Granuloma anular generalizado: un reto terapéutico. Nuestra experiencia en 12 pacientes

Abstract

IntroductionGranuloma annulare is a benign skin disease characterized by the presence of umbilicated papules or annular plaques, which most frequently affects young people and is typically located on the extremities. The generalized form, with later onset, represents 15% of the total. Although spontaneous resolution of lesions is described in up to 80% of cases within 2 years, recurrence is highly frequent, occurring in up to 40% of cases. Materials and methodsWe conducted a retrospective descriptive study of cases of generalized granuloma annulare evaluated at our center between January 1, 2007 and February 28, 2010. ResultsWe identified a total of 12 patients, 11 adults aged between 22 and 65 years, and a boy of 10 years. Most were women (10 out of 12). None of our patients had associated diseases such as diabetes mellitus, thyroid disease, hepatitis, or immunosuppression, and there were only two patients with dyslipidemia. The location of the lesions was most frequently the lower extremities, followed by the lower limbs and trunk. In all patients, the lesions were annular plaques. Most were asymptomatic, except in cases related to pruritus. In all patients, skin biopsy was compatible with granuloma annulare. The most common histological type was interstitial (10 out of 12), and granulomas were found in the remaining two patients. Of all the treatment regimens (topical and oral corticosteroids, phototherapy, antimalarial drugs and potassium iodide), only PUVA (ultraviolet A associated with psoralen) was useful. This treatment improved the lesions in five patients but four of them relapsed after treatment discontinuation. In two patients there was spontaneous remission. DiscussionThe course of generalized granuloma annulare is unpredictable, and spontaneous remission may occur at any time. The therapeutic arsenal used in the treatment of this condition is very broad, but very few treatments have scientifically proven effectiveness. In our series, the most effective treatment was PUVA, but most patients relapsed after this treatment was discontinued.