Granuloma Annulare

Question 1

What are the different clinical presentations of GA?

Answer 1

• • arciform to annular plaques
• • papular form
• • subcutaneous
• • macular (patch form)
• • perforating ( with central keratotic plug or umbilication )

Distribution patterns also vary, from localized to occasionally photodistributed or generalized/disseminated.

Question 2

What is the most comon distribution pattern of GA?

Answer 2

distribution of GA is: 60% isolated to the hands and arms

, 20% on the legs and feet,

Other areas : 5-7%

Question 3

True or false : Facial lesions are common

Answer 3

False, Facial lesions are rare.

Question 4

True or false : Deep dermal/ subcutanious GA are painless and have a predilection for chikdren <6years

Answer 4

True

Deep dermal or subcufaneous GA manifests as large, painless skin-colored nodules which may be mistaken for rheumatoid nodules, leading to the term pseudorheumatoid nodule.

It has a predilection for children <6 years of age.

Typical locations include the palms, hands, anterior tibial surfaces and feet, as
well as the buttocks, scalp and, rarely, the eyelids.

As many as 50% of individuals with deep GA lesions also have
associated classic lesions.

Question 5

Describe features of perforating GA

Answer 5

In perforating GA, the small papules have central umbilication,
scale-crust or focal ulceration, and they occur primarily on the
dorsal hands and fingers (see Fig. 93. 10A E@ ).

This variant occurs up to 5% of patients with GA

histologically transepidermal elimination of degenerating collagen is seen.

Question 6

Is GA associated with malignancy ?

It was described as a paraneoplastic granulomatous reaction to several malugnacies including :

Answer 6

Including : solid organ tumors, Hodgkin disease, non-Hodgkin lymphoma, and granulomatous mycosis fungoides.

The textbook states that based on a recent review of the literature, a relationship between GA and malignancy was not identified.

However if there is atypical presentation : painful lesions in unusual locations, including the palms and soles. In this case warrant a complete physical exam with focused, age-appropriate screening38.

Question 7

What is the most common drug inducing GA?

Answer 7

TNF inhibitors.

Less common culprits include : amlodipine, allopurinol, diclofenac, and gold3

Question 8

True/ False
Classic GA and perforating GA may develop within herpes zoster scars and following BCG
vaccinations.

Answer 8

True

Question 9

What stains should be used in biopsy suspected for GA and why?

Answer 9

colloidal iron and Alcian blue for mucin.

Increased much can be detected in -90% of biopsy specimens
from GA lesions.