Annular granuloma
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- Localization. Feet
- Erythematous lesion? Non-erythematous lesion
- Evolution time. Chronic: more than 2 weeks
- Skin lesion. Raised: papule, plaque or nodule
- Surface texture. Normal/smooth
- Edges Accentuated/embossed
- Color. Skin color: no color change
- Distribution of lesions. Discreet/isolated injury: 1 to 5 injuries
- Associated symptoms.
- Additional information.
Brief information
- Benign disease, usually self-limited and asymptomatic.
- It comprises a spectrum of disease that can manifest itself through different clinical variants:
- Localized (most common, 75% cases):
- It appears in the form of a skin-colored or erythematous plaque, with an annular/oval shape, an empty center and raised edges.
- It can reach a diameter of up to 5 cm.
- It is generally localized to one part of the body, but can be disseminated in 15% of cases.
- occurs mainly on the extremities (dorsal surface of the feet and hands).
- It regresses spontaneously and can last from a few months to 2 years.
more common in females (2:1), young age. - Generalized: papulo-erythematous, annular lesions, with raised edges and central atrophy, which may or may not be associated with itching.
- Various scattered injuries, mainly on the trunk and upper limbs.
- Subcutaneous: appears preferentially in children, manifesting as nodules on the limbs, mimicking rheumatoid nodules (rheumatoid arthritis).
- Perforating (rare): may occur in localized or disseminated form. It manifests itself in the form of umbilicated papules measuring 1 to 4 mm in diameter with a central crust/ulcer/pustule.
- Localized (most common, 75% cases):
Differential diagnosis
- Tinea corporis
- Annular lichen planus
- Nummular eczema
- Pityriasis rosea
- Cutaneous sarcoidosis
- Actinic granuloma
- Interstitial granulomatous dermatitis
- Tertiary nodular syphilis
- Secondary syphilis
- Erythema migrans (Lyme disease)
- Localized granuloma annulare is self-limited and asymptomatic, meaning treatment may not be necessary.
- In symptomatic cases, or for cosmetic reasons, topical or intralesional corticosteroid therapy can be chosen:
- Intralesional injection into the raised edge of the lesion with triamcinolone acetonide in concentrations of 2.5 to 10 mg/mL.
- Clobetasol 0.05% daily with an occlusive dressing for 2 to 4 weeks, after which the response is assessed.
- consider alternatives if there is no improvement after 4 to 8 weeks of treatment.
- For more extensive or severe forms of the disease, treatments may include oral therapy (Isotretinoin 0.5 mg/kg/day, 3 to 4 months; Dapsone 100 mg/day, up to 4 months) or phototherapy.