Tuesday 24 May 2011

Subcutaneous Granuloma Annulare

Subcutaneous Granuloma Annulare Features:
  • Other names - Deep granuloma annulare & Pseudorheumatoid nodule.
  • Aetiology - Unknown cause,
  • Epidemiology - Mostly affects children; boys ~2x more than girls.
  • Associations - Classic lesions of granuloma annulare.
  • Skin location - Deep dermal nodules, often over joints.
  • Clinical features - Hard consistency.
  • Anatomical sites - Most often found on the lower extremities, hands or scalp.
  • Pathogenesis - Repeated trauma may be a triggering factor for the lesions localizing over bony prominences.
  • Pathology - Histologically similar to rheumatoid nodules, though the necrobiosis in rheumatoid nodules has a more homogenous eosinophilic appearance, compared with the mucinous oedematous appearance in subcutaneous granuloma annulare.
  • Genetics - Some cases have been reported as familial.
  • Prognosis - May occur as an early-stage dermatologic manifestation of diabetes in a subset of children; recurrence is common.
  • Medical history - First clearly described by Ziegler in 1941.

References:
  • Chung S, Frush DP, Prose NS, Shea CR, Laor T, Bisset GS (1999). Subcutaneous Granuloma Annulare: MR Imaging Features in Six Children and Literature Review. March 1999 Radiology 1999; 210, March, 845-849
  • Felner EI, Steinberg JB, Weinberg AG (1997). Subcutaneous granuloma annulare: a review of 47 cases. Pediatrics 1997 Dec;100(6):965-7.
  • Karen L. Grogg, Antonio G. Nascimento (2001). Subcutaneous Granuloma Annulare in Childhood: Clinicopathologic Features in 34 Cases. Pediatrics 107(3) March 1, pp. e42 (doi: 10.1542/peds.107.3.e42
  • Grogg KL, Nascimento AG (2001). Subcutaneous granuloma annulare in childhood: clinicopathologic features in 34 cases. Pediatrics. 2001 Mar;107(3):E42.
  • Isdale AH, Helliwell PS (1992). An infiltrating rheumatoid nodule ? Ann Rheum Dis 1992; 51 : 688-89
  • Robin M, Lynch FW (1966). Subcutaneous granuloma annulare. Arch Dermatol 1966; 93: 416-20.
  • Sabuncuoğlu H, Oge K, Söylemezoğlu F, Sağlam A (2007). Subcutaneous granuloma annulare of the scalp in childhood: a case report and review of the literature. Turk Neurosurg. 2007;17(1):19-22.
  • Sandipan Dhar, Asim Das, Kaur (1993). Subcutaneous granuloma annulare. Indian J Dermatol Venereol Leprol 1993; 59(3):146-148
  • Stillians AW (1919). An unusual case of granuloma annulare. J Cutan Dis. 1919; 37:580.
  • Ziegler E (1941). Rheumatismus nodosus als einzige Manifestation der rheumatischen Krankheit. Arch Kinderh 122:1–6
Tags: Diabetes Mellitus - Granuloma Annulare - Rheumatoid Nodule
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