Granuloma anulare

• Colcott-Fox, 1895
• Radcliffe-Crocker, 1903

Granuloma annulare

Granulomatous, benign annular papules and plaques.

• Women > men
• Especially at a young age (children, teenagers)

• Plaque-type granuloma anulare
• Granuloma anulare perforans
• Granuloma anulare subcutaneum
• Erythematous granuloma anulare
• Granuloma anulare disseminatum
• Granuloma anulare giganteum
• Granulomatosis disciformis chronica et progressiva (Miescher's granuloma)

• Polyetiological
  • Genetics
  • Trauma
    • Ictus reactions
  • Infections
  • Autothyroidism
  • Diabetes mellitus
  • Too intensive vitamin D3 therapy (granuloma anulare vigantolicum)

• Mostly solitary, but also occasionally disseminated (granuloma anulare disseminatum) whitish to skin-coloured, annular, anullar papules and plaques
• Granuloma anulare giganteum: With extensive spread (rarely up to 10 cm)
• Granuloma anulare perforans: central umbilication with crusting

• Clinical image
• Biopsy
• In case of ↑ size or dissemination
  • (blood glucose daily profile, glucose load test)
  • X-ray chest
  • Focus search

Acres, backs of hands and feet, backs of fingers, sides of joints

Often lasting for months or years, then often spontaneous regression.

Children:

• Mostly spontaneous remission
• If necessary, occlusive topical steroids

Dermocorticoids

• Mometasone fuorate cream/solution/ointment

• Clobetasol cream/ointment
• Kenacort-A 10 /40 mg injection suspension
• Cryosurgery with liquid nitrogen

Radiation therapy

• Local PUVA cream therapy

Systemic therapy

• Hydroxychloroquine p.o. initially 400 mg daily for 4-8 weeks, then 200 mg 1x daily

In case of generalised infestation

• Acitretin p.o
  • Initial:0.5 mg/kg bw 1x daily
  • Maintenance dose: 0.1-0.2 mg/kg bw 1x daily
• Dapsone p.o. 100-200 mg daily
  • No preparations are currently approved in Switzerland
  • Before administration: exclusion of glucose-6-phosphate dehydrogenase deficiency
  • Met-Hb: should be checked 2 weeks and 6 weeks after starting therapy

1. Schulze-Dirks A, Petzold D. Granuloma anulare disseminatum - erfolgreiche Therapie mit Fumarsäureester. Der Hautarzt 2001;52:228-30.
2. Jantke ME, Bertsch HP, Schön MP, Fuchs T. Therapie des Granuloma anulare disseminatum mit Anthralin. Hautarzt 2011;62:935-9.
3. Lebwohl, Mark. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. Elsevier, 2014. Print.