Cold induced neutrophilic figurate erythema

Abstract

We herein report a 35-year-old man presented with relapsing, rigorous, annular and archiform plaques with central clearing on the trunk, back, shoulders and forehead. They were remarkably aggravated after cold exposure. He had just begun taking anti-oxidant herbal pills containing Ginkgo biloba one month ago. On histologic examination, a perivascular inflammatory cell infiltrate composed of neutrophils and mononuclear inflammatory cells in the upper dermis wer seen. The unique features of this case were the relapsing and recalcitrant character of the lesions, the onset of the lesions after cold exposure and remission after warming or a rise in the body temperature. Though the presence of leukocytoclasia might have been a clue for vasculitis, the absence of other vasculitic histopathological findings such as nuclear dusts and negative direct immunoflu-orescence test have excluded vasculitis. We consider our case to represent a figurate erythema with a dominant infiltration of neutrophils that might be also induced by Ginkgo biloba.