Three Cases of Generalized Granuloma Annulare Successfully Treated with Methotrexate / 대한피부과학회지

Granuloma annulare is a benign granulomatous skin disease, clinically characterized by dermal papules tending to form annular shapes. Granuloma annulare is classified into localized, generalized, subcutaneous, and perforating types. Localized granuloma annulare is likely to resolve spontaneously, while generalized granuloma annulare usually takes a chronic course. Topical steroids, phototherapy, isotretinoin, dapsone, hydroxychloroquine, and other various treatments have been proposed, but some cases have been resistant to all of those treatment modalities. We experienced 3 cases of generalized granuloma annulare demonstrating a recalcitrant course that were successfully treated with methotrexate and propose that methotrexate may be an effective option for recalcitrant generalized granuloma annulare treatment.

A Case of Generalized Granuloma Annulare in a Pediatric Patient / 대한피부과학회지

No abstract available.

Clinical Features of Generalized Granuloma Annulare in Korea / 대한피부과학회지

BACKGROUND: Generalized granuloma annulare (GGA) is a benign granulomatous disease of an unknown etiology. Although numerous studies about GGA have been reported, publications that describe the general clinical features of the disease are very sparse. OBJECTIVE: This study aimed to identify the clinical characteristics of Korean GGA cases. METHODS: We reviewed and analyzed the clinical data derived from four patients diagnosed with GGA at our hospital and the clinical data from 58 patients diagnosed with GGA at other Korean hospitals between 1995 and 2011. RESULTS: The cutaneous lesions could be divided into the annular (n=30, 48%) and nonannular (n=32, 52%) types, and the lesions were more common in males than in females, with 33 males and 29 females affected. The GGA incidence showed a bimodal distribution with respect to age at disease onset. Twenty-six cases (42%) presented within the first decade of life and 29 cases (47%) presented when they were in the fifth decade of life or older. Twelve patients (19%) had systemic diseases. Of note, diabetes mellitus (DM) occurred only in adult GGA patients who were aged over 40 years. CONCLUSION: In contrast to previously reported studies, this study shows that the age at GGA onset has a bimodal distribution, and that GGA occurs more often in males. The prevalence of DM among GGA-affected individuals was higher than that found in the general Korean population. Therefore, a DM workup should be undertaken for GGA-affected patients who are over 40 years of age.

Generalized Granuloma Annulare Associated with Myelodysplastic Syndrome / 대한피부과학회지

Generalized granuloma annulare (GGA) is a rare variant of granuloma annulare, presenting with diffuse papules and annular patches on the trunk and extremities. Though the pathogenesis of GGA has not been totally understood, recent studies have shown the relationship between malignancy and GGA. A 74-year-old man developed a generalized, mildly pruritic erythematous papules, which slowly coalesced into annular patch with elevated rim. Punch biopsy showed palisading and interstitial granuloma with giant cells. A complete blood cell count with differential revealed leukopenia and subsequent findings of the bone marrow biopsy were compatible with myelodysplastic syndrome (MDS). As there was no more progression of MDS, only the skin lesions were treated with hydroxychloroquine, isotretinoin and phototherapy, and improved after 14 months of treatment. We recommend that careful evaluation of the underlying solid tumor, as well as hematologic malignancy, should be done when the dermatologists encounter with the patient presenting generalized granuloma annulare.

Generalized granuloma annulare in a patient with myelocytic leukemia and chronic hepatitis B virus infection.

Granuloma annulare is a granulomatous disorder of the dermis and subcutaneous tissue, with different clinical types. Generalized granuloma annulare is a rarely encountered clinical entity. We describe a 60-year-old woman with a 4-month history of generalized annular lesions. She had a history of myelocytic leukemia and chronic hepatitis B virus infection. To date, both acute myelocytic leukemia and hepatitis B virus infection have been described independently in association with generalized granuloma annulare but have never been described together in association with generalized granuloma annulare. Probable etiological causes of granuloma annulare are discussed in our patient.

Clinical and Pathological Features of Generalized Granuloma Annulare with Their Correlation: A Retrospective Multicenter Study in Korea

BACKGROUND: Generalized granuloma annulare (GGA) is a benign skin disorder of an unknown etiology. Though some cases of GGA have been reported, few systemic reviews of the clinical and pathological features of GGA have been performed. OBJECTIVE: The purpose of this study is to analyze and correlate the clinical and pathological characteristics of GGA in Korean patients. METHODS: We conducted a retrospective study that included 54 biopsy specimens of Korean GGA patients, and the clinical and pathological features of GGA were reviewed and analyzed for their correlation. RESULTS: The cutaneous lesions could be divided into the annular (24, 44%) and nonannular types (30, 56%), and the lesions were more common in males than in females (29 males and 25 females). The incidence of GGA showed a bimodal age distribution. The number of patients who presented within the first decade was 24 cases (44%), and 24 cases (44%) were over the fifth decade. Eight patients (15%) had systemic diseases. Especially, diabetes mellitus (DM) occurred only in the adult GGA patients over forty years old. The pathological findings showed dermal granulomatous lesions that consisted of either a palisading pattern (28, 52%) or an interstitial pattern (26, 48%). CONCLUSION: In contrast to the previously reported studies, the age of GGA onset showed a bimodal distribution, and GGA was observed more often in males. The prevalence of DM in the GGA affected individuals was higher than that found in the general Korean population. Therefore, it is recommended to perform a work-up for DM in the GGA affected patients who are over forty years old.

Clinical and Pathological Features of Generalized Granuloma Annulare with Their Correlation: A Retrospective Multicenter Study in Korea

BACKGROUND: Generalized granuloma annulare (GGA) is a benign skin disorder of an unknown etiology. Though some cases of GGA have been reported, few systemic reviews of the clinical and pathological features of GGA have been performed. OBJECTIVE: The purpose of this study is to analyze and correlate the clinical and pathological characteristics of GGA in Korean patients. METHODS: We conducted a retrospective study that included 54 biopsy specimens of Korean GGA patients, and the clinical and pathological features of GGA were reviewed and analyzed for their correlation. RESULTS: The cutaneous lesions could be divided into the annular (24, 44%) and nonannular types (30, 56%), and the lesions were more common in males than in females (29 males and 25 females). The incidence of GGA showed a bimodal age distribution. The number of patients who presented within the first decade was 24 cases (44%), and 24 cases (44%) were over the fifth decade. Eight patients (15%) had systemic diseases. Especially, diabetes mellitus (DM) occurred only in the adult GGA patients over forty years old. The pathological findings showed dermal granulomatous lesions that consisted of either a palisading pattern (28, 52%) or an interstitial pattern (26, 48%). CONCLUSION: In contrast to the previously reported studies, the age of GGA onset showed a bimodal distribution, and GGA was observed more often in males. The prevalence of DM in the GGA affected individuals was higher than that found in the general Korean population. Therefore, it is recommended to perform a work-up for DM in the GGA affected patients who are over forty years old.

A Case of Generalized Granuloma Annulare That Clinically Presented as Erythema Annulare Centrifugum / 대한피부과학회지

Granuloma annulare (GA) is usually a benign, self-limiting, granulomatous, chronic dermatosis of an unknown cause, characterized by skin colored papules that often have an annular configuration. Generalized granuloma annulare (GGA) is an uncommon variant of GA, and this is characterized by disseminated papules on the trunk and limbs. We report here on an interesting case of GGA that clinically presented as erythema annulare centrifugum.

A Case of Generalized Granuloma Annulare Following BCG Vaccination / 대한피부과학회지

Generalized granuloma annulare is defined as affecting at least the trunk and either the upper or lower extremities, or both. It is represented by disseminated necrobiotic dermal papules forming annular or nonannular configuration. Clinical associations between generalized granuloma annulare and diabetes mellitus, thyroid disease, malignancy, infection, and vaccination have been reported. BCG vaccination induces specific and nonspecific dermatologic complications such as scrofuloderma-like, lupus vulgaris-like, tuberculid, urticaria, erythema multiforme, erythema nodosum, and granuloma annulare. Generalized granuloma annulare associated with BCG vaccination or tuberculin test has not been reported in the Korean literature. Herein, we report a case of generalized granuloma annulare which occurred in a 6-month-old boy following BCGitis on the BCG vaccination site.

Two Cases of Generalized Granuloma Annulare in Infants

Generalized granuloma annulare (GGA) is characterized by disseminated necrotic dermal papules but the pathogenesis has not been fully elucidated. A 5-month and a 3-month male infant had diffusely scattered, erythematous papules on their trunks, and upper and lower extremities. Histopathological examination revealed an infiltration of histiocytes around and between altered collagen fibers in upper and mid dermis. The collagen fibers were separated by mucin, which was positively stained with alcian blue at pH 2.5. After they were treated with topical and/or systemic corticosteroid, the lesions disappeared. To the best of our knowledge, these two cases are non-perforating GGA in the youngest patients yet reported in English literature.

A Case of Generalized Granuloma Annulare in Infant / 대한피부과학회지

Granuloma annulare is a benign, self-limiting dermatosis of unknown cause, and is characterized by necrobiotic dermal papules that often assume an annular configuration. A generalized form is common in the fifth to seventh decades of age, however, it is uncommon in childhood, especially in infancy. We report an interesting case of generalized grannuloma annulare which occurred in a 60 day-old boy. Dermatologists should include generalized granuloma annulare in the differential diagnosis of infants with generalized papular eruptions.

A Case of Generalized Granuloma Annulare Controlled by Isotretinoin / 대한피부과학회지

Generalized granuloma annulare (GGA) is an uncommon type of granuloma annulare. It is frequently characterized by chronicity and unresponsiveness to a number of therapeutic modalities. A variety of systemic treatment modalities for GGA have been tried, including PUVA, dapsone, hydroxychloroquine, systemic corticosteroids, niacinamide, vitamin E and chlorambucil. However, their efficacy was not very encouraging. We present a case of GGA which showed a satisfactory response to isotretinoin. To conclude, isotretinoin may be considered as treatment for GGA in patients with unacceptable cosmetic disfigurements or symptoms.

Two Cases of Generalized Granuloma Annulare in Early Childhood

Generalized granuloma annulare is a rare skin disease presenting generalized eruption with a distinctive histologic picture. The age of onset of generalized granuloma annulare differs from that of localized granuloma annulare. Most of the patients with generalized granuloma annulare were in the fifth to seventh decades and cases of generalized granuloma annulare in infancy or in early childhood have been rarely reported. We herein report two cases of generalized granuloma annulare in 45- and 18-month-old boys, who is the youngest patient yet reported in the Korean literature. The histopathologic findings were compatible with granuloma annulare and all lesions completely involuted in two months after administration of topical or systemic corticosteroids.

Two Cases of Generalized Granuloma Annulare Treated with PUVA / 대한피부과학회지

Granuloma annulare is a benign granulomatous disease which has an unknown etiology and it is represented by typical annular lesions. Recently various therapeutic modalities have been suggested such as intralesional injections of steroid, chloroquine, dapsone, surgical excision and so on. But any satisfactory result has not been reported yet. In the first case, a 65 year-old-man, Polycyclic, erythematous patches with raised edges were noted on the upper arm spreading to the trunk and both lower extremities for the past 3 years. In the second case, a 63-year-old man, numerous match-head sized skin-colored papules were detected on the sun exposed area such as both shoulders, upper extremities and hands dorsum for the past 3 months. On the histological examination of back, hands dorsum respectively, incomplete degeneration of collagen bundles surrounded by lymphocytes, histiocytes in a palisade pattern and a few giant cells were found in the dermis. Two patients were treated with systemic PUVA, one for 2 months and the other, 4 months.

Two Cases of Generalized Granuloma Annulare Treated with PUVA / 대한피부과학회지

Granuloma annulare is a benign granulomatous disease which has an unknown etiology and it is represented by typical annular lesions. Recently various therapeutic modalities have been suggested such as intralesional injections of steroid, chloroquine, dapsone, surgical excision and so on. But any satisfactory result has not been reported yet. In the first case, a 65 year-old-man, Polycyclic, erythematous patches with raised edges were noted on the upper arm spreading to the trunk and both lower extremities for the past 3 years. In the second case, a 63-year-old man, numerous match-head sized skin-colored papules were detected on the sun exposed area such as both shoulders, upper extremities and hands dorsum for the past 3 months. On the histological examination of back, hands dorsum respectively, incomplete degeneration of collagen bundles surrounded by lymphocytes, histiocytes in a palisade pattern and a few giant cells were found in the dermis. Two patients were treated with systemic PUVA, one for 2 months and the other, 4 months.

A Case of Generalized Granuloma Annulare / 대한피부과학회지

We experienced a case of generalized granuloma annular e in a 68-year-old man. Many factors have been implicated in the genesis of this disease, but in this case no etiologic factors were identified. He was treated successfully with systemic corticosteroid for about l year.