Granuloma annulare and necrobiosis lipoidica with sequential occurrence in a patient: report and review of literature

Abstract

Granuloma annulare (GA) and necrobiosis lipoidica (NL) are granulomatous diseases of undetermined etiology. Rarely, both dermatoses have been reported to occur concomitantly in patients. GA and NL are characterized histologically by areas of necrobiosis of collagen. The two diseases share some common characteristics, which may suggest that these dermatoses could occur as a spectrum in some patients or possibly share a similar pathogenesis. We report on a 67-year-old Caucasian woman with a history of NL on the anterior shins that later developed lesions of GA on the breasts, trunk, and wrist. We also review the literature and discuss the characteristics of patients with concomitant GA and NL.

Disseminated perforating necrobiosis lipoidica: a case report and literature review

“…There is frequent extension into the superficial subcutis in NL. Plasma cells accompany the lymphocytic perivascular infiltrate in NL and are not a feature of GA. Eosinophils maybe seen in GA. Mucin deposition is absent in the zones of necrobiosis in NL but typically present in GA (2,3,5,6,11,14). There is discordance between Authors whether to accept transfollicular perforation within the spectrum of PGA (3,18,19), however it is widely accepted in PNL.…”

“…These conditions can be challenging to differentiate, as both are more common in women, have been associated with diabetes and rarely involve the face. It is not possible to distinguish between them on clinical examination alone, as both have been described as red-yellow annular plaques with perforation (1,6), and tend to have a long clinical course (17). PNL always presents as a plaque, typically on the lower legs and always results in atrophic, hypopigmented © C I C E d i z i o n i I n t e r n a z i o n a l i scars (17).…”

“…Since this time, only sparse reports of PGA and PNL have appeared in the literature, particularly cases with a disseminated distribution. The histopathology of NL and GA is a granulomatous dermatitis associated with degeneration of dermal collagen, histiocytes arranged in a palisade around zones of necrobiosis and interstitially between collagen fibres, and a perivascular chronic inflammatory cell infiltrate (6,(17)(18)(19). The perforating variants show transepithelial elimination of necrotic material.…”

Necrobiosis lipoidica and granuloma annulare: Part 2- Granuloma annulare

“…Histological features found in both conditions include leucocytoclasia, in early lesions, necrobiosis with a lymphohistiocytic infiltrate and epithelioid cells. 14 …”

“…13,14 Possible reasons for the apparent different rates of association with diabetes could be explained by differences in the pathogenesis of these conditions.…”