A Rare Association of Disseminated Granuloma Annulare With Recurrent Uveitis.

Granuloma annulare is a benign chronic inflammatory granulomatous dermatosis with a variable clinical presentation. The disseminated form of the disease is characterized by a widespread papular eruption, primarily affecting the trunk, neck, and extremities. The development of granuloma annulare in patients with systemic diseases, such as diabetes mellitus, malignancy, or dyslipidemia, has been extensively documented. Still, only a few cases of granuloma annulare associated with recurrent uveitis have been reported. Herein, we present a rare case of generalized granuloma annulare that was associated with concomitant recurrent uveitis in a 60-year-old male patient with a history of type II diabetes mellitus. A general physical exam revealed widespread erythematous papules in an annular pattern on the trunk, characteristic of granuloma annulare. A series of tests were conducted, including autoimmune workup, all within normal limits. Histopathologic findings revealed features consistent with granuloma annulare. The patient was successfully treated with systemic corticosteroids for the uveitis and isotretinoin for the skin lesions. A close follow-up is recommended given the rare association of granuloma annulare and uveitis.

Generalized granuloma annulare associated with essential thrombocythemia.

The only myeloproliferative neoplasm associated with generalized granuloma annulare (GA) is chronic myelogenous leukemia (CML). We present the first reported case of GA in a patient with essential thrombocythemia (ET). Future work investigating the shared pathophysiology of GA-associated CML and ET may improve our understanding of GA pathophysiology and treatment.

A Monocentric, Retrospective Analysis of 61 Patients with Generalized Granuloma Annulare.

BACKGROUND: Granuloma annulare is a chronic noninfectious granulomatous skin condition with variable clinical presentations. Generalized granuloma annulare, defined as widespread disease with >10 skin lesions, accounts for 15% of all cases. Numerous associated diseases have been controversially discussed, most importantly diabetes mellitus, dyslipidemia, thyroid disease, malignancy and systemic infections. OBJECTIVES: The objective of our study is to describe disease characteristics, treatment outcome and associated diseases in patients treated at the Department of Dermatology of the University Hospital Zurich during the last 20 years. METHODS: The hospital database was searched for patients with generalized granuloma annulare in the last 20 years (January 1, 1998, to December 31, 2017). Overall, 61 patients, 14 males and 47 females, were included in our study. The mean age was 58 years at first consultation. The diagnosis was verified clinically and histologically. RESULTS: Generalized granuloma annulare occurred at a mean age of 55 years, more commonly in females. Pruritus was absent in 51% of all patients. Metabolic diseases including diabetes mellitus, hypercholesterinemia and hypertriglyceridemia were present in 10.5, 8.2 and 4.9%, respectively. Thyroid disease was present in 9.8% and malignant disease in 23%, including colorectal cancer, lymphoproliferative disease, squamous cell carcinoma of the esophagus, basal cell carcinoma and gynecological malignancy. Therapy was initiated in 92%, while second- and third-line therapy was performed in 70 and 39%, respectively. Benefit during therapy (e.g., full and partial remission) was achieved in 39.3% during first-line, in 39.4% during second-line and in 33.8% during third-line treatment. Topical corticosteroids were the most commonly prescribed treatment, mostly leading to stable disease (46.6%). Combined full and partial remission occurred in a large proportion of patients receiving UVA1 (45%), PUVA (63.6%) and intralesional triamcinolone acetonide (100%). CONCLUSIONS: Generalized granuloma annulare is a mostly asymptomatic and benign disease with a strong tendency for treatment resistance. We suggest to screen all patients for dyslipidemia, thyroid disease and malignant disease. While randomized trials are needed, we suggest topical corticosteroids as the first-line treatment, intralesional triamcinolone acetonide for persistent solitary lesions and, if further treatment is needed, UVA1 or PUVA.

[Generalized granuloma annulare: A clinicopathological study]. / Granulome annulaire généralisé : étude anatomoclinique.

BACKGROUND: Granuloma annulare (GA) is a benign granulomatous skin disorder that is generalized (GGA) in 15 % of cases. Although many case reports describe a relationship between GGA and systemic diseases, few large series have been published, and their association is debated. We present herein a series of GGA in order to describe their clinical and histological features. PATIENTS AND METHODS: We included all biopsy-proven cases of GA presenting at the dermatopathology laboratory of Strasbourg where generalized (i.e. over 10 lesions). Clinical features were obtained from patients' medical files. RESULTS: We included 35 GGA, with a sex ratio of 0.5. The mean age was 54 years. Lesions were annular or non-annular in equal measure and were symptomatic in 25 % of cases. Most patients (77 %) had an associated disease, already known in 60 % of cases, including dyslipidemia (27 %), diabetes mellitus (20 %), immunosuppressive drugs (17 %), atopy (17 %), auto-immune disease (17 %), hematological disease (14 %), and cancer (9 %). Histological analysis revealed the predominant pattern to be interstitial (54 %) rather than palisading (20 %), having no correlation with clinical type. Eosinophils were frequent (46 %) in GA but were not correlated with systemic disease or drug taking. Among the 40 % of patients treated, 50 % had a successful outcome on topical corticosteroids, doxycycline, antimalarial drugs or phototherapy. DISCUSSION: GGA differs from localized GA, which is mostly associated with an already known systemic disease, whether metabolic, infectious or neoplastic, uncorrelated with clinical or histological features, and screening is necessary.

Giant Cell Arteritis with Generalized Granuloma Annulare.

We report the case of an 80-year-old man with generalized granuloma annulare (GGA) who subsequently developed giant cell arteritis (GCA). Steroid treatment was effective for both diseases in this case. Although cases of concomitant GGA and GCA have rarely been reported, previous studies suggest that common histological characteristics underlie the two diseases. It is therefore necessary to recognize that GGA can be complicated by GCA, particularly when typical symptoms, such as headache and visual disturbance, are present.

Methotrexate treatment of generalized granuloma annulare: a retrospective case series.

BACKGROUND: Management of generalized granuloma annulare (GGA) poses challenges for both patients and dermatologists. Currently, there are no established first-line therapies for GGA and the available therapeutic modalities are based on individual case reports and a few small case series. Further, there are limited publications assessing the efficacy of methotrexate in treating GGA. OBJECTIVE: To evaluate the efficacy and adverse effects associated with methotrexate treatment of GGA. METHODS: Descriptive retrospective case series of 11 patients with GGA receiving methotrexate. RESULTS: Sixty four percent of patients receiving methotrexate noted improvement of their skin disease, of which 43% achieved complete clearance and 57% partial clearance. Initial dose of methotrexate ranged from 12.5 to 15 mg weekly, administered either orally or subcutaneously. The majority of patients tolerated the treatment well. However, 18% of patients experienced the adverse effects of either GI upset or hair loss. LIMITATIONS: This case series lacks a control group and therefore has low internal validity. The lack of a disease severity and therapy responsiveness measurement tool made quantifying disease improvement inexact. CONCLUSIONS: Methotrexate can be a successful and well-tolerated treatment option for patients with generalized GA.

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

No abstract available.

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.

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.

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.

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.