Generalized granuloma annulare

Medical condition

Generalized granuloma annulare

Specialty	Dermatology

Generalized granuloma annulare is a skin condition of unknown cause, tending to affect women in the fifth and sixth decades, presenting as a diffuse but symmetrical, papular or annular eruption of more than ten skin lesions, and often hundreds.

Signs and symptoms

Generalized granuloma annulare is a chronic granulomatous dermatosis that typically affects young adults' distal extremities and manifests as annular grouped papules. On the trunk and extremities, numerous flesh-colored papules arranged in an annular pattern are the hallmark of generalized granuloma annulare. These lesions are frequently itchy, in contrast to the traditional presentation.

Causes

A variety of factors, such as infection, sun exposure, medication use, and trauma, appear to play a role in the development of the disease.

Diagnosis

It has been observed that certain laboratory abnormalities exist, such as hyperlipidemia, hypergammaglobulinemia, and the presence of circulating antinuclear antibodies. Histopathologic analysis may show lymphohistiocytic granuloma-related alterations primarily in the papillary and mid dermis. Palisaded or interstitial patterns, or a combination of the two, may be seen in inflammatory infiltrates.

Treatment

Generalized granuloma annulare is mostly treated with phototherapy as opposed to oral steroids, however treatment efficacy is constrained by a high rate of recurrence after stopping treatment.

Epidemiology

Generalized granuloma annulare accounts for up to 15% of granuloma annulare cases.

References

James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 978-0-7216-2921-6.
Mangold, Aaron R.; Cumsky, Helen J.L.; Costello, Collin M.; Xie, Daniel Y.; Buras, Matthew R.; Nelson, Steven A.; DiCaudo, David J.; Sekulic, Aleksandar; Pittelkow, Mark R. (2018). "Clinical and histopathologic features of paraneoplastic granuloma annulare in association with solid organ malignancies: A case–control study". Journal of the American Academy of Dermatology. 79 (5). Elsevier BV: 913–920.e1. doi:10.1016/j.jaad.2018.06.022. ISSN 0190-9622. PMID 29920319. S2CID 49309849.
^ Schmieder, Shawn J.; Harper, Chelsea D.; Schmieder, George J. (June 21, 2023). "Granuloma Annulare". StatPearls Publishing. PMID 29083715. Retrieved February 5, 2024.
^ Lee, Jun Hyo; Cho, Soyun (2022). "Resolution of refractory generalized granuloma annulare after treatment with alitretinoin". JAAD Case Reports. 24. Elsevier BV: 38–41. doi:10.1016/j.jdcr.2022.04.006. ISSN 2352-5126. PMC 9118481. PMID 35600571.
Dabski, Krzysztof; Winkelmann, R.K. (1989). "Generalized granuloma annulare: Clinical and laboratory findings in 100 patients". Journal of the American Academy of Dermatology. 20 (1). Elsevier BV: 39–47. doi:10.1016/s0190-9622(89)70005-0. ISSN 0190-9622.
Lukács, J.; Schliemann, S.; Elsner, P. (February 4, 2015). "Treatment of generalized granuloma annulare – a systematic review". Journal of the European Academy of Dermatology and Venereology. 29 (8). Wiley: 1467–1480. doi:10.1111/jdv.12976. ISSN 0926-9959. PMID 25651003. S2CID 20884856.

External links

VisualDx

Classification	D ICD-11: EE80.0 ICD-10: L92.0 SNOMED CT: 402364005
External resources	Scholia: Q5532480

Cutaneous keratosis, ulcer, atrophy, and necrobiosis

Epidermal thickening

Necrobiosis/granuloma

Necrobiotic/palisading	Granuloma annulare Perforating Generalized Subcutaneous Granuloma annulare in HIV disease Localized granuloma annulare Patch-type granuloma annulare Necrobiosis lipoidica Annular elastolytic giant-cell granuloma Granuloma multiforme Necrobiotic xanthogranuloma Palisaded neutrophilic and granulomatous dermatitis Rheumatoid nodulosis Interstitial granulomatous dermatitis/Interstitial granulomatous drug reaction
Foreign body granuloma	Beryllium granuloma Mercury granuloma Silica granuloma Silicone granuloma Zirconium granuloma Soot tattoo Tattoo Carbon stain
Other/ungrouped	eosinophilic dermatosis Granuloma faciale

Dermis/
localized CTD

Cutaneous lupus erythematosus	chronic: Discoid Panniculitis subacute: Neonatal ungrouped: Chilblain Lupus erythematosus–lichen planus overlap syndrome Tumid Verrucous Rowell's syndrome
Scleroderma/ Morphea	Localized scleroderma Localized morphea Morphea–lichen sclerosus et atrophicus overlap Generalized morphea Atrophoderma of Pasini and Pierini Pansclerotic morphea Morphea profunda Linear scleroderma
Atrophic/ atrophoderma	Lichen sclerosus Anetoderma Schweninger–Buzzi anetoderma Jadassohn–Pellizzari anetoderma Atrophoderma of Pasini and Pierini Acrodermatitis chronica atrophicans Semicircular lipoatrophy Follicular atrophoderma Linear atrophoderma of Moulin Atrophia maculosa varioliformis cutis
Perforating	Kyrle disease Reactive perforating collagenosis Elastosis perforans serpiginosa Perforating folliculitis Acquired perforating dermatosis
Skin ulcer	Pyoderma gangrenosum
Other	Calcinosis cutis Sclerodactyly Poikiloderma vasculare atrophicans Ainhum/Pseudo-ainhum

Category:

Monocyte- and macrophage-related cutaneous conditions

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