34266 Is generalized granuloma annulare truly associated with diabetes mellitus, hyperlipidemia, thyroid disorders, and malignancy? A systematic review

Abstract

Objective: Generalized granuloma annulare (GGA) is a rare subtype of granuloma annulare (GA) characterized by its benign, yet chronic recurrent course. Several studies have debated GGA’s association with underlying systemic disease such as diabetes mellitus (DM), dyslipidemia (DLD), malignancy, and thyroid disorders (TD). Our objective was to evaluate the association between GGA and systemic diseases. Methods: The databases PubMed, Embase, and Cochrane Library were searched on June 15, 2021, for “generalized or disseminated granuloma annulare.” Results were reported using the Preferred Reporting Systems for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Results: A total of 579 studies were screened for inclusion, yielding 194 studies with 934 patients. The mean age was 51.2 years, and 68.3% of patients were female.The 3 most common associated systemic conditions were DLD (14.6%, n = 136/934), DM (14.5%, n = 135/934), and TD (9.1%, n = 85/934). A total of 93 malignancies (10.0%, n = 93/934) were reported, 69 being non-hematologic malignancies. In total, 35.5% (n = 33/93) of patients had paraneoplastic GGA. Conclusion: Our evidence-based review showed much lower prevalence of DLD, DM, and TD than previous studies. Moreover, only 15 patients experienced resolution of GGA with appropriate management of these comorbidities. Therefore, only a small percentage of patients seem to have a true association of GGA with systemic disease. However, our findings revealed paraneoplastic GGA in 35.5% of patients with underlying malignancy. Therefore, we advocate that it may be beneficial to update age-appropriate cancer screening in individuals with refractory or severe GGA, and history or signs of underlying malignancy.