Precipitating Factors and Associated Diseases in 84 Patients with Granuloma annulare: A Retrospective Study

Abstract

In a retrospective study including 84 patients, we assessed precipitating factors of granuloma annulare (GA) and asssociated pathologies. Fifteen per cent of the patients reported stress as an important trigger of GA, and in 10 patients (12%) we found an association between GA and diabetes mellitus: 3 latent, 4 type I and 3 type II. Eight of the diabetic patients presented multiple and 5 generalized GA. They suffered significantly more often from chronic relapsing GA than nondiabetic patients.

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

“…The association of GGA with DM is not yet clearly established. Studer et al 13 noted that 10 of 84 adult patients (12%) with GA (localized or generalized) had DM, as opposed to the 5% prevalence of DM among the regional population. However, other studies that looked for carbohydrate intolerance by performing glucose tolerance testing 4 or assessing the hemoglobin A1c values 14 failed to find an increased prevalence of altered carbohydrate metabolism in the patients with GA.…”

Necrobiosis lipoidica and granuloma annulare: Part 2- Granuloma annulare

“…Studer et al found that 12% (10/84) patients with GA had diabetes. 5 These patients were significantly more likely to experience recurrent disease and 6/10 reported exacerbation of their skin with poor glycaemic control. A subsequent case control study found no association between type 2 diabetes and GA. 12 However, the control group used were patients with psoriasis, a condition now known to be associated with a number of comorbidities, including diabetes.…”

“…3,4 A variety of infectious agents have been implicated, including tuberculosis, Borrelia, varicella, EBV, hepatitis B and C and HIV. 4,5 Sun exposure and phototherapy with psoralen combined with ultraviolet A are also reported to precipitate GA. 4,6 Reported drug causes of GA included amlodipine, gold, allopurinol, diclofenac, quinidine, intra-nasal calcitonin and anti-tumour necrosis factor (TNF) agents. 6,7 In one study 15% of patients attributed onset of GA to psychological stress.…”

“…6,7 In one study 15% of patients attributed onset of GA to psychological stress. 5 It has been suggested that GA is due to a delayed type hypersensitivity reaction, 5 but other theories have also been proposed. These include the possibility that GA results from the expression of TNFα and matrix metalloproteinases by activated macrophages leading to matrix degeneration.…”

“…5,9 The average age of onset varies by clinical subtype. 10,11 Historically, GA has been reported to be associated with diabetes.…”