Overview
Granuloma annulare is a benign, noninfectious skin condition characterized by necrobiotic granulomas, often presenting as annular plaques. It can manifest in various forms and locations, sometimes associated with systemic conditions like diabetes mellitus and insulin resistance 1310.Diagnosis
Clinical presentation of annular, erythematous, or skin-colored plaques 1210.
Histopathological examination showing palisading granulomas without caseation 12.
Association with underlying conditions such as hypothyroidism, diabetes mellitus, and insulin resistance should be considered 13.
Open comedones may develop in photoexposed areas due to dermal elastic fiber damage 13.Management
First-line treatments: Topical corticosteroids 12.
Adjunctive treatments: Oral hypoglycemics or insulin therapy in cases associated with insulin resistance 13.
Alternative therapies: Cryosurgery for granuloma faciale 8.
Other options: Pentoxifylline (topical or oral) with variable response 3.Special Populations
Diabetes Mellitus: Insulin therapy may lead to regression of granuloma annulare lesions 13.
Elderly: Erythematous generalized form can occur, often with comorbidities like pulmonary emphysema 10.
Pediatrics: Pseudorheumatoid nodules preceding granuloma annulare have been observed in children 9.Key Recommendations
Evaluate for underlying systemic conditions, particularly diabetes mellitus and insulin resistance, in patients with granuloma annulare (Evidence: Moderate 13).
Consider topical corticosteroids as first-line therapy for granuloma annulare (Evidence: Expert opinion).
In cases where insulin resistance is suspected, initiating insulin therapy may lead to significant improvement in both diabetes and granuloma annulare (Evidence: Moderate 13).
For granuloma faciale, cryosurgery can be highly effective (Evidence: Moderate 8).
Monitor for development of open comedones in photoexposed areas, especially in patients with dermal damage, and consider associated elastic fiber changes (Evidence: Weak 13).References
1 Bhushan P, Aggarwal A, Yadav R, Baliyan V. Generalized granuloma annulare with open comedones in photoexposed areas. Clinical and experimental dermatology 2011. link
2 Stewart LR, George S, Hamacher KL, Hsu S. Granuloma annulare of the palms. Dermatology online journal 2011. link
3 Sudy E, Urbina F, Espinoza X. Open comedones overlying granuloma annulare in a photoexposed area. Photodermatology, photoimmunology & photomedicine 2006. link
4 Konohana A. Extrafacial granuloma faciale. The Journal of dermatology 1994. link
5 Murakami S, Koeda T, Azuma R, Fujiwara H. Experimental Tonsillophilus suis granuloma in rats and guinea pigs. The Journal of veterinary medical science 1992. link
6 Ferro MA, Smith JH, Smith PJ. Periurethral granuloma: unusual complication of Teflon periurethral injection. Urology 1988. link90740-6)
7 Fulghum DD. Octopus bite resulting in granuloma annulare. Southern medical journal 1986. link
8 Zacarian SA. Cryosurgery effective for granuloma faciale. The Journal of dermatologic surgery and oncology 1985. link
9 Mukamel M, Metzker A. Pseudorheumatoid nodules preceding granuloma annulare. Cutis 1984. link
10 Eng AM. Erythematous generalized granuloma annulare. Archives of dermatology 1979. link