Summary
Definition
O GA é uma condição benigna incomum de etiologia incerta.[1] As lesões são normalmente descritas como pápulas dérmicas, que coalescem formando anéis e podem apresentar uma coloração cor de pele, rosa-forte ou violácea; elas são comumente encontradas no dorso das mãos, tornozelos, joelhos e cotovelos. [Figure caption and citation for the preceding image starts]: Granuloma anular localizado clássicoDo acervo de Susmita Mukherjee, BSc, MBBS, MRCP; usado com permissão [Citation ends].
Há uma grande quantidade de variações clínicas.[2] A histologia é característica. A maior parte dos casos é autolimitada.[3]
History and exam
Key diagnostic factors
- pápulas dérmicas assintomáticas cor de pele ou rosa-forte agrupadas anularmente
Other diagnostic factors
- máculas ou pápulas pequenas em cor de pele, rosa-forte ou marrom
- nódulos de tecidos moles
- pápulas perfurantes, lesões ulceradas ou com crostas
- manchas eritematosas
Risk factors
- diabetes mellitus
- neoplasia hematológica
- herpes-zóster
- vírus da imunodeficiência humana (HIV)
- hepatite
- hiperlipidemia
- doença tireoidiana
- medicamentos
Diagnostic tests
1st tests to order
- diagnóstico clínico
Tests to consider
- biópsia de pele
- glicemia de jejum
- testes da função tireoidiana
- rastreamento lipídico
- sorologia para hepatite
- teste de vírus da imunodeficiência humana (HIV)
Treatment algorithm
variante localizada (erupção cutânea anular clássica)
variante generalizada (erupção cutânea macular disseminada)
variante subcutânea (nódulos macios)
variante tipo mancha (placas eritematosas)
variante perfurante (lesões com crostas ou ulceração)
Contributors
Authors
Misha Rosenbach, MD
Professor
Dermatology and Internal Medicine (Rheumatology)
University of Pennsylvania
Philadelphia, PA
Disclosures
MR has received consulting fees from Merck, Johnson & Johnson, Novartis, and Processa Pharma, not related to granuloma annulare.
Acknowledgements
Dr Misha Rosenbach would like to gratefully acknowledge Dr Susmita Mukherjee, a previous contributor to this topic.
Disclosures
SM declares that she has no competing interests.
Peer reviewers
Aisha Sethi, MD
Assistant Professor of Medicine
Associate Residency Program Director
University of Chicago
Chicago
IL
Disclosures
AS declares that she has no competing interests.
Robert Herd, MSc, MD, FRCP
Consultant Dermatologist
Department of Dermatology
Nuffield Hospital
Glasgow
UK
Disclosures
RH declares that he has no competing interests.
Brenda L. Pellicane, MD
Dermatologist
Wayne State University School of Medicine
Department of Dermatology
Detroit, MI
Disclosures
BLP declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Piette EW, Rosenbach M. Granuloma annulare: clinical and histologic variants, epidemiology, and genetics. J Am Acad Dermatol. 2016 Sep;75(3):457-65. Abstract
Kachlik Z, Kaczmarek A, Grych K. et al. Granuloma annulare: a clinical update. Curr Derm Rep. 2024 May 22;13:183-97.Full text
Piette EW, Rosenbach M. Granuloma annulare: pathogenesis, disease associations and triggers, and therapeutic options. J Am Acad Dermatol. 2016 Sep;75(3):467-79. Abstract
Wang J, Khachemoune A. Granuloma annulare: a focused review of therapeutic options. Am J Clin Dermatol. 2018 Jun;19(3):333-44. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Líquen plano anular
- Infecções dermatofíticas
- Micose fungoide
More Differentials
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