Summary
Definition
O granuloma anular (GA) é uma doença benigna incomum de etiologia desconhecida.[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
- medicações
Diagnostic investigations
1st investigations to order
- diagnóstico clínico
Investigations to consider
- biópsia de pele
- glicemia de jejum
- testes da função tireoidiana
- rastreamento lipídico
- rastreamento de hepatite
- teste de vírus da imunodeficiência humana (HIV)
Treatment algorithm
variante localizada (erupção cutânea anular clássica)
variante generalizada (erupção cutânea macular disseminada)
variante perfurante (lesões com crostas ou ulceração)
variante subcutânea (nódulos macios)
variante tipo mancha (placas eritematosas)
Contributors
Authors
Misha Rosenbach, MD
Associate Professor
Dermatology and Internal Medicine
University of Pennsylvania
Philadelphia
PA
Disclosures
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.
Acknowledgements
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.
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.
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
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. Abstract
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
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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