“I've had eight years of rings on my skin and I'm tired of them. The only good news is they only come in the winter,” complained a thirty-nine-year-old woman. At first her lesions had been limited to her forearms, but in the ensuing winters the ringed red cords had spread to involve her trunk, arms and legs. They would start out as bumps, then enlarge and clear in the center, leaving mildly itchy red rings that sort of resembled hives. Cortisone would clear them, but they always came back to stay until May.

We knew what she had, but we did not know why. Her diagnosis was erythema annulare centrifugum, which translates into red rings expanding centrifugally while clearing centrally. But what causes it? Again, like so many other skin diseases, it does not have a single cause, but is a reaction pattern to many different things. It can have many patterns, such as polycyclic, arcuate, annular, festooned, serpentine, figurate, geographic, or annular (ring-shaped). Although the shape of the lesions belies the diagnosis, it does not reveal the cause.

Her long-suffering winters led us to admit her to the hospital. We wanted to know for sure that her rings were not a sign of internal malignancy. Fortunately, extensive studies revealed no underlying cancer or any other disease. She had no intestinal parasites found on stool examination, and her tests for lupus erythematosus were negative.