Deep Granuloma Annulare Mimicking Inflamed Cysts in a Teenager.

We describe deep granuloma annulare (DGA) of the forehead mimicking inflamed cysts. Reactive inflammation and sterile purulent drainage may be an underrecognized feature of DGA.

Subcutaneous granuloma annulare of the penis associated with a urethral anomaly: case report and review of the literature.

Granuloma annulare (GA) is an uncommon benign inflammatory skin condition, most often found on the extremities of young females. The subcutaneous variant of GA involving the penis is very rare. We report a case of subcutaneous GA associated with a urethral anomaly in a 15-year-old boy that persisted for a year. Treatment options are discussed with a review of the current literature.

Treatment of granuloma annulare with the 595-nm pulsed dye laser, a multicentre retrospective study with long-term follow-up.

BACKGROUND: Granuloma annulare (GA) is limited in most cases to isolated lesions, but more widespread generalized forms can be observed. In both cases, the treatment remains highly challenging. Isolated case reports suggested the interest of treating GA with a pulsed dye laser (PDL). OBJECTIVE: To evaluate the PDL in treating GA. MATERIALS AND METHODS: Retrospective multicentre study. Each patient should have at least two lesions of GA including at least one that remained untreated to serve as a control. The evaluation was performed on an Investigator Global Assessment for each lesion as compared with baseline. RESULTS: Thirteen patients (five with localized GA and eight with generalized GA) with a total of 59 lesions have been treated with a maximum of three PDL sessions. Sixteen lesions (27.1%) achieved >50% of clearing (14% of lesions for generalized GA and 56.2% for localized GA). Transient hyperpigmentation and crusting were observed in 59% and 86% of lesions respectively. The median follow-up was 6 months (2-12) and 10 lesions (all in generalized GA) recurred after initial clearing. CONCLUSION: Generalized GA showed weak improvement after treatment with a high recurrence rate. Only localized forms showed notable improvement in a more than half of treated lesions. Thus, PDL could be proposed as an alternative approach, but only for localized forms of GA.

Orbital granuloma annulare as presentation of systemic sarcoidosis.

PURPOSE: To report a unique case of an orbital mass with atypical histopathologic features that although overlap with other granulomatous disorders, likely represents orbital involvement of systemic sarcoidosis. METHODS: Observational case report. RESULTS: A 51-year-old woman presented with an orbital mass and was found to have mild proptosis and restriction of ocular motility. The remainder of her ophthalmic exam was unremarkable. Excisional biopsy revealed ill-defined granulomas with central necrosis, chronic inflammation and sclerotic collagen; several features consistent with granuloma annulare. Further systemic workup including laboratory and radiologic studies were compatible with a diagnosis of systemic sarcoidosis. CONCLUSION: Our case emphasizes the importance of a complete systemic workup with the detection of an orbital granuloma to ensure accurate diagnosis and appropriate management.

Granuloma annulare of the penis: a uncommon location for an usual disease.

The subcutaneous clinical variant of granuloma annulare (GA) is rare and tends to present more frequently in children, in locations unusual for conventional GA. Involvement of the penis is exceptional and has been rarely reported. Most cases are located in the shaft of the penis and tend to persist without spontaneous remission. Diagnosis is done only after biopsy, and surgical resection of the lesions is not unusual. We report a new case of subcutaneous GA of the penis in a 13-year-old boy with lesions persistent for the past year. Surgical excision of one of them allowed the correct diagnosis. No further treatment was done, and the condition has not remitted 1 year later. We stress the importance of clinical recognition of unusual presentations of GA to avoid overtreatment of lesions that do not need an aggressive approach.

Granuloma annulare mimicking dorsal knuckle pads.

A 37-year-old man underwent excision of what was presumed to be knuckle pads associated with Dupuytren disease. The histology revealed granuloma annulare, which is typically treated nonsurgically. This report includes a discussion of granuloma annulare and its differentiation from knuckle pads.

[Perforating granuloma annulare with transfollicular perforation]. / Granulome annulaire perforant unique avec phénomène d'élimination transfolliculaire.

INTRODUCTION: The perforating granuloma annulare is a rare form of granuloma annulare. The clinical diagnosis is difficult and the confirmation is histological. The localisation is unique in less than 10% of all cases. We report a documented case with a histological suspicion of transfollicular perforation. OBSERVATION: A 36 year-old woman, without any particular antecedent, presented on her upper arm a single ulcerated nodular lesion that had evolved for one year. The clinical examination and biological investigations were normal. The histological examination led to the diagnosis of perforating granuloma annulare with a large epidermic ulceration. Treatment with a topical corticosteroid was disappointing and the removal was decided. DISCUSSION: In our observation, the single localization of this lesion raises the problem of differential diagnosis such as cutaneous tuberculosis, atypical mycobacteriosis, skin sarcoidosis, foreign body granuloma, epidermoid carcinoma or perforating dermatitis. The histological examination permitted diagnosis of a perforating granuloma annulare with large epidermic ulceration. The infiltration and destruction of a hair follicle evoked the possible transfollicular elimination of the necrotic material. Other pathologies with the histological aspect of a palisading granuloma were excluded from this context. No associated pathology such as diabetes nor any other favouring factors such as ultraviolet light or insect bites or traumas were identified. The physiopathology of perforating granuloma annulare and the process of perforation remain unknown. Numerous therapies have been proposed with variable results.

A giant rheumatoid nodule.

Subcutaneous rheumatoid nodules occur commonly in advanced cases of rheumatoid arthritis and are the most common extra-articular lesion of this disease. We present a case of a very unusual giant rheumatoid nodule that developed on the lateral side of a knee. The case was devoid of systemic symptoms of arthritis and the lesion was limited to a rheumatoid nodule. The nodule was successfully treated by surgical excision. However, other new nodules developed in her hand. Her clinical course has not been satisfactory.

Multiple palisading granulomas in the scalp of an infant: a case report.

BACKGROUND: We describe an unusual lesion that represents an uncommon but important element in the differential diagnosis of subcutaneous scalp nodules in a child. CASE DESCRIPTION: A 1-year-old boy presented with two clusters of subcutaneous scalp nodules. The lesions increased in size and number. Computed tomography showed no changes in underlying bone. Findings on magnetic resonance imaging were nonspecific. Serologic and clinical evaluation showed no evidence of rheumatic disease. Complete excision of the nodules, together with adjacent fascia and galea, was performed. Histopathologic examination showed the lesions to be palisading granulomas; given the absence of rheumatic disease, these represented deep granuloma annulare, a benign condition. No recurrence has been observed in our patient. CONCLUSION: While we chose total excision because of preoperative concerns about a possible malignant tumor, some other authors have suggested that surgery be limited to confirmatory biopsy when a benign lesion such as palisading granuloma is strongly suspected.

Subcutaneous granuloma annulare of the eyelid. A case report.

A rare case of subcutaneous granuloma annulare of the eyelid is reported. A diabetic patient developed a unilateral periorbital tumorous mass. Biopsy revealed subcutaneous palisading granuloma. By microscopy and immunohistology, other granulomatous reactions including necrobiosis lipoidica could be ruled out. Since treatment with dapsone was without effect, the tumor was surgically excised. The differential diagnosis and the literature are briefly discussed.

Granuloma annulare, nodular type--a subcutaneous pseudorheumatoid lesion in children.

Five cases of patients aged between 2 years 8 months and 5 years 6 months with subcutaneous nodular granuloma annulare are reported. Histologically the lesions resembled rheumatoid nodules, consisting of acellular central areas surrounded by palisading histiocytes. Complete or partial excisions were done for diagnosis. Initially the granulomata were not associated with any symptoms of systemic illness, but one patient with IgG deficiency developed subsequent polyarthritis. Antistreptolysin O, antinuclear antibodies and latex fixation test for rheumatoid arthritis were negative except for one patient with additional erythema nodosum and elevated antistreptolysin level. In the other patients the laboratory data were uncharacteristic. The clinical course may be characterized by spontaneous regression and frequent recurrence. In asymptomatic patients further treatment is not necessary. Patients with progressive disease or elevated inflammatory activity were treated with nonsteroidal antirheumatics. The development of subsequent rheumatoid disease in primarily asymptomatic patients is unlikely, but we recommend further observation by an experienced pediatrician.

[Subcutaneous nodules in children: subcutaneous granuloma annulare]. / Nódulos subcutáneos en la infancia: granuloma anular subcutáneo.

Subcutaneous granuloma annulare is a benign, chronic inflammatory lesion located usually at scalp or extremities and typical of childhood. Its etiology is unknown and no link with systemic diseases has been found. A thorough clinical history and normality at complementary tests are enough for its identification. It tends to dissaparition, so no therapy is needed although histologic study will let a definitive diagnosis. A case in a three years-old boy is reported. He was submitted because of four asymptomatic, long-lasting tough lesions at his scalp, without other antecedents. Radiologic and hematologic tests found no alteration. Two months later a larger size was appreciated in one of them, so it was removed and its histology was diagnostic for granuloma annulare. After a 10 months follow-up, no change in size has been detected in the remaining ones.

Atypical subcutaneous granuloma annulare on the digit: a case report.

Subcutaneous granuloma annulare is a benign inflammatory disorder consisting of deep dermal or subcutaneous nodules, and frequently occurring in the extremities and scalp in children. The occurrence of aggregated multiple nodules in a digit is quite atypical. This is a report of an eight-year-old girl who presented with increasingly asymptomatic multiple nodules on her middle finger over a period of six months. Definitive diagnosis of subcutaneous granuloma annulare was achieved with surgical biopsy and no aggressive growth subsequently and showed a tendency toward spontaneous resolution.