Erythema annulare centrifugum associated with insulin therapy: a case report

Abstract

Abstract A 52‐year‐old man with type 2 diabetes presented with peripherally spreading erythematous annular eruptions around the insulin injection sites on the anterior thighs. These lesions appeared shortly after initiation of subcutaneous premix human insulin injection. On examination, two well‐defined annular erythematous plaques of size around 10cm x 5cm with a rim of trailing scale over the margin were seen over the anterior aspect of bilateral thighs. He underwent assessment for diabetic complications screening and other relevant investigations. Histopathological examination of the lesion revealed uninvolved epidermis along with classical coat sleeve appearance of perivascular lymphocytic infiltration and dermal oedema in the upper dermis, which was suggestive of a diagnosis of erythema annulare centrifugum (EAC). The lesions resolved completely in two weeks after stoppage of insulin.Insulin administration is associated with many cutaneous adverse reactions such as lipohypertrophy, lipoatrophy, oedema and allergic reactions. Allergic reactions to insulin may be localised cutaneous ones or systemic ones necessitating stoppage or change of insulin preparation. EAC is an uncommon inflammatory dermatologic condition whose exact aetiology is unknown and most probably represents delayed type hypersensitivity to various allergens. To the best of our knowledge, the association of insulin therapy induced EAC has not been previously reported in the literature. Copyright © 2022 John Wiley & Sons.