Abstract
Granuloma annulare (GA) and interstitial granulomatous dermatitis (IGD) are granulomatous dermatoses with variable clinical appearances. GA is associated with diabetes mellitus, metabolic syndrome, chronic infections, and malignancies, while two Japanese reports described unusual cases of interstitial-type GA in setting of Sjogren syndrome. IGD was associated with rheumatoid arthritis, systemic lupus erythematosus, and autoantibodies. We report a case series of six patients with GA or IGD. Half of the patients were diagnosed with Sjogren syndrome, while all of them presented ANA positivity and the majority reported arthralgia. In many cases, GA showed interstitial-type histology, arising challenges in differential diagnosis with IGD. The overlap of clinical and histological features of GA and IGD can be explained considering them as a broad disease spectrum, including also the other forms of reactive granulomatous dermatitis. These conditions should be considered as an indicator of possible systemic disorders or other immunological dyscrasias, for which patients must be screened. Sjogren syndrome may be associated to GA also in Caucasians.
Highlights
Granulomatous dermatoses are a group of clinically and histologically heterogeneous inflammatory skin conditions including granuloma annulare (GA) and reactive granulomatous dermatitis (RGD).Granuloma annulare (GA) was described in association with diabetes mellitus, chronic infections, malignancies, and thyroid autoimmune diseases [1], while in the last decade association with autoimmune systemic diseases was reported in Japanese population
We report a case series of six patients with GA or interstitial granulomatous dermatitis (IGD)
We present the series of six GA or RGD patients referred to our centre in 2019, describing clinical and histological features, serological findings, and associations
Summary
Granulomatous dermatoses are a group of clinically and histologically heterogeneous inflammatory skin conditions including granuloma annulare (GA) and reactive granulomatous dermatitis (RGD). IGD is described in association with autoimmune diseases like arthritis, systemic lupus erythematous, and autoimmune hepatitis, while Verneuil et al highlighted the correlation with autoantibodies or rheumatic symptoms like arthralgia. It presents with asymptomatic papules and plaques, varying in colour from skin-coloured to erythematous and frequently located in lateral upper trunk, axillae, and proximal upper limbs. The histological picture of a biopsy taken three years before was consistent with IGD, whereas the second biopsy taken to address the correct diagnosis was compatible with GA (Figure 2(f)). Two patients started a treatment with HCQ and topical steroids: one of them had complete disappearing of the lesions, while the other had no improvements after one year
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