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Granuloma Annulare (Localized)
Published in Charles Theisler, Adjuvant Medical Care, 2023
Localized granuloma annulare is characterized by the presence of small, raised, red bumps (nodules or papules) that generally appear arranged in a ring on the skin, although the ring may not always be closed. This chronic degenerative skin disorder affects twice as many women as men. In most cases, granuloma annulare is asymptomatic and no treatment is required because the patches disappear by themselves in a few months, leaving no trace. Nonetheless, treatment is often sought for cosmetic reasons. In some cases, the lesions can last for years. While granuloma annulare resembles a tinea infection, also known as “ringworm,” there is no itching or scaling.
Chronic erythematous rash and lesions on trunk and limbs
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
Granuloma annulare can present in one of three ways: Small pink papules, which join together to form rings. There is never any scale on the surface so it should not be confused with tinea. It is usually seen on the dorsum of hands, elbows and knees, but can occur anywhere.A flat pink or mauve patch often seen on the thighs, upper arms, trunk or dorsum of the foot (Fig. 8.54).A generalised asymptomatic macular rash with no surface change (a biopsy is usually needed for diagnosis).
Immunologically mediated skin disorders
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
There are several disorders that are marked by the appearance of erythematous rings, which usually gradually enlarge and then disappear. Various annular erythemas are granuloma annulare, erythema annulare centrifugum, erythema gyratum repens, and erythema migrans. Granuloma annulare is the common type.
Unusual Corneal Sarcoidosis Manifestations
Published in Ocular Immunology and Inflammation, 2023
Andrea Córdoba, Luis F. Mejía, Natalia González, Juan C. Gil
Six months later, the patient reported intermittent irritation of the temporal conjunctiva; no PUK reactivation was evidenced, but a 2x2mm temporal conjunctival nodule was found (Figure 4a). Furthermore, the patient reported the appearance of erythematous and pruritic skin lesions of hands and forearms dorsum that improved with sun exposure. A directed biopsy for the temporal conjunctival nodular lesion of the right eye was performed and, histopathological analysis revealed a conjunctival mucosa with granuloma at the lamina propria level, composed of epithelioid histiocytes and some multinucleated giant cells with minimal adjacent lymphocytic infiltrate, without areas of necrosis or suppuration (Figure 4b). This histopatological findings added to the spectrum of eye and systemic clinical manifestations supported the diagnosis of sarcoidosis. Additionally, an online dermatological assessment of the skin lesions was performed, clinically suspecting granuloma annulare, but a skin biopsy was pending.
Eosinophilic annular erythema
Published in Baylor University Medical Center Proceedings, 2021
Nicole Dacy, Kyle Oney, Katherine Fiala, Palak Parekh
Our patient’s case was also not consistent with other entities on our differential. Granuloma annulare typically affects the dorsal hands and feet with only one or two lesions and less commonly presents with generalized involvement. Histologically, granuloma annulare is characterized by a palisading granuloma with histiocytes and epithelioid cells surrounding a central zone of altered collagen.8 Erythema annulare centrifugum is the most common gyrate erythema with a characteristic trailing scale at the inner border of the erythema. Histologically, the epidermis will show mild spongiosis and parakeratosis, with the superficial dermis showing lymphocytes tightly around the blood vessels in a “coat sleeve” pattern.9 Sarcoidosis is known as a “great imitator,” and cutaneous annular sarcoidosis could have a similar clinical appearance to EAE. However, histology would show noncaseating granulomas.10
Granuloma annulare: strengthening potential associations and pentoxifylline as a therapeutic option
Published in Journal of Dermatological Treatment, 2021
Michael J. Visconti, Kurt A. Ashack, Richard J. Ashack
Granuloma annulare (GA) is a therapeutically challenging granulomatous skin disease frequently described in association with multiple systemic conditions. Proposed associations with GA include glucose intolerance, malignancy, dyslipidemia, and thyroid disease—yet many of these associations have been challenged (1,2). High-potency corticosteroids (topical and intralesional) are considered first-line treatment, but consensus for other therapeutic options is lacking (1). Data to both strengthen the proposed systemic associations in GA and define appropriate therapeutic options in recalcitrant cases are limited. Our findings from a single site, retrospective review describe subjective improvement in GA with the use of pentoxifylline and strengthen the association of GA and hypothyroidism previously described in one of the larger GA retrospective case studies.