Generalized granuloma annulare

Diagnosis: Generalized granuloma annulare

Generalized granuloma annulare

Clinical Presentation

Generalized granuloma annulare

Clinical History

Asymptomatic or mildly pruritic annular plaques, often on dorsal hands and feet. Usually in young adults. Check fasting glucose for generalized form.

Treatment

Localized: observation (self-limited), potent topical or intralesional corticosteroids, cryotherapy. Generalized: phototherapy (NB-UVB, PUVA), dapsone, hydroxychloroquine, isotretinoin.

Differential Diagnosis

• Tinea corporis • Annular lichen planus • Sarcoidosis • Necrobiosis lipoidica • Morphea • Erythema annulare centrifugum • Mycosis fungoides

Key Learnings

• Classic appearance: flesh-colored to erythematous annular plaques with a raised border and depressed center • Localized form is most common (75%) — often on dorsal hands/feet • Generalized form: consider screening for diabetes mellitus (controversial association) • Palisading granulomatous inflammation with central mucin and collagen degeneration on histology • Self-limited in ~50% of localized cases within 2 years • Dermoscopy: structureless orange-yellow areas ("setting sun" pattern)

Tags: dermatologist, dermatology, Generalized granuloma annulare