Resumo
Definição
Granuloma annulare (GA) is an uncommon benign condition of unknown aetiology.[1] Lesions are typically described as dermal papules, which coalesce to form rings, and may be skin-coloured, pink, or violaceous; commonly found on the back of hands, ankles, knees, and elbows.[Figure caption and citation for the preceding image starts]: Classic localised granuloma annulareFrom the collection of Susmita Mukherjee, BSc, MBBS, MRCP; used with permission [Citation ends].
A number of clinical variants exist.[2] Histology is characteristic. Most cases are self-limiting.[3]
História e exame físico
Principais fatores diagnósticos
- asymptomatic grouped annular pink or flesh-coloured dermal papules
Outros fatores diagnósticos
- flesh-coloured, pink, or brown macules or small papules
- soft-tissue nodules
- perforating papules, crusting or ulcerated lesions
- erythematous patches
Fatores de risco
- diabetes mellitus
- haematological malignancy
- herpes zoster
- HIV
- hepatitis
- hyperlipidaemia
- thyroid disease
- medications
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- clinical diagnosis
Investigações a serem consideradas
- skin biopsy
- fasting blood sugar
- thyroid function tests
- lipid screening
- hepatitis screen
- HIV testing
Algoritmo de tratamento
localised variant (classic annular rash)
generalised variant (widespread macular rash)
perforating variant (crusted or ulcerated lesion)
subcutaneous variant (soft nodule)
patch variant (erythematous plaques)
Colaboradores
Autores
Misha Rosenbach, MD
Associate Professor
Dermatology and Internal Medicine
University of Pennsylvania
Philadelphia
PA
Declarações
MR has received consulting fees from Merck, aTyr Pharma, and Processa Pharma, not related to granuloma annulare. He has received grant support from Processa Pharma, not related to granuloma annulare. MR has received salary support from the AMA/JAMA for his role at JAMA Dermatology as Deputy Editor. MR is an author of references cited in this topic.
Agradecimentos
Dr Misha Rosenbach would like to gratefully acknowledge Dr Susmita Mukherjee, a previous contributor to this topic. SM declares that she has no competing interests.
Revisores
Aisha Sethi, MD
Assistant Professor of Medicine
Associate Residency Program Director
University of Chicago
Chicago
IL
Declarações
AS declares that she has no competing interests.
Robert Herd, MSc, MD, FRCP
Consultant Dermatologist
Department of Dermatology
Nuffield Hospital
Glasgow
UK
Declarações
RH declares that he has no competing interests.
Brenda L. Pellicane, MD
Dermatologist
Wayne State University School of Medicine
Department of Dermatology
Detroit
MI
Declarações
BLP declares that she has no competing interests.
Referências
Principais artigos
Piette EW, Rosenbach M. Granuloma annulare: clinical and histologic variants, epidemiology, and genetics. J Am Acad Dermatol. 2016 Sep;75(3):457-65. Resumo
Thornsberry LA, English JC 3rd. Etiology, diagnosis, and therapeutic management of granuloma annulare: an update. Am J Clin Dermatol. 2013 Aug;14(4):279-90. Resumo
Piette EW, Rosenbach M. Granuloma annulare: pathogenesis, disease associations and triggers, and therapeutic options. J Am Acad Dermatol. 2016 Sep;75(3):467-79. Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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