Association between adipophilin expression and risk of dyslipidaemia in patients with granuloma annulare.

BACKGROUND: An association between granuloma annulare (GA) and dyslipidaemia has been reported. Adipophilin expression may play a plausible role as a cutaneous biomarker for dyslipidaemia in patients with GA; however, this potential link remains to be explored. METHODS: Patients with GA were identified at our hospital between January 1, 1990, and December 31, 2021, with a thorough review of their clinical and histological characteristics. Adipophilin staining was assessed in biopsies of GA lesions. RESULTS: A total of 107 patients with GA were included. The prevalence of dyslipidaemia in patients with positive adipophilin staining was clearly higher than in those with negative labelling (62.3% vs 13.3%). Relative to the dyslipidaemia risk for patients with negative adipophilin expression, the odds for patients with positive adipophilin expression were increased 10-fold (OR: 10.8; p-value<.01). We identified 23 incident cases of dyslipidaemia over a median follow-up period of 91 months among 54 patients with no history of dyslipidaemia. The patients with positive adipophilin expression showed a higher risk of developing dyslipidaemia (HR: 8.9; p-value<.01). CONCLUSIONS: Patients with positive adipophilin staining in their GA biopsies were found to be associated with a higher risk for both baseline and incident dyslipidaemia.

Pruritus and Cutaneous Lesions: Granuloma Annulare vs. Mycosis Fungoides in a Pa-tient with Comorbidities. Case Report

Introduction: Pruritus is a common symptom in dermatological practice. Affecting patients with a wide range of cutaneous and systemic diseases. It can be caused by cutaneous disorders, systemic diseases, neurological disorders, psychological disorders, medications, among others. When assessing individuals with pruritus and cutaneous lesions, it is essential to consider mycosis fungoides and granuloma annulare as noteworthy differential diagnoses. Case presentation: A 51-year-old female patient exhibited symptoms of pruritus and two occurrences of pruritic skin lesions. Accompanied by a low-grade fever measuring 37.7 ºC, as well as asthenia and myalgia. Physical examination revealed two rounded plaques with erythematous borders and multiple non-confluent papular lesions. Discussion: Differentiating between mycosis fungoides and granuloma annulare can be challenging due to the similarities in their clinical presentations. However, performing a biopsy is essential to reach a definitive diagnosis.Conclusions: A biopsy is being suggested for the front part of the left lower limb. The application of mometasone furoate twice a day for two weeks was prescribed. Subsequently, a meeting has been arranged to conduct a review and to carefully analyze the biopsy findings within thirty days.

Introducción: El prurito es un síntoma frecuente en la práctica dermatológica, que afecta a pacientes con una amplia gama de enfermedades cutáneas y sistémicas. Puede estar causado por trastornos cutáneos, enfermedades sistémicas, trastornos neurológicos, trastornos psicológicos y medicamentos, entre otros. En la evaluación de personas con prurito y lesiones cutáneas, es fundamental tener en cuenta la micosis fungoide y el granuloma anular como diagnósticos diferenciales destacables. Presentación del caso clínico: Una paciente de 51 años de edad presentaba síntomas de prurito y dos apariciones de lesiones cutáneas pruriginosas, acompañadas de fiebre baja de 37.7 ºC, así como astenia y mialgias. El examen físico reveló dos placas redondeadas con bordes eritematosos y múltiples lesiones papulares no confluentes. Discusión: Diferenciar entre micosis fungoide y granuloma anular puede ser un reto debido a las similitudes en sus presentaciones clínicas. Sin embargo, la realización de una biopsia es esencial para llegar a un diagnóstico definitivo. Conclusiones:Se sugiere la realización de una biopsia en la parte anterior del miembro inferior izquierdo. Se prescribe la aplicación de furoato de mometasona dos veces al día durante dos semanas. Posteriormente, se ha concertado una reunión para realizar una revisión y deliberar sobre los resultados de la biopsia en un plazo de treinta días

Imaging palpable tumors in pediatrics.

Palpable tumors in children are a common reason for consulting a radiologist. The differential diagnosis is extensive and considerably different from that used in adults. Some of the etiologies of palpable tumors are little known outside of pediatrics. The most commonly used imaging test is ultrasonography, because in addition to being harmless and cost-effective, it is conclusive in most cases. Most palpable lesions in children are benign; it is estimated that only 1% are malignant. Knowing these lesions enables the correct diagnosis without the need to resort to unnecessary, sometimes invasive tests, thus avoiding delays in treatment when more severe disease is present. This article aims to review the clinical and radiological characteristics of the palpable lesions that are most common in pediatric patients, explaining the key features that enable accurate diagnosis.

Granuloma actínico: reporte de un caso / Actinic granuloma: a case report

Resumen El granuloma actínico es una dermatosis granulomatosa poco frecuente, que se observa en adultos de mediana edad con antecedentes de fotoexposición. Su patogénesis no es clara; siendo la teoría más aceptada la radiación solar como factor disparador. Se caracteriza por placas anulares con atrofia central y bordes eritematosos elevados que son similares a los observados en el granuloma anular. Se presenta el caso clínico de una paciente de 71 años, con placas anulares en antebrazos compatibles con granuloma actínico. Se comunica el caso por lo infrecuente de esta entidad y se realiza una revisión bibliográfica.

Abstract Actinic granuloma is a rare granulomatous dermatosis, seen in middle-aged adults with a history of photoexposure. Its pathogenesis is not clear; the most accepted theory being solar radiation as a triggering factor. It is characterized by annular plaques with central atrophy and raised erythematous borders that are similar to those seen in granuloma annulare. The clinical case of a 71-year-old patient with annular plaques on the forearms compatible with actinic granuloma is presented. The case is reported due to the infrequent nature of this entity and a bibliographical review is carried out.

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.

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)

Interstitial mycosis fungoides / Micose fungoide intersticial

ABSTRACT Interstitial mycosis fungoides (IMF) is a rare variant of mycosis fungoides, a cutaneous T-cell non-Hodgkin's lymphoma. It is characterized by an interstitial dermal infiltrate of lymphocytes and histiocytes between collagen bundles. We report the case of a 54-year-old patient with pruritic hypochromic macules on the arms and forearms diagnosed with IMF. Special attention was given to the anatomopathological features that differentiate this entity from its differential diagnoses, such as inflammatory morphea, interstitial annular granuloma, and other variants of the mycosis fungoides itself. We also present a review of the literature on the classification of the IMF.

RESUMEN La micosis fungoide intersticial (MFI) es una variante poco común de la micosis fungoide, un linfoma cutáneo de células T no Hodgkin. Se caracteriza por un infiltrado dérmico intersticial de linfocitos e histiocitos entre haces de colágeno. Presentamos el caso de un paciente de 54 años con máculas hipocrómicas pruriginosas en brazos y antebrazos diagnosticado de MFI. Se prestó especial atención a las características anatomopatológicas que diferencian a esta entidad de sus diagnósticos diferenciales, como morfea inflamatoria, granuloma anular intersticial y otras variantes de la propia micosis fungoide. También presentamos una revisión de la literatura sobre la clasificación de la MFI.

RESUMO A micose fungoide intersticial (MFI) é uma variante rara da micose fungoide, um linfoma cutâneo de células T não Hodgkin. É caracterizada por um infiltrado dérmico intersticial de linfócitos e histiócitos entre feixes de colágeno. Relatamos o caso de um paciente de 54 anos com máculas hipocrômicas pruriginosas nos braços e antebraços com diagnóstico de MFI. Atenção especial foi dada às características anatomopatológicas que diferenciam essa entidade de seus diagnósticos diferenciais, como morfeia inflamatória, granuloma anular intersticial e outras variantes da própria micose fungoide. Apresentamos também uma revisão da literatura sobre a classificação da MFI.

Granuloma Anular diseminado: a propósito de un caso / Disseminated annular granuloma: on the purpose of a case

RESUMEN El granuloma anular es un trastorno relativamente frecuente, se desconoce la prevalencia exacta, tiene mayor frecuencia en niños y adultos jóvenes. Se caracteriza por pequeñas pápulas agrupadas, en configuración anular, a menudo con distribución simétrica y acra. La mayor parte los casos se resuelve en forma espontánea dentro de los 2 años, pero la tasa de recidivas es del 40%. Presentamos el caso clínico de una paciente de 72 años de edad con granuloma anular diseminado, tratado con pentoxifilina, con buen resultado terapéutico.

ABSTRACT Annular granuloma is a relatively frequent disorder, the exact prevalence is unknown, it is more frequent in children and young adults. It is characterized by small grouped papules, in annular configuration, often with symmetric and acrid distribution. Most cases resolve spontaneously within 2 years, but the recurrence rate is 40%. We present the clinical case of a 72-year-old patient with disseminated annular granuloma, treated with pentoxifylline, with good therapeutic results.

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 atípico ¿sólo una patología benigna? / Atypical granuloma annulare¿only a benign entity?

RESUMEN El granuloma anular (GA) es una dermatosis inflamatoria crónica de carácter benigno, asintomática y autolimitada. Aún permanece desconocida la fisiopatología de dicha entidad, pero se ha sugerido una base inmunológica. Dicha dermatosis se caracteriza, en su forma clásica, por presentar pápulas que confluyen formando placas, de periferia elevada y centro deprimido, endisposición anular. Las lesiones son de color piel normal, ligeramente eritematosas o violáceas. Se describen diversas formas clínicas. Los cuatro tipos más frecuentes son: GA localizado, GA generalizado, GA perforante y GA profundo, subcutáneo o nodular. La clínica por sí sola, habitualmente, no presenta ningún desafío diagnóstico, ya que suele ser característica en la mayoría de los casos, peroen el caso de las formas clínicas atípicas es necesaria la confirmación con un estudio histopatológico. Se presenta el caso de un paciente masculino de 41 años de edad con dermatosis compatible con una forma atípica de GA.

ABSTRACT Granuloma annulare is a benign cutaneous inflammatory disease. It is usually asymptomatic and self-limited. While the exact pathophysiology is unknown, it has been associated with a retarded hypersensitivity of type IV driven by the presence of unspecified antigens. Classical cutaneous lesions are characterized by the presence of papules coalescing to form annular plaques with a central clearing or a central depression.The clinical manifestations vary from a usual localized form to a generalized one, both with erythematous, violaceous or skin-colored lesions. Given that most cases present the classical form, they do not pose a diagnostic challenge. However, histopathological study is necessary in the case of atypical clinical presentations. A 41-year-old male presented with a 4-month dermatosis. The physical examination showed four 2cm erythematous plaques, slightly infiltrated in the right upper limb and three lesions of 1cm in the left upper limb with the same characteristics. Tactile, pain and thermal sensitivity was conserved. The patient only referred to an occasionally mild pruritus.

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.

Granuloma anular elastolítico a células gigantes: Comunicación de un caso y comentarios sobre su ubicación nosológica / Annular elastolytic giant cell granuloma: A case report and commentaries about its nosological ubication

Comunicamos un caso del denominado granuloma anular elastolítico, con células gigantes, en una mujer de 73 años, quien lamentablemente no concurrió al control evolutivo. La ubicación nosológica y la relación con el granuloma actínico y el granuloma anular son discutidas.

A 73-year-old white female, with a several months of history of ring shaped skin lesions, localized in her proximal limbs are communicated. The annular lesions have erythematous raised borders, and an atrophic hypo pigmented central patches. The hematoxylin and eosin staining showed a granulomatous infiltrate in the upper and middle dermis, with elastophagocytosis and elastolisis. The histological diagnosis was annular elastolytic giant cell granuloma. The relationship with the actinic y annular granulomas is discussed.

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)

Granuloma anular generalizado y enfermedad de Hansen. Presentación de un caso / Generalized Annular Granuloma and Hansen’s disease. Presentation of a Case

El granuloma anular es una dermatosis inflamatoria crónica, benigna, de etiología desconocida, generalmente autolimitada. En muchas ocasiones la lepra tuberculoide asemeja un granuloma anular y este siempre debe ser un diagnóstico diferencial a tener en cuenta. La relación entre el granuloma anular y la lepra aún no está muy clara, aunque pudiera estar relacionado con mecanismos inmunológicos desencadenados en el curso de ambas enfermedades. Por tales razones se presenta el caso de una paciente con manifestaciones cutáneas de ungranuloma anulargeneralizado, cuyo comienzo fue concomitante con el noveno mes de tratamiento para la enfermedad de Hansen (forma clínica tuberculoide). Las principales manifestaciones cutáneas que presentaba eran lesiones eritematosas, papulosas y anulares, de tamaños predominantemente pequeño, formando grandes placas, localizadas en cuello, región superior de la espalda y miembros. Se detectaron las alteraciones histológicas propias de la enfermedad, lo que corroboró el diagnóstico planteado. Se presenta el caso porque,en la literatura consultada, esta enfermedad no está descrita frecuentemente en asociación con la enfermedad de Hansen.

Annular Granuloma is benign chronic inflammatory dermatoses of unknown etiology, usually self-limited. In many cases tuberculoid leprosy resembles an Annular Granuloma and this should always be a differential diagnosis to be considered. The relationship between Annular Granuloma and Leprosy is not yet clear, although it may be related to immunological mechanisms triggered in the course of both diseases. For these reasons it is presented a case of a patient with cutaneous manifestations of annular generalized granuloma, whose onset was concomitant with the ninth month of treatment for Hansen’s disease (tuberculoid clinical form). The main cutaneous manifestations presented were erythematous, papular and annular lesions, predominantly small in size, forming large plaques, located in the neck, upper region of the back and limbs. Histological alterations of the disease were detected, which corroborated the diagnosis. The case is presented because, in the consulted literature, this disease is not frequently described in association with Hansen’s disease.

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.

Necrobiosis lipoidica: a descriptive study of 35 cases.

INTRODUCTION AND OBJECTIVES: Necrobiosis lipoidica (NL) is a chronic idiopathic granulomatous disease considered to occur in association with diabetes mellitus. Data on the frequency of this association, however, are inconsistent. Our aim was to retrospectively analyze the clinical characteristics of patients diagnosed with NL at our hospital and to investigate the association with diabetes mellitus and other diseases. MATERIAL AND METHODS: We performed a chart review of all patients with a clinical and histologic diagnosis of NL treated and followed in the dermatology department of Hospital de Bellvitge in Barcelona, Spain between 1987 and 2013. RESULTS: Thirty-five patients (6 men and 29 women with a mean age of 47.20 years) were diagnosed with NL in the study period. At the time of diagnosis, 31 patients had pretibial lesions. Thirteen patients (37%) had a single lesion at diagnosis, and the mean number of lesions was 3.37. Twenty-three patients (65.71%) had diabetes mellitus (type 1 in 10 cases and type 2 in 13). In 20 patients, onset of diabetes preceded that of NL by a mean of 135.70 months. The 2 conditions were diagnosed simultaneously in 3 patients. None of the 35 patients developed diabetes mellitus during follow-up. Six patients had hypothyroidism, and 4 of these also had type 1 diabetes. CONCLUSIONS: NL is frequently associated with type 1 and 2 diabetes. Although diabetes tends to develop before NL, it can occur simultaneously.

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.

Granuloma anular: un desafío diagnóstico y terapéutico / Granuloma annulare: a therapeutic and diagnostic challenge

Efectuamos una revisión de la etiopatogenia, clínica, histopatología, diagnósticos diferenciales y tratamiento del granuloma anular, cuyas diversas facetas constituyen un desafío para el dermatólogo clínico y en ocasiones el dermatopatólogo.

A review of the ethiopathogenic, clinical features, histological patterns, differential diagnosis and therapeutics approach of the granuloma annulare are made. The different aspects of this enigmatic disease are a challenge for the clinical dermatologist and the dermopathologist.