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granuloma annulare (GA)
Self-limited asymptomatic dermatosis characterized by papules in an annular arrangement.
Etiology:
1) unknown
2) may be associated with diabetes mellitus [2]
Epidemiology:
1) children & young adults
2) female:male ratio 2:1
Pathology:
1) chronic inflammatory & histiocytic infiltration of superficial & mid dermis
2) reversible necrobiosis of connective tissue surrounded by palisading histiocytes & multinucleated giant cells
- degenerating collagen within the dermis [2]
3) inflammatory reaction around blood vessels
Clinical manifestations:
1) generally asymptomatic
2) smooth papules or plaques, skin-colored, erythematous or violaceous
3) annular or ring-like arrangement
4) commonly arises on the dorsal aspect of the hands & feet, elbows & knees, but may appear on other surfaces including the trunk
5) case report of symmetric distribution of lesions on trunk, arms, & legs [2]
Laboratory:
- serum glucose, hemoglobin A1c to confirm diabetes mellitus
- microscopic examination of KOH preparation of skin scraping
Management:
1) patient education
- spontaneous resolution in 75 of cases within 2 years
- recurrence is common (40%)
2) pharmacologic agents
- topical glucocorticoids
- intralesional triamcinolone 3 mg/mL
- hydroxychloroquine [2]
- glycemic control [2]
3) cryotherapy with liquid nitrogen
4) PUVA phototherapy
Related
diabetes mellitus
necrobiosis lipoidica
General
granulomatous disease of skin & subcutaneous tissue
figurate dermatitis (rings, arcs)
References
- Color Atlas & Synopsis of Clinical Dermatology, Common
& Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY,
1997, pg 272-73
- Ran M, Wang Y
IMAGES IN CLINICAL MEDICINE.
Generalized Granuloma Annulare Associated with Diabetes Mellitus
N Engl J Med 2016; 375:e21. September 8, 2016
PMID: 27602682 Free Article
http://www.nejm.org/doi/full/10.1056/NEJMicm1513798