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Rapid resolution of erythema marginatum after icatibant in acquired angioedema.

© 2011 The Authors. doi: 10.2340/00015555-1055 Journal Compilation © 2011 Acta Dermato-Venereologica. ISSN 0001-5555 Acquired C1 inhibitor deficiency (AAE) is a rare syndrome with features similar to those of hereditary angio­ edema (HAE), but differing in its later onset and lack of family history. AAE is characterized by increased consumption of C1 inhibitor associated with lympho­ proliferative or malignant disorders, autoimmune or infectious diseases (1, 2). In C1 inhibitor deficiency two different skin manifestations can be seen: angioedema and erythema marginatum. Erythema marginatum is a highly characteristic serpiginous, non­pruritic exanthema, also known as chicken wire erythema, reported by up to 60% of patients (3). Erythema marginatum may precede or accompany the angioedema attack or it can be an isolated finding. Bradykinin is a key mediator in these angioedema attacks (4), and deposits of bradykinin have been identified in a skin biopsy of erythema marginatum (5). Icatibant, a bradykinin­B2­receptor antagonist, is an emerging treatment option in C1 inhibitor deficiency, licensed in Europe in 2008 for the indication HAE.