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Atypical eosinophilic annular erythema clinically resembling granuloma annulare Dear Editor, Eosinophilic annular erythema (EAE) is a rare skin disease characterized by urticarial annular erythematous lesions with tissue eosinophilia on histopathology. It is debated whether EAE is a subset of Wells syndrome or an independent entity. We present a case of EAE that was clinically similar to granuloma annulare (GA). A 76-year-old woman presented with an 8-month history of multiple erythema on her limbs. The lesions on the upper limbs improved with time; however, new erythematous lesions on the thighs gradually emerged. Physical examination revealed annular erythematous plaques with central hyperpigmentation on the thighs (Fig. 1a). The plaques consisted of multiple erythematous solid papules, some with small bloody crusts (Fig. 1b). These papules were predominantly arranged on the periphery of the lesions. A biopsy specimen showed epidermal acanthosis and some subepidermal microvesicles, including eosinophils (Fig. 1c,d). There was a perivascular and diffuse infiltration of eosinophils and lymphocytes in the upper dermis (Fig. 1e). Neither a flame figure nor palisading granuloma was observed. Laboratory studies revealed slight hypereosinophilia (a white blood cell count of 96,500/μl, with 6.5% eosinophils). Based on these observations, we diagnosed the patient with EAE. Although new lesions developed on the soles (Fig. 1f), the administration of systemic prednisolone (20 mg daily) rapidly improved these remaining lesions. There were no erythematous lesions or hypereosinophilia for 6 months after the systemic treatment. The clinical appearance of EAE mainly showed an urticarial annular or polycyclic pattern with central pigmentation and an elevated border on the demarcated erythema. Unlike typical EAE, the annular lesions of our case comprised multiple red papules, such as GA. Histological examination revealed that subepidermal microvesicles with eosinophils and marked acanthosis clinically composed the individual erythematous papules. Moreover, observation by high magnification revealed the small bloody crusts on the red papules that distinguished EAE from GA. Subepidermal microvesicles and hemorrhage by