Granuloma multiforme (GM) is a rare reactive, cutaneous disorder of unknown etiology that was originally described in Nigeria and has since been reported in other countries in central Africa (eg, Congo) and in Indonesia, India, and Tunisia. Prior to its description in 1964, GM was often misdiagnosed as leprosy due to its similar clinical presentation and the high prevalence in leprosy in these geographic locales. Contemporary authors have since debated whether GM is a distinct entity or a variant of granuloma annulare, necrobiosis lipoidica, or annular elastolytic giant cell granuloma (which it resembles most closely histopathologically).
GM is more commonly seen in adults older than 40 years and is predominantly seen in females. It typically begins as pruritic papules that evolve slowly over the course of a year or so into often asymptomatic annular or polycyclic plaques with raised edges that may measure up to 15 cm, which can persist for years with hypopigmentation and atrophy in the center. The sun-exposed areas of the trunk, neck, and arms are most frequently affected.
Granuloma multiforme
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Synopsis
Codes
ICD10CM:
L92.8 – Other granulomatous disorders of the skin and subcutaneous tissue
SNOMEDCT:
238682006 – Granuloma multiforme
L92.8 – Other granulomatous disorders of the skin and subcutaneous tissue
SNOMEDCT:
238682006 – Granuloma multiforme
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Differential Diagnosis & Pitfalls
- Granuloma annulare
- Necrobiosis lipoidica
- Annular sarcoidosis
- Tumid lupus erythematosus
- Subacute cutaneous lupus erythematosus
- Polar tuberculoid (TT) leprosy – A single, slightly infiltrated, annular plaque which may be a few to many centimeters in diameter, found anywhere on the skin's surface. The center may be hypopigmented and have sensory changes, including loss of temperature, pain, and light touch.
- Borderline tuberculoid (BT) leprosy – A few infiltrated plaques with sharply defined and circinate margins, peripheral spread, and central healing. Lesions vary in size from a few to many centimeters in diameter and are most commonly seen on the face, neck, and extremities, but they may be found anywhere on the body. Peripheral nerve trunks are often enlarged, typically asymmetrically so, and often in the vicinity of skin involvement. Commonly, the involved nerves include the great auricular nerve (neck), the ulnar nerve (elbow), the radial cutaneous nerve (wrist), the median nerve (wrist), the lateral popliteal nerve (leg), or the posterior tibial nerve (ankle).
- Interstitial granulomatous dermatitis
- Palisaded neutrophilic granulomatous dermatitis
- Tinea corporis
- Majocchi granuloma
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Last Reviewed:07/10/2023
Last Updated:07/23/2023
Last Updated:07/23/2023