Perforating granuloma annulare

Abstract

PGA is different to GA not only histologically but also clinically. It is a disseminated disease, affecting both children and adults, which is characterized by the presence of multiple papules, most of them umbilicated and/or crusted, and characteristically pustular lesions and scars. Histology suggests that the superficial localization of the necrobiotic granuloma leads to the epidermal perforation. Treatment is disappointing.

Granuloma anular perfurante generalizado

“…In an article published by Pablo F. Peñas et al, it is observed that in the generalized form, pustuliform lesions and scarring appear in significantly higher percentages than in the localized and perforating variants. 3 In the case that we reported, defined as a generalized and perforating form, the patient showed the initial characteristics of most lesions in the pustular lesion, a fact which reinforces the findings of the literature. 3 Harsch Mohan et al published a study with 586 cases of granulomatous dermatitis, of which 71 (12.11%) were classified as non-infectious granulomas by means of clinicopathologic analyses.…”

“…3 The average age of onset is higher among diabetic patients, which is around 33 years for the generalized form. 7 The case that we described had a delayed onset.…”

“…1,2 Perforating granuloma annulare (GAP) is a rare subtype of GA, first reported by Owens and Freeman in 1971. 3 Itching may occur in about 25% of the cases, especially when there are lesions on palms. Painful symptom 4 has also been described.…”

“…3.6 The variety, known as generalized PGA, constitutes only 5% of the cases of granuloma annulare. 3,5,7 The literature reports a sex ratio of female-male of 2.9:1 in the group of patients with annular lesions, and an average of 51.7 years of age, when evaluated at the initial period of the disease. 6 The cause of Generalized Perforating Granuloma Annulare (GPGA) is unknown, but some authors agree in asserting the existence of factors implicated in its pathogenesis, including insect bites, ultraviolet radiation, minor trauma, viral infection, thyroiditis and diabetes mellitus.…”

“…Epithelial atrophy and, possibly, perforation could be explained by the expansive, multidirectional growth of the necrobiotic granuloma and by a possible deviation of blood supply to the epidermis. 3 Authors suggest that lymphokines and lysosomal enzymes released would lead to the destruction of collagen tissue. 5 …”