AESS) preferentially occurs in Asian but not in Western populations. However, the precise clinical course and standard regimen for the management of AESS have remained obscure, primarily because of its rare occurrence in Western populations and the fact that most Asian cases are isolated reports. In this study, 28 cases of AESS from our department and 92 cases distilled from the literature were enrolled in a retrospective study to evaluate the clinical characteristics and most desirable management of this skin manifestation in Sjögren’s syndrome. We found that 75% of all cases with AESS were positive for both anti-SSA and anti-SSB antibodies. Multiple therapeutic options are available to treat AESS, including oral steroids. Several anti-malaria drugs or tacrolimus ointment have also been reported to be effective against AESS. AESS is a distinct clinical entity, and a small dose of prednisolone (approx. 10 mg) is sufficient to control diseases activity, except in some cases with systemic manifestations, and this treatment has a more rapid clinical effect than topical steroids.

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Abbreviations

AESS:

Annular erythema with Sjögren’s syndrome

LE:

Lupus erythematosus

SCLE:

Subacute cutaneous lupus erythematosus

SS:

Sjögren’s syndrome

References

  1. Sjögren H. Zur Kenntnis der Keratoconjunctivitis Sicca. Acta Opthal. 1933;11[Suppl 2]:1–151.

    Google Scholar 

  2. Fox RI. Sjögren’s syndrome. Lancet. 2005;366:321–31.

    Article  CAS  PubMed  Google Scholar 

  3. Teramoto N, Katayama I, Arai H, Eto H, Kamimura K, Kondo S, et al. Annular erythema: possible association with primary Sjögren’s syndrome. J Am Acad Dermatol. 1989;20:596–601.

    Article  CAS  PubMed  Google Scholar 

  4. Katayama I, Teramoto N, Arai H, Nishioka K, Nshiyama S. Annular erythema: a comparative study of Sjögren’s syndrome with subacute cutaneous lupus erythematosus. Int J Dermatol. 1991;30:635–9.

    Article  CAS  PubMed  Google Scholar 

  5. Katayama I, Yamamoto T, Otoyama K, Matsunaga T, Nishioka K. Clinical and immunological analysis of annular erythema associated with Sjögren’s syndrome. Dermatology. 1994;189[Suppl 1]:14–7.

    Article  PubMed  Google Scholar 

  6. Ostlere LS, Harris D, Rustin MH. Urticated annular erythema: a new manifestation of Sjögren’s syndrome. Clin Exp Dermatol. 1993;18:50–1.

    Article  CAS  PubMed  Google Scholar 

  7. Haimowitz JE, McCauliffe DP, Seykora J, Werth VP. Annular erythema of Sjögren’s syndrome in a white woman. J Am Acad Dermatol. 2000;42:1069–73.

    Article  CAS  PubMed  Google Scholar 

  8. De Winter S, van Buchem M, Vermer MH. Annular erythema of Sjögren’s syndrome. Lancet. 2006;367:1604.

    Article  PubMed  Google Scholar 

  9. Ruzicka T, Faes J, Bergner T, Peter RU, Braun-Falco O. Annular erythema associated with Sjögren’s syndrome: a variant of systemic lupus erythematosus. J Am Acad Dermatol. 1991;25:557–60.

    Article  CAS  PubMed  Google Scholar 

  10. Kamo K, Nagasihma M. Sjögren’s syndrome—with special reference to a case complaining of erythematous lesion (in Japanese). Rinsho Hifu Ka. 1976;30:761–71.

    Google Scholar 

  11. Yamagami Y, Ichikawa K, Mukuno A, Eto H. Recurrent annular erythema in a case of seronegative Sjögren ‘s syndrome. J Dermatol. 1998;25:167–70.

    CAS  PubMed  Google Scholar 

  12. Kawakami T, Saito R. The relationship between facial annular erythema and anti-SS-A/Ro antibodies in three East Asian women. Br J Dermatol. 1999;140:136–40.

    Article  CAS  PubMed  Google Scholar 

  13. Yamamoto T, Nishioka K. Coexistence of psoriasis vulgaris, systemic sclerosis, and annular erythema in association with Sjögren’s syndrome. J Dermatol. 2004;31:69–72.

    PubMed  Google Scholar 

  14. Yokota K, Shichinohe R, Hayasaka T. Topical tacrolimus in the treatment of annular erythema associated with Sjogren’s syndrome. Clin Exp Dermatol. 2005;30:450–1.

    Article  CAS  PubMed  Google Scholar 

  15. Lee CW, Kang SG. Recurrent annular erythema in Sjögren’s/lupus erythematosus overlap syndrome: an additional case from Korea. J Dermatol. 1996;23:431–2.

    CAS  PubMed  Google Scholar 

  16. Lee CW. (2000) Clinical constellation of annular erythema associated with anti-Ro/La autoantibodies. J Korean Med Sci. 2000;15:199–202.

    CAS  PubMed  Google Scholar 

  17. Soy M, Piskin S. Cutaneous findings in patients with primary Sjögren’s syndrome. Clin Rheumatol. 2007;26:1350–2.

    Article  PubMed  Google Scholar 

  18. Nomoto M, Saito K, Shigemi F, Takeda K. A case of Sjögren’s syndrome presenting erythema (in Japanese). Nishinihon Hifuka. 1978;40:822–5.

    Google Scholar 

  19. Usuda T, Kawade H, Aoyama H, Izawa Y, Abe Y, Miyachi S, et al. A case of Sjögren Syndrome with autoimmune annular erythema (in Japanese). Rinsho Hifu Ka. 1981;35:457–62.

    Google Scholar 

  20. Yasue T. Annular erythema in the patients with collagen diseases (in Japanese). Nippon hifuka Gakkai Zassi. 1982;92:127–38.

    CAS  Google Scholar 

  21. Usuda T, Izawa Y, Yasue T, Tanaka T, Torikai K. Sjögren’s syndrome presenting skin lesions (in Japanese). Nippon hifuka Gakkai Zassi. 1982;92:489–501.

    CAS  Google Scholar 

  22. Furukawa T, Nagashima M. A case of subclinical Sjögren’s syndrome presenting erythema (in Japanese). Ronsho Hifu Ka. 1984;38:847–50.

    Google Scholar 

  23. Nagata H, Takei Y, Ueki H. Three cases of Sjögren’s syndrome presenting skin lesions (in Japanese). Nishinihon Hifuka. 1984;46:485–91.

    Google Scholar 

  24. Kosogabe E, Mizuta E, Nagao H, Kodama H, Nohara N. Two cases of Sjögren’s syndrome with autoimmune annular erythema (in Japanese). Rinsho Hifu Ka. 1985;39:379–83.

    Google Scholar 

  25. Tanuma H, Yagi K. A case of Sjögre’s syndrome diagnosed by annular erythema (in Japanese). Hifuka no Rinsho. 1985;27:1269–74.

    Google Scholar 

  26. Kawamura I, Nishikawa T, Kurihara S. A case of Sjögren’s syndrome presenting annular erythema (in Japanese). Rinsho Hifu Ka. 1985;39:17–21.

    Google Scholar 

  27. Haneda T, Matsuura T, Morita H. A case of Sjögren’s syndrome (in Japanese). Hifu. 1985;27:715–9.

    Google Scholar 

  28. Hoshino M, Naito T, Baba T. A case of subclinical Sjögren’s syndrome (in Japanese). Hifuka No Rinsho. 1986;28:251–5.

    Google Scholar 

  29. Nagata R, Tsukamoto K, Udagawa A. Sjögren’s syndrome presenting annular erythema (in Japanese). Hifuka No Rinsho. 1987;29:1241–2.

    Google Scholar 

  30. Tsutsui M, Kishiyama K, Taneichi K. Two cases of Sjögren’s syndrome complaining annular erythema (in Japanese). Rinsho Hifu Ka. 1988;42:805–9.

    Google Scholar 

  31. Yamagata M, Morita H, Asano S. Immunohistochemical analysis skin lesions of annular erythema in Sjögren’s syndrome (in Japanese). Hifu. 1988;30:710–6.

    Google Scholar 

  32. Teraki Y, Sugiura M, Akiyama M. Anti-SSB recurrent erythema (in Japanese). Rinsho Hifu Ka. 1989;43:25–31.

    Google Scholar 

  33. Eto H, Katayama I, Teramoto N. A case of Sjögren’s syndrome developing annular erythema (in Japanese). Hifubyo Shinryo. 1990;12:33–6.

    Google Scholar 

  34. Ueda M, Hashimoto T. A male case of primary. A case of Sjögren’s syndrome (in Japanese). Hifubyo Shinryo. 1990;12:53–6.

    Google Scholar 

  35. Watanabe M, Nonaka S, Ogami T. A case of Sjögren’s syndrome developing annular erythema (in Japanese). Nishinihon Hifuka. 1990;52:12–6.

    Google Scholar 

  36. Higashi Y, Jitsukawa K, Hayashi Y. A case of Sjögren’s syndrome developing annular erythema (in Japanese). Rinsho Hifu Ka. 1991;45:955–7.

    Google Scholar 

  37. Hoshino Y, Nishikawa T. Sjögren ‘s syndrome and subcacute cutaneous lupus erythematosus (in Japanese). Hifu Rinsho. 1991;33:367–74.

    Google Scholar 

  38. Washio K, Kazama T, Oguro K, Ito M. A case of subcacute cutaneous lupus erythematosus with subclinical Sjögren’s syndrome (in Japanese). Rinsho Hifu Ka. 1992;46:639–42.

    Google Scholar 

  39. Imamura T, Oota T, Nakano J, Tominaga K, Matutani S, Nagai H, et al. Primary Sjögren’s syndrome: alternate appearance of annular erythema and pernio-like erythema (in Japanese). Hifu. 1992;34:121–5.

    Google Scholar 

  40. Takada M, Taniguchi A, Inaoki M. Two cases of subclinical Sjögren’s syndrome manifesting facial erythema and annular erythema on the face (in Japanese). Hifubyo Shinryo. 1993;15:155–8.

    Google Scholar 

  41. Nagata T, Masutani M, Eika Y. A case of Sjögren’s syndrome (in Japanese). Hifuka No Rinsho. 1993;35:897–900.

    Google Scholar 

  42. Yajima C, Kumakiri M. A case of Sjögren’s syndrome with insect-bite like erythema localized to the fingers (in Japanese). Hifuka No Rinsho. 1993;35:901–5.

    Google Scholar 

  43. Manabe A, Kinouchi M, Tsutsui M. A case of subclinical Sjögren’s syndrome presented annular erythema (in Japanese). Rinsho Hifu Ka. 1993;47:965–9.

    Google Scholar 

  44. Yoshizawa M, Otoyama K, Katuoka K, Kunihiro Y. A case of Sjögren’s syndrome. Presenting edematous erythema (in Japanese). Nishinihon Hifu Ka. 1993;55:691–7.

    Google Scholar 

  45. Ishikawa M, Tamamori T, Horiguchi D, Iwatsuki K, Tokura Y, Shirahama S, et al. Annular erythema associated with anti-SS-A and anti SS-B antibodies––clinical and histological observations (in Japanese). Rinsho-Hifu-Ka. 1993;47:945–51.

    Google Scholar 

  46. Kawakami T, Saito R. A case of systemic lupus erythematosus with subclinical Sjögren syndrome (in Japanese). Hifuka No Rinsho. 1994;36:51–4.

    Google Scholar 

  47. Hosokawa K, Tomizawa K, Kobayashi K. A case of neonatal erythematosus with mother and grandmother associated with Sjögren’s syndrome (in Japanese). Hifuka No Rinsho. 1994;36:745–8.

    Google Scholar 

  48. Noda T, Aoyama Y, Shikano Y. A case of Sjögren’s syndrome combined with systemic lupus erythematosus (in Japanese). Nishinihon Hifuka. 1994;56:694–8.

    Google Scholar 

  49. Nogami R, Maekawa Y, Yasuno K, Shin Y. A female case of neonatal lupus erythematosus-delivered from the mother with SCLE and Sjögren’s syndrome (in Japanese). Hifuka No Rinsho. 1996;38:2002–3.

    Google Scholar 

  50. Fujimoto M, Nagata A, Tajiri C. A case of Sjögren’s syndrome presenting annular erythema (in Japanese). Hifuka No Rinsho. 1998;40:739–42.

    Google Scholar 

  51. Takahashi A, Oonishi K, Miyachi Y. A case of subclinical Sjögren syndrome with acute fever and marked skin lesions (in Japanese). Rinsho Hifu Ka. 1999;53:728–31.

    Google Scholar 

  52. Matsumura A, Shimizu A, Koga T, Nakayama J. A case of annular erythema of Sjögren’s syndrome (in Japanese). Hifuka No Rinsho. 1999;41:429–33.

    Google Scholar 

  53. Usuda T, Yanagida K, Kawachi T. Annular erythtma of Sjögren’s syndrome (in Japanese). Hifubyo Shinryo. 1999;21:909–12.

    Google Scholar 

  54. Kinebuchi A, Hashikabe M, Orima S, Otsuka S, Yamakage A, Yamazaki S. Three cases of Sjögren’s syndrome with clinical presentation of annular erythema (in Japanese). Hifuka No Rinsho. 2000;42:281–5.

    Google Scholar 

  55. Hattori H, Katayama H, Takahashi Y, Okuma N, Fujii M, Miyoshi K. A case of neonatal lupus erythematosus delivered from the mother with positive anti-SS-A and anti-SS-B antibody (in Japanese). Rinsho Hifu Ka. 2000;55:763–5.

    Google Scholar 

  56. Maeyama T, Nakama T, Mori O, Hashimoto T. Three cases of Sjögren’s syndrome with annular erythema (in Japanese). Rinsho Hifu Ka. 2003;57:258–61.

    Google Scholar 

  57. Okiyama N, Minatohara K, Yokozeki H, Nishioka K. A case of subclinical Sjögren’s syndrome with alopecia areata and annular erythema (in Japanese). Hifuka No Rinsho. 2004;46:109–12.

    Google Scholar 

  58. Saita T, Hashimoto M, Nagashima Y, Tsuchida T. A case of subacute cutaneous lupus erythematosus (in Japanese). Hifubyo Shinryo. 2004;26:587–90.

    Google Scholar 

  59. Kubota Y, Nakayama J. A case of childhood Sjögren’s syndrome (in Japanese). Nishinihon Hifuka. 2004;66:336–41.

    Article  Google Scholar 

  60. Oda M, Oyama Z, Seijima M. A child with Sjögren’s syndrome and annular erythema (in Japanese). Nihon Hifukagakkai Zasshi. 2004;114:1781–6.

    Google Scholar 

  61. Taniguchi A, Tsuchida T. Annular erythema of Sjögren’s syndrome, SCLE (in Japanese). Vis Dermatol. 2005;4:134–6.

    Google Scholar 

  62. Wada N, Ichikawa N, Kobayashi S, Kawahara Y, Tanigawa E, Nishikawa T. A case of annular erythema with positive anti-SS-A and anti-SS-B antibody during twice pregnancy (in Japanese). Rinsho Hifu Ka. 2005;59:596–9.

    Google Scholar 

  63. Sugawara K, Higashitani K, Usuda T, Iwata Y, Kodera M. A case of Sjögren’s syndrome with SCLE-type erythema (in Japanese). Hifubyo Shinryo. 2005;27:1441–6.

    Google Scholar 

  64. Mizuno M, Matsuba S, Takamori K. Erythema on the face: clinical case of Sjögren syndrome (in Japanese). Hifubyo Shinryo. 2006;28:207–10.

    Google Scholar 

  65. Fujita Y, Matsumura K, Murata J, Kuroda T, Ukae S. A case of childhood Sjögren syndrome with diagnosed by annular erythema (in Japanese). Hifuka No Rinsho. 2006;8:909–13.

    Google Scholar 

  66. Yoshida M, Maeyama Y, Kusuhara M, Yasumoto S, Hashimoto T. A case of childhood subclinical Sjögren syndrome with annular erythema on the face (in Japanese). Hifubyo Shinryo. 2007;29:555–8.

    Google Scholar 

  67. Miyata S, Masuzawa M, Katsuoka K. A case of Sjögren’s syndrome with double-ringed annular erythema (in Japanese). Rinsho Hifu Ka. 2007;61:514–7.

    Google Scholar 

  68. Gushi M, Yamamoto Y, Uezato H, Kinjo N. A case of childhood Sjögren’s syndrome associated with vitiligo vulgaris (in Japanese). Hifu Byo Shinryo. 2007;29:551–4.

    Google Scholar 

  69. Hashimoto A, Katsuoka K, Eto H. Annular erythema in SLE. Hifu Byo Shinryo. 1999;21:913–6.

    Google Scholar 

  70. Vitali C, Moutsopoulos HM, Bombardieri S. The European Community Study Group on diagnostic criteria for Sjögren’s syndrome. Sensitivity and specificity of tests for ocular and oral involvement in Sjögren’s syndrome. Ann Rheum Dis. 1994;53:637–47.

    Article  CAS  PubMed  Google Scholar 

  71. Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, Alexander EL, European Study Group on Classification Criteria for Sjögren’s Syndrome. Classification criteria for Sjögren syndrome; a revised version of the European criteria proposed by the American–European Consensus Group. Ann Rheum Dis. 2002;61:554–8.

    Article  CAS  PubMed  Google Scholar 

  72. Fujibayashi K, Japanese Medical Society for Sjögren’s syndrome. Revised Japanese criteria for Sjögren’s syndrome. Annual report of Japanese Ministry of Health and Welfare. Tokyo: Ministry of Health and Welfare, 1999; p. 35–138.

  73. Sontheimer RD. Subacute cutaneous lupus erythematosus: a decade’s perspective. Med Clin North Am. 1989;73:1000–73.

    Google Scholar 

  74. Nishikawa T, Hayakawa K, Takahashi S, Kawakubo A, Yamakage M, Akizuki M. Recurrent erythema associated with immunological abnormalities: anti-SSB recurrent erythema. Jpn J Dermatol. 1988;98:825–34.

    CAS  Google Scholar 

  75. Kuhn A, Richter-Hinz D, Schuppe H, Ruzicka T, Lehmann P. Anulares Erythem bei Sjögren’s-syndrome. Hauarzt. 2000;51:270–5.

    Article  CAS  Google Scholar 

  76. Miyagawa S, Dohi K, Shima H, Shirai T. HLA antigens in anti- Ro (SS-A)-positive patients with recurrent annular erythema. J Am Acad Dermatol. 1993;28:185–8.

    Article  CAS  PubMed  Google Scholar 

  77. Caroline C. Sex differences in autoimmune disease. Nature Immunol. 2001;2:777–80.

    Article  Google Scholar 

  78. Katayama I, Asai T, Nishioka K, Nishiyama S. Annular erythema associated with primary Sjögren’s syndrome: analysis of T cell subsets in cutaneous infiltrates. J Am Acad Dermatol. 1989;21:1218–21.

    Article  CAS  PubMed  Google Scholar 

  79. Polihronis M, Tapinos NI, Theocharis SE, Economou A, Kittas C, Moutsopoulos HM. Modes of epithelial cell death and repair in Sjögren syndrome (SS). Clin Exp Immunol. 1998;114:485–90.

    Article  CAS  PubMed  Google Scholar 

  80. Arakaki R, Ishimaru N, Saito I, Kobayashi M, Yasui N, Sumida T, et al. Development of autoimmune exocrinopathy resembling Sjögren’s syndrome in adoptively transferred mice with autoreactive CD4+ T cells. Arthritis Rheum. 2003;48:3603–9.

    Article  CAS  PubMed  Google Scholar 

  81. Shiari R, Kobayashi I, Toita N, Hatano N, Kawamura N, Okano M, et al. Epitope mapping of anti-alpha-fodrin autoantibody in juvenile Sjögren’s syndrome: difference in major epitopes between primary and secondary cases. J Rheumatol. 2006;33:1395–400.

    PubMed  Google Scholar 

  82. McCauliffe DP, Faircloth E, Wang L, Hashimoto T, Hoshino Y, Nishikawa T. Similar Ro/SS-A autoantibody epitope and titer responses in annular erythema of Sjögren’s syndrome and subacute cutaneous lupus erythematosus. Arch Dermatol. 1996;132:528–31.

    Article  CAS  PubMed  Google Scholar 

  83. Provost TT, Talal N, Harley JB, Reichlin M, Alexander E. The relationship between anti-Ro (SS-A) antibody-positive Sjögren’s syndrome and anti-Ro (SS-A) antibody-positive lupus erythematosus. Arch Dermatol. 1988;124:63–71.

    Article  CAS  PubMed  Google Scholar 

  84. Katayama I. Immunomodulatory therapy of recurrent purpura associated with Sjögren’s syndrome. Effect of oral gold compound. J Rheumatol. 1994;21:1376–7.

    CAS  PubMed  Google Scholar 

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Katayama, I., Kotobuki, Y., Kiyohara, E. et al. Annular erythema associated with Sjögren’s syndrome: review of the literature on the management and clinical analysis of skin lesions. Mod Rheumatol 20, 123–129 (2010). https://doi.org/10.1007/s10165-009-0257-y

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