Clinical and Pathological Features of Generalized Granuloma Annulare with Their Correlation: A Retrospective Multicenter Study in Korea

Abstract

Background: Generalized granuloma annulare (GGA) is a benign skin disorder of an unknown etiology. Though some cases of GGA have been reported, few systemic reviews of the clinical and pathological features of GGA have been performed. Objective: The purpose of this study is to analyze and correlate the clinical and pathological characteristics of GGA in Korean patients. Methods: We conducted a retrospective study that included 54 biopsy specimens of Korean GGA patients, and the clinical and pathological features of GGA were reviewed and analyzed for their correlation. Results: The cutaneous lesions could be divided into the annular (24, 44%) and nonannular types (30, 56%), and the lesions were more common in males than in females (29 males and 25 females). The incidence of GGA showed a bimodal age distribution. The number of patients who presented within the first decade was 24 cases (44%), and 24 cases (44%) were over the fifth decade. Eight patients (15%) had systemic diseases. Especially, diabetes mellitus (DM) occurred only in the adult GGA patients over forty years old. The pathological findings showed dermal granulomatous lesions that consisted of either a palisading pattern (28, 52%) or an interstitial pattern (26, 48%). Conclusion: In contrast to the previously reported studies, the age of GGA onset showed a bimodal distribution, and GGA was observed more often in males. The prevalence of DM in the GGA affected individuals was higher than that found in the general Korean population. Therefore, it is recommended to perform a work-up for DM in the GGA affected patients who are over forty years old. (Ann Dermatol 21(2) 113∼119, 2009)

Granuloma annulare on the palms: A clinicopathological study of seven cases

“…[6] In a study by Yun et al, 28 out of 54 patients showed necrobiotic collagen with classic palisading granulomas while interstitial pattern without much collagen alteration was seen in 26 patients. [7] We did not find significant vascular changes in our study. No vessel wall damage, fibrin thrombi or extravasation of RBCs was seen.…”

Infliximab in recalcitrant granuloma annulare

“…We report a case of clearance of GA with infliximab, with histological confirmation of the complete disappearance of granulomatous lesions. Granuloma annulare is a primarily idiopathic inflammatory condition sometimes associated with general diseases, most notably diabetes . Diffuse forms with functional, esthetic, and psychological impact often require treatment.…”

Dissemine granüloma anulare ve asemptomatik multipl myelom birlikteliği

“…diyabetes mellitus ile ilişkisi, uzun süren seyri, spontan gerilemenin çok nadir görülmesi ve tedavilere yanıtının zayıf olması gibi farklı özellikleri bulunmaktadır 1,8 . Klinik olarak gövde ve ekstremite yerleşimli olan lezyonlar deri renginde, eritemli ya da viyolase renkli, sınırları hafif kabarık dermal papül ya da küçük anuler plaklar ile karakterizedir.…”

“…Klinik olarak gövde ve ekstremite yerleşimli olan lezyonlar deri renginde, eritemli ya da viyolase renkli, sınırları hafif kabarık dermal papül ya da küçük anuler plaklar ile karakterizedir. Histopatolojik olarak dermiste nekrobiyotik kollajeni çevreleyen histiyositler, lenfositler ve multinükleer dev hücreler saptanmaktadır 1,7 . Bizim olgumuza da benzer klinik ve histopatolojik bulgular eşliğinde dissemine GA tanısı konulmuştur.…”

“…Tipik lezyonlar zamanla genişleyerek etrafı daha kabarık anuler plaklara dönüşme eğilimi gösteren tek veya çok sayıdaki hafif eritemli papüllerden oluşur. Klinik olarak en sık lokalize formda görülmekle birlikte dissemine, nodüler, perforan, subkutanöz, lineer, püstüler ve arkuat dermal eritem gibi değişik görünümlerde de olabilir 1,2 . Nadir görülen dissemine formun patogenezi tam olarak bilinmemekle birlikte diyabetes mellitus, tiroid hastalıkları, maligniteler, hepatit B ve C virüsü infeksiyonları, medikasyonlar ve edinsel immün yetmezlik sendromu ile birlikte görülen olgular bildirilmiştir [3][4][5][6][7] .…”