Granuloma annulare in Adult
See also in: External and Internal EyeAlerts and Notices
Synopsis

Granuloma annulare (GA) is a benign granulomatous inflammatory disorder of the dermis or subcutis. Its cause is unknown. Small dermal papules may present in isolation or coalesce to form smooth annular plaques, often on extremities. Lesions are typically asymptomatic or only mildly pruritic, but the appearance may cause patients distress. The disease is more common in women (female-to-male ratio of 2:1), and two-thirds of patients are aged younger than 30. The disease usually resolves spontaneously with no adverse sequelae, though some cases prove persistent or recurrent.
Some reports in the literature have suggested that GA is associated with certain triggers or systemic diseases, most commonly diabetes mellitus; other diseases that may be associated include thyroid disease, dyslipidemia, malignancy, and infections.
There are 3 principal variants of GA: localized (75% of cases), generalized (or disseminated), and subcutaneous (also known as pseudo-rheumatoid nodules). Patch GA is a variant of localized GA in which the plaques are extremely thin and barely palpable. A fourth type – perforating GA – refers to rare lesions that demonstrate histologic evidence of transepidermal extrusion of degraded collagen. Actinic granuloma presents with similar lesions and is thought by some to represent GA occurring in sun-damaged skin. Palmoplantar GA is a rare variant favoring the palms.
Some reports in the literature have suggested that GA is associated with certain triggers or systemic diseases, most commonly diabetes mellitus; other diseases that may be associated include thyroid disease, dyslipidemia, malignancy, and infections.
There are 3 principal variants of GA: localized (75% of cases), generalized (or disseminated), and subcutaneous (also known as pseudo-rheumatoid nodules). Patch GA is a variant of localized GA in which the plaques are extremely thin and barely palpable. A fourth type – perforating GA – refers to rare lesions that demonstrate histologic evidence of transepidermal extrusion of degraded collagen. Actinic granuloma presents with similar lesions and is thought by some to represent GA occurring in sun-damaged skin. Palmoplantar GA is a rare variant favoring the palms.
Codes
ICD10CM:
L92.0 – Granuloma annulare
SNOMEDCT:
65508009 – Granuloma annulare
L92.0 – Granuloma annulare
SNOMEDCT:
65508009 – Granuloma annulare
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- GA is often mistaken for dermatophyte infection (tinea corporis, or "ringworm"). The presence of scale in dermatophyte infection should allow the distinction.
- Subcutaneous forms of GA may be confused with rheumatoid nodules.
- Interstitial granulomatous dermatitis
- Palisaded neutrophilic granulomatous dermatitis
- Panniculitis
- Perforating collagenosis
- Elastosis perforans serpiginosa
- Sarcoidosis
- Erythema annulare centrifugum
- Lichen planus (especially the annular variant) – Usually pruritic.
- Leprosy – Anesthetic lesions in endemic countries.
- Erythema elevatum diutinum – Over extensors, pruritic.
- Necrobiosis lipoidica – Atrophic plaques.
- Erythema migrans (Lyme disease) – Slow growing, more erythematous.
- Erythema gyratum repens
- Sweet syndrome
- Subacute cutaneous lupus erythematosus
- Annular elastolytic giant cell granuloma
- Pseudolymphoma
- Mycosis fungoides
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Updated:10/14/2020

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Granuloma annulare in Adult
See also in: External and Internal Eye