Granuloma anular maculoso / Patch granuloma annulare

El granuloma anular maculoso es una variante rara de granuloma anular, que representa un desafío diagnóstico. Su incidencia se desconoce y se presenta con mayor frecuencia en las mujeres de entre 40 y 70 años. Se asocia a las mismas entidades y responde a los mismos tratamientos que las otras variantes clínicas de granuloma anular. Se presentan los casos de 5 mujeres con diagnóstico de granuloma anular maculoso, que recibieron diferentes tratamientos tópicos y sistémicos, con respuestas clínicas variables.

Patch-type granuloma annulare is a rare variant of granuloma annulare, thus which represents diagnostic challenge. It has an unknown incidence and occurs most often in women between 40 and 70 years of age. It presents similar associations and responds to treatment as the clinical variants. We present 5 emale patients with patch-type granuloma annulare, who received different topical and systemic treatments, with variable clinical responses.

Generalized granuloma annulare after pneumococcal vaccination

Abstract Granuloma annulare may be caused by multiple triggers. Among these are vaccinations, which have been described as an infrequent cause of granuloma annulare. The authors report the first case of generalized granuloma annulare associated with pneumococcal vaccination in a 57-year-old woman, who presented cutaneous lesions 12 days after vaccination.

Granuloma anular en niños: serie de casos / Annulare Granuloma in children: case series

Antecedentes: El Granuloma anular es una dermatosis benigna, autolimitada, de etiología desconocida, más frecuente en el género femenino y caracterizada por pápulas que adoptan usualmente una configuración anular. De acuerdo a su presentación ha sido clasificado en: localizado, generalizado, subcutáneo y perforante. El diagnóstico es clínico, pero en casos dudosos se recurre a estudios histopatológicos y dermatoscópicos. Su curso es generalmente autolimitado por lo que una conducta expectante, es lo más apropiado. Descripción de casos clínicos: Se presentan 3 casos pediátricos evaluados en la consulta externa del servicio de dermatología del Hospital Escuela, por lesiones localizadas principalmente en manos y pies. El caso 1 y 2, corresponden típicamente a granuloma anular localizado. El caso 3 presentó lesiones poco usuales, tipo pápulas de 1 a 3 mm de diámetro con umbilicación central, correspondiendo clínicamente a una variante rara, de granuloma anular papular umbilicado. La biopsia confirmó el diagnóstico de granuloma anular en los 3 casos. Conclusiones: El conocimiento de esta patología relativamente frecuente, permitirá al gremio médico en general y pediatras en particular, reconocer que se trata de una enfermedad que tiene un curso benigno y autolimitado, evitando así procedimientos agresivos e innecesarios...(AU)

Granuloma anular perforante: patologia inusual / Perforating Granuloma Annulare: unusual pathology

Resumen El Granuloma Anular (GA) es una dermatosis inflamatoria crónica, benigna, auto limitada, de etiología desconocida. Existen numerosas variantes clínicas dentro de las cuales se encuentra la perforante, de presentación inusual. La histopatología más característica de GA, cuenta con la presencia de histiocitos epitelioides en empalizada alrededor de áreas de degeneración focal de fibras de colágeno con depósitos de mucina. La variedad perforante evidencia eliminación transepidérmica de fibras de colágeno. Se presenta un paciente de 72 años de edad, diabético, dislipémico, con lesiones pruriginosas en dorso de ambas manos, con el diagnóstico de granuloma anular perforante. Realizó tratamiento con clobetasol tópico, más antihistamínicos por vía oral, quedando una cicatriz atrófica.

Abstract Granuloma annulare is a chronic, benign, self-limiting, inflammatory dermatosis of unknown etiology. There are numerous clinical variants within which is the perforating, unusual presentation. The most histopathology characteristic of GA is the presence of palisading epithelioid histiocytes around areas of focal degeneration of collagen with mucin deposits. The perforating variety evidences transepidermal elimination of collagen tissue. A 72 years-old, diabetes, dyslipidemic patient is presented with pruritic lessions on the dorsum of both hands, with the diagnosis of perforating granuloma annulare. I perform medical treatment with topical clobetasol, leaving an atrophic scar.

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.

Granuloma anular generalizado y fenómeno isotópico de Wolf / Generalized annular granuloma and Wolf''s isotopic response

El granuloma anular (GA) es una dermatosis inflamatoria granulomatosa, generalmente asintomática, con distintas formas de presentación clínica, que puede distribuirse de forma localizada o generalizada. su etiología es incierta pero se la ha vinculado a factores desencadenantes como traumatismos, fármacos, diabetes mellitus, tiroideopatías, neoplasias, infecciones virales (herpes simple y varicela zóster) y excepcionalmente puede aparecer en la misma localización donde previamente aconteció otra enfermedad con la cual no guarda relación alguna (fenómeno isotópico de Wolf). En su patogenia intervendrían mecanismos de hipersensibilidad retardada y de estrés oxidativo celular. Existen múltiples terapias con respuesta variable y se ha observado autorresolución en casi el 75% de los casos. Presentamos el caso de una mujer de 64 años de edad, hipotiroidea de larga data, con un granuloma anular generalizado que apareció sobre cicatrices residuales de un herpes zóster (fenómeno isotópico de Wolf) y su respuesta al tratamiento con Vitamina E por vía oral

Granuloma annulare (GA) is a granulomatous inflammatory dermatosis, usually asymptomatic, with different forms of clinical presentation, which can be localized or generalized. Its etiology is uncertain but has been linked to triggers such as trauma, drugs, diabetes mellitus, thyroid disease, neoplasms and viral infections (herpes simplex, varicella-zoster). Exceptionally, it may appear in the same location where another disease has previously occurred but with no relationship to it (Wolf isotopic response). In their pathogenesis, delayed hypersensitivity mechanisms and cellular oxidative stress would intervene. There are multiple therapies with variable response, and autorresolution has been observed in almost 75% of the cases. We present the case of a 64-year-old woman with a long history of hypothyroidism, with diagnosis of generalized granuloma annulare on residual scars of Herpes Zoster (Wolf 's isotopic response) and its response to oral Vitamin E.

Coexistence of morphea and granuloma annulare: a rare case report

ABSTRACT CONTEXT: Localized scleroderma (morphea) is characterized by fibrosis of skin and subcutaneous tissue. Granuloma annulare is a relatively common disease that is characterized by dermal papules and arciform plaques. CASE REPORT: Here, we present the case of a 42-year-old woman who developed granuloma annulare on the dorsum of her feet and abdominal region, and morphea on the anterior side of her lower limbs. We also discuss the etiological and pathogenetic processes that may cause the rare coexistence of these two diseases. CONCLUSION: Only a few cases in the literature have described coexistence of morphea and granuloma annulare.

Granuloma annulare on the palms in an elderly patient

Abstract: Granuloma annulare is a relatively common, idiopathic, benign inflammatory dermatosis, with a varied clinical presentation that often makes diagnosis difficult. It mainly affects the extremities, such as the dorsa of the hands and feet, forearms and legs. Palmar and plantar regions are generally spared. It occurs mainly in young female patients. The presentation of the palmar variant in an elderly patient is a rarity.

Scanning electron microscopy of granuloma annulare

Abstract: Light microscopy of granuloma annulare shows mucin deposition with lympho-histiocytic infiltrate. We describe the ultrastructural three-dimensional aspects of a typical case of granuloma with characteristic histopathological findings. At the ultrastructural level, affected collagen bundles and granular mucin deposition were observed. Round cells corresponding to lymphocytes were identified. Bigger oval cells, corresponding to isolated or palisading histiocytes were also found. The ultrastructural aspects overlap with light microscopy and contribute to its iconographic documentation.

Case for diagnosis. Patch granuloma annulare

Abstract A 59-year-old woman reported a 20-day history of slightly scaly erythematous infiltrated patches on her palms and soles with a histopathological result which was consistent with interstitial-pattern granuloma annulare, clinically classified as patch granuloma annulare. This is a rare clinical variant of granuloma annulare, with an unknown incidence and characteristic clinical and histopathological features. The patient evolved with a complete remission of the lesions after biopsy and the use of high-potency topical corticosteroid.

Patch-type granuloma annulare: a case report

Granuloma annulare (GA) is a benign, self-limited condition which the etiology remains unknown. It is clinically characterized as annularly, erythematous papules on the extremities. Histologically, it shows as palisading granulomas with central degenerated collagen and mucin deposits. The patient in this case report had a rare GA variant named patch-type GA. It appeared as asymptomatic erythematous macules with central clarification on the upper portion of thighs. Histopathology was compatible with interstitialtype GA. We highlight that a high index of suspicion is necessary to make the diagnosis of patch-type GA and confirmation can only be achieved through histopathology study. (AU)

O granuloma anular (GA) é uma condição benigna, autolimitada e de etiologia desconhecida. Clinicamente é caracterizado por pápulas eritematosas anulares nas extremidades. Do ponto de vista histológico, observa-se a formação de granulomas com colágeno degenerado em sua porção central e depósito de mucina. O paciente deste caso clínico foi diagnosticado com uma variante rara de granuloma anular, na sua forma macular. A lesão se apresentava como máculas eritematosas assintomáticas na porção superior das coxas. Nos cortes histológicos, o quadro era compatível com GA do tipo intersticial. Neste trabalho enfatiza-se a necessidade de um elevado índice de suspeição clínica para o diagnóstico de GA macular e a confirmação só poderá ser alcançada através do estudo histopatológico. (AU)

Diabetes mellitus and the skin

Abstract: Several dermatoses are routinely associated with diabetes mellitus, especially in patients with chronic disease. This relationship can be easily proven in some skin disorders, but it is not so clear in others. Dermatoses such necrobiosis lipoidica, granuloma annulare, acanthosis nigricans and others are discussed in this text, with an emphasis on proven link with the diabetes or not, disease identification and treatment strategy used to control those dermatoses and diabetes.

Granuloma annulare treated with narrowband UVB phototherapy

Abstract Granuloma annulare is a benign cutaneous inflammatory disease, whose lesions have spontaneous improvement in two years in 50% of cases, but there is recurrence in 40% of patients. Treatment may be topical, intralesional or systemic. The use of phototherapy with narrowband UVB is highlighted, whose mechanism of action in this disease is still unclear, probably related to the inhibition of T lymphocytes. Herein, a case of a disseminated granuloma annulare of difficult therapeutic management is described. It was treated with narrowband UVB phototherapy twice a week for six months, with good clinical improvement, being a good low-risk therapeutic option and that, in this case, provided quick and satisfactory response.

Granuloma anular subcutáneo: reporte de un caso / Subcutaneous granuloma annulare: a case report

El granuloma anular es una dermatosis inflamatoria granulomatosa de carácter benigno y autolimitado. El granuloma anular subcutáneo es una variante poco común, que se presenta casi exclusivamente en niños menores y se caracteriza por la aparición de nódulos de consistencia firme de predominio en extremidades inferiores, glúteos, manos y cuero cabelludo. OBJETIVO: Reportar un caso de granuloma anular subcutáneo, revisar su diagnóstico diferencial y las opciones terapéuticas actuales. CASO CLÍNICO: Paciente de sexo masculino de 4 años. Desde los 2 años y medio con nódulos subcutáneos indurados asintomáticos, inicialmente en dorso de dedo medio mano izquierda, luego en dorso de mano izquierda, primer ortejo derecho, zona frontal izquierda y cuero cabelludo. La biopsia excisional de algunas lesiones de cuero cabelludo fue compatible con granuloma anular subcutáneo. Como tratamiento se indicó clobetasol 0,05% crema 2 veces al día en lesiones por 1 mes, sin cambio en las lesiones. CONCLUSIONES: El granuloma anular subcutáneo debe considerarse dentro del diagnóstico diferencial de nódulos subcutáneos en niños. En la mayoría de los casos se requerirá biopsia y estudio histopatológico de las lesiones para su confirmación diagnóstica. Debido a su tendencia a la resolución espontánea, generalmente se sugiere no tratar y controlar periódicamente.

Granuloma annulare is a benign and self-limited cutaneous disease. Subcutaneous granuloma annulare is an uncommon variant seen almost exclusively in young children, characterized by firm nodules appearing more frequently in lower extremities, buttocks, hands and scalp. OBJECTIVE: To report a case of subcutaneous granuloma annulare and review its differential diagnoses and treatments. CLINICAL CASE: A 4 year-old male patient. Since 2 and a half years of age he presented asymptomatic firm subcutaneous nodules on the back of the left middle finger and later on the back of the left hand, right big toe, left frontal area and scalp. Excisional biopsy of some lesions from the scalp was consistent with subcutaneous granuloma annulare. Clobetasol 0,05% cream twice a day for 1 month was prescribed without response. CONCLUSIONS: Subcutaneous granuloma annulare must be considered within the differential diagnosis of subcutaneous nodules in children. In most of the cases a biopsy and histopathology of the lesions will be required to confirm the diagnosis. Due to its tendency to spontaneous resolution, treatment often is not necessary and periodic evaluation is recommended.

Perforating granuloma annulare mimicking papulonecrotic tuberculid / Granuloma anular perfurante simulando tuberculide papulo-necrotica

A case is reported of a patient presenting lymph node tuberculosis and cutaneous lesions resembling papulonecrotic tuberculid, but histologically compatible with perforating granuloma annulare and which responded satisfactorily to antituberculous therapy. This is probably one of the first reports of the association of perforating granuloma annulare and tuberculosis, and it is important therefore to highlight the relevance of this disorder in the differential diagnosis of papulonecrotic tuberculid and to raise the hypothesis that this entity should also be considered to be a variant of tuberculid.

Os autores relatam o caso de uma paciente com tuberculose ganglionar e lesões cutâneas clinicamente sugestivas de tubercúlide pápulo-necrótica, porém com histopatologia compatível com granuloma anular perfurante, e que apresentaram melhora após tratamento para a tuberculose. Trata-se, possivelmente, de um dos primeiros relatos da associação de granuloma anular perfurante com tuberculose, salientando a importância desta entidade no diagnóstico diferencial da tubercúlide pápulo-necrótica e levantando a possibilidade da mesma ser considerada, também, uma variante de tubercúlide.

Granuloma anula papular umbilicado en un adolescente / Papular umilicatted granuloma annulare in an adolescent / Grauloma anular papular umbilicado em um adolescente

El granuloma anular es una enfermedad granulomatosa benigna con diferentes manifestaciones clínicas que incluye la forma localizada, generalizada, perforante, subcutánea, en parche, papular y lineal. El granuloma anular papular umbilicado es considerado una variante de la forma papular y en la literatura anglosajona se han reportado muy pocos casos. Se presenta el caso de un adolescente con pápulas eucrómicas asintomáticas en el dorso de las manos desde la infancia. La biopsia sugirió liquen nitidus, posteriormente la correlación clínico-patológica permitió hacer diagnóstico de granuloma anular papular umbilicado. Se resalta la importancia de este diagnóstico diferencial y la cronicidad de las lesiones.

The granuloma annulare is a benign granulomatous disease with different clinical manifestations including, localized, generalized, perforating, subcutaneous, patch type, papular and linear types. Papular umbilicated granuloma annulare is considered to be a variant of the papular type and in the Anglo-Saxon literature very few cases have been reported. We describe the case of an adolescent with asymptomatic skin colored papules on the dorsal aspect of the hands since infancy. The biopsy suggested lichen nitidus and after the clinicopathological correlation the diagnosis of papular umbilicated granuloma annulare was made. We highlight the importance of this differential diagnosis and the chronicity of the lesions.

O granuloma anular é uma doença granulomatosa benigna com diferentes manifestações clínicas que inclui a forma localizada, generalizada, perfurante, subcutânea, em parche, papular e linear. O granuloma anular papular umbilicado é considerado uma variante da forma papular e na literatura anglo-saxã foram relatados muito poucos casos. Apresenta-se o caso de um adolescente com pápulas acrômicas assintomáticas no dorso das mãos desde a infância. A biopsia sugeriu líquen nitidus, posteriormente a correlação clínico-patológica permitiu fazer diagnóstico de granuloma anular papular umbilicado. Destaca-se a importância deste diagnóstico diferencial e a cronicidade das lesões.