Localized Versus Generalized Granuloma Annulare: A Retrospective Review of 407 Patients.

BACKGROUND: Granuloma annulare has been linked to diabetes, dyslipidemia, thyroid disease, collagen vascular disease, malignancies, infectious hepatitis, and systemic infections. However, these associations have not been systematically investigated when categorized by its clinical variants. OBJECTIVE: To evaluate disease associations of localized and generalized granuloma annulare. METHODS: In total, 407 granuloma annulare patients from 1989 to 2019 were retrospectively reviewed, categorized by clinical variant (localized or generalized), age (pediatric or adult), and diagnostic method (clinical or histologic). Descriptive statistical analyses and multivariate logistic regression analysis were performed. Fisher's exact tests were conducted to produce unbiased probability values. RESULTS: Overall, 75.2% of the study sample was female, 47.2% had dyslipidemia, 24.8% were diabetic, and 24.6% had thyroid disease. Dyslipidemia (OR 2.15, CI 1.95-2.35, P < .001), diabetes (OR 1.16, CI 1.01-1.31, P = .041), and histologic diagnosis (OR 2.08, CI 1.21-3.52, P = .007) were associated with increased risk of GGA compared to LGA. When stratified by adult versus pediatric cases, dyslipidemia and diagnostic method remained significant, but diabetes did not. CONCLUSIONS: Evaluating granuloma annulare by its clinical variants may help to determine disease associations with each variant.

Granuloma anular, pronóstico de diabetes mellitus. A propósito de un caso / Annular granuloma, prognosis of diabetes mellitus. On the purpose of a case

RESUMEN El granuloma anular es una dermatosis de relativa frecuencia en niños, jóvenes y adultos. Está caracterizado por lesiones cutáneas eritemato-pápulo-nodulares, que adoptan una disposición anular. Su etiopatogenia es desconocida, pero con numerosos factores predisponentes, desencadenantes o asociados a ella; como es la diabetes mellitus y/o procesos neoplásicos o paraneoplásicos. Resulta importante el estudio de pacientes con este diagnóstico por su asociación con entidades como las antes mencionadas. Se realizó el reporte de un caso en adulto mayor de 65 años, con diagnóstico de granuloma anular, diabetes mellitus y neoplasia de páncreas (AU).

ABSTRACT Annular granuloma is a dermatosis relatively frequent in children, young and adult people. It is characterized by erythematous-papular-nodular skin lesions adopting annular disposition. Its etio-pathogenesis is unknown, but there are many predisposal, unleashing factors, or associated to this disease, like diabetes mellitus and/or neoplastic or paraneoplastic processes. It is important to study the patients diagnosed with the disease due to its association with entities like those before mentioned. The reported case is the case of a patient elder than 65 years, diagnosed with annular granuloma, diabetes mellitus and pancreas neoplasia (AU).

Granuloma anular, pronóstico de diabetes mellitus. A propósito de un caso / Annular granuloma, prognosis of diabetes mellitus. On the purpose of a case

RESUMEN El granuloma anular es una dermatosis de relativa frecuencia en niños, jóvenes y adultos. Está caracterizado por lesiones cutáneas eritemato-pápulo-nodulares, que adoptan una disposición anular. Su etiopatogenia es desconocida, pero con numerosos factores predisponentes, desencadenantes o asociados a ella; como es la diabetes mellitus y/o procesos neoplásicos o paraneoplásicos. Resulta importante el estudio de pacientes con este diagnóstico por su asociación con entidades como las antes mencionadas. Se realizó el reporte de un caso en adulto mayor de 65 años, con diagnóstico de granuloma anular, diabetes mellitus y neoplasia de páncreas.

ABSTRACT Annular granuloma is a dermatosis relatively frequent in children, young and adult people. It is characterized by erythematous-papular-nodular skin lesions adopting annular disposition. Its etio-pathogenesis is unknown, but there are many predisposal, unleashing factors, or associated to this disease, like diabetes mellitus and/or neoplastic or paraneoplastic processes. It is important to study the patients diagnosed with the disease due to its association with entities like those before mentioned. The reported case is the case of a patient elder than 65 years, diagnosed with annular granuloma, diabetes mellitus and pancreas neoplasia.

Childhood granuloma annulare: a review.

Granuloma annulare (GA) is a self-limited benign inflammatory dermatosis of unknown origin characterized by the development of papules arranged in an annular, circinate pattern, mainly involving the extensor surfaces of lower and upper extremities. The diagnosis depends on clinical and histological features. There are four main variants of GA: localized GA (LGA), subcutaneous GA (SGA), generalized GA (GGA) and perforating GA (PGA) and 2 uncommon subtypes: papular umbilicated GA and linear or segmental GA. Children most commonly present with the localized and subcutaneous forms. The aim of this review was to provide an update on the etiology, diagnosis and management of GA focusing on the pediatric age.

A rare variant of generalized granuloma annulare presenting with chronic Epstein-Barr virus infection: coincidence or association?

We report a rare variant of generalized granuloma annulare (GGA) in a 62-year-old male patient. The patient presented with large, annular, violaceous patches on the upper arms and thighs. Histological findings were consistent with interstitial granuloma annulare. In addition, high titers of Epstein-Barr Viral Capsid Antigen (EBV VCA) and EBV Nuclear Antigen (EBVNA) antibodies were found. In-situ hybridization did not reveal EBV RNA in the skin lesions. Immune dysregulation in the setting of chronic EBV infection has been suggested as a contributing factor to the development of this rare variant of GGA.

Diagnosis and management of granuloma annulare.

Granuloma annulare is a benign, asymptomatic, self-limited papular eruption found in patients of all ages. The primary skin lesion usually is grouped papules in an enlarging annular shape, with color ranging from flesh-colored to erythematous. The two most common types of granuloma annulare are localized, which typically is found on the lateral or dorsal surfaces of the hands and feet; and disseminated, which is widespread. Localized disease generally is self-limited and resolves within one to two years, whereas disseminated disease lasts longer. Because localized granuloma annulare is self-limited, no treatment other than reassurance may be necessary. There are no well-designed randomized controlled trials of the treatment of granuloma annulare. Treatment recommendations are based on the pathophysiology of the disease, expert opinion, and case reports only. Liquid nitrogen, injected steroids, or topical steroids under occlusion have been recommended for treatment of localized disease. Disseminated granuloma annulare may be treated with one of several systemic therapies such as dapsone, retinoids, niacinamide, antimalarials, psoralen plus ultraviolet A therapy, fumaric acid esters, tacrolimus, and pimecrolimus. Consultation with a dermatologist is recommended because of the possible toxicities of these agents.

The spectrum of primary cutaneous elastolytic granulomas and their distinction from granuloma annulare: a clinicopathological analysis.

AIMS: Actinic granuloma (AG) and annular elastolytic giant cell granuloma (AEGCG) are terms commonly applied to cutaneous lesions characterized by elastolysis, elastophagocytosis and a multinucleated cell infiltrate. The aim of this study was to clarify the relationship of these lesions to granuloma annulare (GA) which they resemble clinically. METHODS AND RESULTS: The clinicopathological data of 20 patients whose biopsies showed the histology of elastolytic granuloma as well as those of previously published cases with identical tissue changes were analysed to assess differences between AG, AEGCG and GA. The tissue changes of AG and AEGCG are identical and differ substantially from GA because of the predominant elastolysis and elastophagocytosis in the absence of necrobiosis and palisading granuloma. Actinic and/or thermal injury could be elicited frequently in the patient's history, but not always. CONCLUSIONS: AG may be considered as an aetiopathological subdivision of AEGCG. Patients with biopsies showing both GA and AEGCG are occasionally encountered. AEGCG is easily differentiated from incidental elastolysis which may be seen in a variety of aetiologically unrelated processes.

Actinic granuloma is a unique and distinct entity: a comparative study with granuloma annulare.

Since the initial description of actinic granuloma (AG), debate has continued over whether it should be considered a specific condition or simply granuloma annulare (GA) located in sun-exposed areas of skin. We conducted a case-control study to clarify this issue. Twenty cases given the diagnosis of AG between 1991 and 2001 were retrieved from our archives. We applied the following inclusion criteria: extensive loss of elastic tissue in or at the side of the granuloma, and elastophagocytosis. Sixteen cases of GA that involved sun-exposed and non-sun-exposed sites, 8 cases from each group, were randomly selected as controls. Histologic parameters were quantitated on hematoxylin-eosin, Verhoeff van Gieson, and Alcian blue stains for each case. Results were statistically analyzed by SPSS program version 9. Fourteen cases of AG met our inclusion criteria. Presence of mucin, occurrence of multinucleated giant cells, and the type of granulomata were of high statistical significance (p < 0.01) in distinguishing the two entities. We also found that the location of the granulomata in these conditions is different and of statistical significance (p < 0.05). Based on histomorphology, we believe that AG should be considered a separate, independent condition and should be distinguished from GA even in sun-exposed areas of skin.

A case of recurrent disseminated granuloma annulare.

We present an 11-year-old boy who developed multiple pruritic, skin-coloured papules on his forehead, which subsequently spread to his trunk and limbs over a period of 6 months. Histology revealed granuloma annulare. The lesions underwent spontaneous regression over the next five years. He presented again when he was 18 years old, with a spontaneous eruption of multiple lesions on the trunk and the limbs 2 years after complete clinical remission from the first attack. A punch biopsy performed at this presentation revealed granuloma annulare again. No treatment was given and he is still being followed up. The tendency for spontaneous resolution of granuloma annulare is well recognised. Recurrent localized lesions often disappeared more rapidly than the original ones. Recurrence of disseminated GA, to our knowledge, has not been reported before.

Papular elastolytic giant cell granuloma: a clinical variant of annular elastolytic giant cell granuloma or generalized granuloma annulare?

A 71-year-old man with asymptomatic red papules on the trunk and upper arms was reported as a case of papular elastolytic giant cell granuloma. A skin biopsy specimen from a papule on the back showed similar findings to those of annular elastolytic giant cell granuloma. However, centrifugal annular lesions were not clinically observed. He was successfully treated with tranilast and topical steroids.

Granuloma anular: sus variedades clínicas y asociaciones con enfermedades sistemicas/ nuestra experiencia / Annular granuloma: Clinical variants and the associations with systemic diseases/ our experiencie

Se realiza una revisión bibliográfica sobre granuloma anular, sus variantes clínicas y sus asociaciones con enfermedades sistémicas. Presentamos un estudio retrospectivo que incluye una serie de 32 pacientes atendidos en el servicio de dermatología del Hospital de Córdoba, en el lapsop de 10 años, comprendidos entre los años 1988 a 1997. Tales pacientes tenían diagnóstico clínico de granuloma anular corroborado histopatológicamente. Se estudia la incidencia etaria, de sexo, las variantes clínicas, así como tambien sus asociaciones con otras patologías

Granuloma anular: sus variedades clínicas y asociaciones con enfermedades sistemicas/ nuestra experiencia / Annular granuloma: Clinical variants and the associations with systemic diseases/ our experiencie

Se realiza una revisión bibliográfica sobre granuloma anular, sus variantes clínicas y sus asociaciones con enfermedades sistémicas. Presentamos un estudio retrospectivo que incluye una serie de 32 pacientes atendidos en el servicio de dermatología del Hospital de Córdoba, en el lapsop de 10 años, comprendidos entre los años 1988 a 1997. Tales pacientes tenían diagnóstico clínico de granuloma anular corroborado histopatológicamente. Se estudia la incidencia etaria, de sexo, las variantes clínicas, así como tambien sus asociaciones con otras patologías(AU)

Granuloma anular subcutáneo en la infancia: a propósito de un caso / Subcutaneous granuloma annulare in infant: a case report

Comunicamos un caso clínico caracterizado por la aparición progresiva de nódulos en el borde lateral de ambos antebrazos, en un paciente de 6 años sin antecedentes mórbidos ni quirúrgicos de importancia. El estudio histopatológico reveló focos de necrobiosis de colágeno en la dermis papilar y reticular con granulomas perifocales típicos de granuloma anular. El interés de este caso reside en su baja frecuencia y en la variedad de diagnósticos diferenciales que deben plantearse