Clearance of Generalized Papular Umbilicated Granuloma Annulare in a Child with Bath PUVA Therapy

Abstract

Papular umbilicated granuloma annulare is usually localized and is relatively asymptomatic. The generalized condition is rarely reported in children and tends to respond less well to treatment than the localized form. We report the first instance of generalized papular umbilicated granuloma annulare in an 11-year-old boy, which cleared following bath psoralen plus ultraviolet A therapy.

Granuloma Annulare

“…[103][104][105] Psoralen-UV-A (PUVA) has been effective in clearing the lesions of GA in case reports and small case series. [106][107][108][109] As in the case of UV-A1 therapy, although many patients showed improvement, [106][107][108][109] recurrence was common and maintenance therapy was required. 107,109 One challenge with any form of phototherapy is the need for frequent and consistent office visits.…”

“…Immunosuppression with methotrexate, cyclosporine, and TNF-a inhibitors can be considered in patients with severe disease that has been recalcitrant to other therapies. 28,[87][88][89][90][91][93][94][95][96][97][98][99][100][101][102][103][104][105][106][107][108][109][114][115][116][117][118][119][120][121][122][123][124]126,127,129,130,[132][133][134][140][141][142][144][145][146][147][148]150,…”

Granuloma anular papular umbilicado en un adolescente

“…Las lesiones típicas de liquen nitidus consisten en múltiples y diminutas pápulas eucrómicas y brillantes que confluyen, de predominio en la superficie flexora de los miembros superiores, genitales y tronco anterior (5); mientras que la presentación característica del GA papular umbilicado son pápulas asintomáticas, firmes, color piel, con umbilicación central, localizadas en el dorso de las manos (4). Esta variedad puede representar hasta un 5% de todos los casos de GA y comúnmente afecta niños y adultos jóvenes al igual que el liquen nitidus (1,5), lo cual coincide con la clínica y edad de aparición en el paciente que se presenta. A pesar de que ambas entidades suelen ser autolimitadas, el GA papular umbilicado suele persistir durante años (1), como sucedió en este caso, mientras que el liquen nitidus rara vez persiste indefinidamente (3).…”

Phototherapy and photochemotherapy in childhood dermatoses

“…Jain et al [34] treated 20 patients with psoriasis (plaque psoriasis 18, guttate psoriasis 2) aged between 6 and 14 years with NBUVB. In a twice-weekly treatment regimen, the mean cumulative dose required for clearance was 4286 mJ/cm 2 (1,687-7,509 mJ/cm 2 ) over a mean number of treatment sessions of 24 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). The highest dose per treatment was 329 mJ/cm 2 (165-462 mJ/cm 2 ).…”

“…Mycosis fungoides (topical PUVA) [17] Lymphomatoid papulosis (bath PUVA) [18] Keratosis lichenoides chronica (bath PUVA) [19] Vitiligo (bath PUVA) [20] Urticaria pigmentosa/systemic mastocytosis [21] Generalized Schamberg's disease [22] Generalized granuloma annulare (bath PUVA) [23] Pansclerotic morphea (UVA) [24] Pansclerotic morphea [25,26] Cutaneous graft versus host disease (bath PUVA) [27] Palmoplantar keratoderma (bath PUVA) [28] Atopic dermatitis [29] BBUVB Psoriasis [16,30] Atopic dermatitis [16] Pityriasis lichenoides chronica [16] NBUVB Vitiligo [31,32] Psoriasis [33,34] Atopic dermatitis [33] Mycosis fungoides [35] Keratosis lichenoides chronica [36] Lichen nitidus [37] UVA1 (not discussed) Morphea, low-dose UVA1, combined with calcipotriol [38] Disabling pansclerotic morphea [39] Lichen sclerosus et atrophicus, low dose [40] Chronic graft versus host disease [41,42] Hypopigmented mycosis fungoides [43] been proven and, in comparison to BBUVB, it elicits faster clearance of lesions, fewer episodes of erythema and longer remission. However, large studies on phototherapy in childhood psoriasis are rare.…”