Abstract
Perforating granuloma annulare (PGA) is a rare inflammatory condition characterized by transepithelial elimination of necrobiotic collagen with granulomas in the dermis. It commonly presents as umbilicated papules or pustules on the extremities and dorsal hands. The distribution of PGA can be described as generalized or localized, with only 9% of patients presenting with a single lesion. Herein, we report an unusual presentation of PGA as a single localized plaque on the forearm that resembled psoriasis.
Highlights
Granuloma annulare (GA) is a benign, granulomatous condition that presents with annular papules on the hands and feet [1]
Perforating granuloma annulare (PGA) is a rare inflammatory condition characterized by transepithelial elimination of necrobiotic collagen with granulomas in the dermis
One rare subtype of GA is perforating granuloma annulare (PGA), characterized by histopathologic evidence of granulomas surrounding trans-epidermal elimination of necrotic material [2]
Summary
Granuloma annulare (GA) is a benign, granulomatous condition that presents with annular papules on the hands and feet [1]. Past dermatologic history included multiple actinic keratoses on the scalp and back treated with cryotherapy and topical 5-fluorouracil. Physical exam revealed a single asymmetric pink tender plaque with overlying scaling and crusting on the left forearm. Histopathologic examination of the shave biopsy demonstrated pseudoepitheliomatous hyperplasia of the epidermis and trans-epidermal elimination of granulomas (Figure 2). Granulomatous inflammation with multinuclear giant cells and occasional damaged elastic fibers were present in the superficial and middermis (Figure 3). Stains for elastin and mucin were conducted, demonstrating elastic fibers and mucin within the granulomas (Figures 4-5). Bracket demonstrates pseudoepitheliomatous hyperplasia of epidermis and arrow points to trans-epidermal elimination of granulomas. Damaged elastic fibers (yellow arrows) are seen in the granuloma. Abundant mucin is seen in the center of the granulomas in areas of necrobiosis (yellow arrows).
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