EDITORIAL ESPANOL:

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Hola amigos DERMAGICOS de la red, ayer estuve revisando la discusión en la lista DERMLIST (Brasil) y encontré interesante el tema sobre GRANULOMA ANULAR DISEMINADO (Dr. Rolando Hernández), me fui de viaje y encontré estas 44 REFERENCIAS, espero que ayuden a esclarecer un poco las alternativas terapéuticas,,,

Saludos,,,

Dr. José Lapenta.

Tema pendiente: alopecia Androgénica. 

 EDITORIAL ENGLISH:

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Hello friends DERMAGIC of the net, yesterday I was revising the discussion in the list DERMLIST (Brazil) and I found interesting the topic DISSEMINATED GRANULOMA ANNULARE. I went on a trip and I found these 44 REFERENCES, I wait that they help to clarify the therapeutic alternatives a little.

Greetings,,,

Dr. José Lapenta

Next edition: androgenic alopecia

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DERMAGIC/EXPRESS(24)

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GRANULOMA ANULAR DISEMINADO 

DISSEMINATED GRANULOMA ANNULARE 

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1.) [Retinoids in therapy of granuloma anulare disseminatum]

[Retinoide in der Therapie des Granuloma anulare disseminatum.]

2.) [Granuloma anulare disseminatum as a rare side effect of allopurinol]

[Granuloma anulare disseminatum als seltene Nebenwirkung von 

Allopurinol.]

3.) Disseminated granuloma annulare in acquired immunodeficiency syndrome: case report and review of the literature.

4.) Disseminated granuloma annulare as a presentation of acquired immunodeficiency syndrome (AIDS).

5.) Resolution of disseminated granuloma annulare following isotretinoin therapy.

6.) Potassium iodide in the treatment of disseminated granuloma annulare.

7.) Antimalarials for control of disseminated granuloma annulare in children.

8.) [Local treatment of disseminated granuloma anulare with a vitamin E emulsion]

TT - [Lokalbehandlung des disseminierten Granuloma anulare mit einer Vitamin-E-Emulsion.]

9.) Disseminated cutaneous granulomatous eruptions associated with myelodysplastic syndrome and acute myeloid leukaemia.

10.) Disseminated granuloma anulare: therapy with vitamin E topically.

11.) Generalized elastophagocytic granuloma.

12.) Recent advances in phototherapy and photochemotherapy of skin disease.

13.) Treatment of granuloma annulare with tranilast.

14.) Cyclosporine in the treatment of generalized granuloma annulare [letter; comment]

15.) Generalized granuloma annulare, mononucleosis, and positive rheumatoid factor.

16.) Successful treatment response of granuloma annulare and carpal 

tunnel syndrome to chlorambucil.

17.) Granuloma annulare in patients with malignant lymphoma: clinicopathologic study of thirteen new cases.

18.) Successful outcome of cryosurgery in patients with granuloma annulare.

19.) Ulcerated necrobiosis lipoidica diabeticorum in a patient with history of generalized granuloma annulare.

20.) [Generalized granuloma annulare]

[Granulome annulaire generalise.]

21.)Granuloma annulare perforans in herpes zoster scars.

22.) Association of generalized granuloma annulare with autoantibodies.

23.) Generalised granuloma annulare successfully treated with pentoxifylline.

25.) Generalized perforating granuloma annulare.

26.) Psoriasis, necrobiosis lipoidica, granuloma annulare, vitiligo and skin infections in the same diabetic patient.

27.) Photochemotherapy of generalized granuloma annulare.

28.) Generalized granuloma annulare in a patient with temporal arteritis--are these conditions associated?

29.) Elastic tissue changes in generalized granuloma annulare.

30.) Generalized granuloma annulare: histopathology and immunopathology. Systematic review of 100 cases and comparison with localized granuloma annulare.

31.) Agranulocytosis caused by dapsone therapy for granuloma annulare.

32.) Generalized granuloma annulare: clinical and laboratory findings in 100 patients.

33.) Antibodies to the Borrelia burgdorferi flagellum in patients with scleroderma, granuloma annulare and porphyria cutanea tarda.

34.) Familial granuloma annulare. Report of two cases and review of the literature.

35.) Octopus bite resulting in granuloma annulare.

36.) Visceral and skin granuloma annulare, diabetes, and polyendocrine disease.

37.) A study of HLA antigen association in localized and generalized granuloma annulare.

38.) Comparative ultrastructural study of generalized and localized granuloma annulare.

39.) Granuloma annulare arising in herpes zoster scars. Report of two cases and review of the literature.

40.) The response of generalized granuloma annulare to dapsone.

41.) Perforating granuloma annulare.

42.) Precipitating factors and associated diseases in 84 patients with granuloma annulare: a retrospective study.

43.) Mitotic granuloma annulare: a clinicopathologic study of 20 cases.

44.) Anti-oxidative therapy with oral dapsone improved HCV antibody positive annular elastolytic giant cell granuloma.

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1.) [Retinoids in therapy of granuloma anulare disseminatum]

TT - [Retinoide in der Therapie des Granuloma anulare disseminatum.]

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SO - Hautarzt 1993 Nov;44(11):693-8

AU - Harth W; Richard G

AD - Haut- und Poliklinik, Medizinischen Hochschule Erfurt.

PT - JOURNAL ARTICLE

AB - We report on four patients with granuloma annulare disseminatum successfully treated with etretinate as basic medication. In two cases there was complete remission after treatment with initial doses of up to 0.9 mg/kg body weight etretinate. One patient did not respond to etretinate alone but the condition was cured when Re-PUVA therapy was administered in addition. In another patient, with widespread granuloma annulare, primary treatment with Re-PUVA was instigated, followed by low-dose monotherapy with etretinate. According to these findings, we propose a three-stage regimen of therapy. After checking that the indications are appropriate, we first initiate monotherapy with etretinate and switch to a low-dose treatment over a longer period on response. If there is no response we switch to the second stage, i.e. Re-PUVA therapy; the third is then etretinate monotherapy to prevent relapse.

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2.) [Granuloma anulare disseminatum as a rare side effect of allopurinol]

TT - [Granuloma anulare disseminatum als seltene Nebenwirkung von Allopurinol.]

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SO - Hautarzt 1995 May;46(5):343-5

AU - Becker D; Enk A; Brauninger W; Knop J

AD - Hautklinik, Johannes Gutenberg-Universitat, Mainz.

PT - JOURNAL ARTICLE

AB - During long-term therapy of hyperuricaemia with allopurinol (300 mg/d) two patients developed generalized granuloma annulare. The diagnoses were confirmed by histology; concomitant diseases, especially diabetes mellitus, were not detectable. Following discontinuation of allopurinol therapy, cutaneous granulomas healed without relapse. Hyperuricaemia could be controlled by low-purine diet and medication avoiding allopurinol. The clinical history of our two patients suggested a causal connection between allopurinol therapy and generalized granuloma annulare. For this reason we rate the development of this disease in both cases as a rare but significant side effect of allopurinol. This should give rise to critical assessment of concomitant drug therapy during development of generalized granuloma annulare.

24.) Widespread granuloma annulare and cervical adenocarcinoma [letter; comment]

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3.) Disseminated granuloma annulare in acquired immunodeficiency syndrome: case report and review of the literature.

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SO - Cutis 1995 Mar;55(3):158-60

AU - Calista D; Landi G

AD - Department of Dermatology, Ospedale M. Bufalini, Cesena, Italy.

PT - JOURNAL ARTICLE; REVIEW (17 references); REVIEW, TUTORIAL

AB - The authors report the case of a 27-year-old woman who presented with disseminated granuloma annulare in association with acquired immunodeficiency syndrome. The lesions were asymptomatic, tiny, erythematous or flesh-colored umbilicated papules on the neck, trunk, and flexor surface of the arms and knees that regressed without any treatment in two months. The case reported is the nineteenth description of the association of granuloma annulare and acquired immunodeficiency syndrome but the first in a female patient. The causes and pathogenesis of granuloma annulare are unknown, but after reviewing the previous case reports we hypothesize that circulating human immunodeficiency virus particles may be a precipitating factor in granuloma annulare and that the CD4+ and CD8+ cell dysfunction may be responsible for the atypically short course of the disease.

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4.) Disseminated granuloma annulare as a presentation of acquired immunodeficiency syndrome (AIDS).

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SO - Clin Exp Dermatol 1992 Jan;17(1):60-2

AU - McGregor JM; McGibbon DH

AD - St John's Dermatology Centre, St Thomas' Hospital, London, UK.

MJ - Acquired Immunodeficiency Syndrome [pathology]; Granuloma Annulare [pathology]

PT - JOURNAL ARTICLE

AB - Localized granuloma annulare is the commonest form of a granulomatous dermatosis characterized by flesh coloured or violaceous papules often arranged in rings. Several rare atypical variants are also reported including disseminated or generalized, subcutaneous and perforating types. There is a predilection for females and a documented association with diabetes mellitus in some cases. Recently it has been suggested that atypical variants of granuloma annulare might be associated with the acquired immunodeficiency syndrome (AIDS). We describe a patient presenting with extensive generalized granuloma annulare in whom an underlying diagnosis of Human Immunodeficiency Virus (HIV) disease was confirmed.

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5.) Resolution of disseminated granuloma annulare following isotretinoin therapy.

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SO - Cutis 1985 Aug;36(2):147-8

AU - Schleicher SM; Milstein HJ

PT - JOURNAL ARTICLE

AB - Disseminated granuloma annulare is often a chronic disorder that may prove refractory to treatment and lead to prolonged cosmetic disfigurement. In a patient with disseminated granuloma annulare that was unresponsive to multiple therapeutic regimens, administration of isotretinoin resulted in rapid clearing of nearly all lesions. To our knowledge this is the first reported case in which this agent was used to treat disseminated granuloma annulare.

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6.) Potassium iodide in the treatment of disseminated granuloma annulare.

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SO - J Am Acad Dermatol 1994 May;30(5 Pt 1):791-2

AU - Smith JB; Hansen CD; Zone JJ

AD - Emergency Department, USAF Hospital Hill, Hill AFB, Utah.

MJ - Granuloma Annulare [drug therapy]; Potassium Iodide [therapeutic use]

MN - Administration, Oral; Adolescence; Adult; Aged; Double-Blind Method; Follow-Up Studies; Middle Age; Placebos; Potassium Iodide [administration & dosage] [adverse effects]; Remission Induction

MT - Female; Human; Male; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S.

PT - CLINICAL TRIAL; CLINICAL TRIAL, PHASE I; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL

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7.) Antimalarials for control of disseminated granuloma annulare in children.

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SO - J Am Acad Dermatol 1994 Dec;31(6):1064-5

AU - Simon M Jr; von den Driesch P

AD - Department of Dermatology, University of Erlangen-Nurnberg, Germany.

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8.) [Local treatment of disseminated granuloma anulare with a vitamin E emulsion]

TT - [Lokalbehandlung des disseminierten Granuloma anulare mit einer Vitamin-E-Emulsion.]

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SO - Hautarzt 1991 Mar;42(3):176-8

AU - Goldstein RK; Zillikens D; Miller K; Elsner P; Burg G

AD - Klinik und Poliklinik fur Haut- und Geschlechtskrankheiten, Universitat Wurzburg.

MC - English Abstract

PT - JOURNAL ARTICLE

AB - The treatment of granuloma annulare is still unsatisfactory. A number of topical and systemic therapies have been tried, some of which can improve the condition, but serious side effects are possible with those reported so far. We treated a patient with disseminated granuloma annulare by local application of a vitamin E emulsion and achieved a marked improvement within as little as 12 days.

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9.) Disseminated cutaneous granulomatous eruptions associated with myelodysplastic syndrome and acute myeloid leukaemia.

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SO - Clin Exp Dermatol 1993 Nov;18(6):559-63

AU - Vestey JP; Turner M; Biddlestone L; McLaren K; Goulden N; Hunter JA

AD - University Department of Dermatology, Royal Infirmary of Edinburgh, Scotland.

MT - Case Report; Human; Male

PT - JOURNAL ARTICLE

AB - Two elderly male patients presented with similar, widespread, papular, granulomatous eruptions and developed myelodysplastic syndromes. The first showed histological features of diffuse granuloma annulare and had mild hypergammaglobulinaemia, slightly abnormal liver function and a leucoerythroblastic anaemia. He developed acute myeloid leukaemia (AML) secondary to a background myelodysplastic syndrome and was treated with combination chemotherapy during which his eruption settled; his AML and his skin are in remission 1 year later. The second developed a myelodysplastic syndrome and a similar rash with histological features of papular cutaneous sarcoidosis but no systemic abnormalities apart from mild hypergammaglobulinaemia, cutaneous anergy to multiple recall antigens and activation of circulating monocytes. He has remained well but his rash and myelodysplastic syndrome have persisted. These cases are interesting because of the striking similarity of their granulomatous eruptions and their associated haematological abnormalities. Patients with such disseminated, granulomatous cutaneous infiltrations should be investigated to exclude associated haematological abnormalities if there is any abnormality of their peripheral blood picture.

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10.) Disseminated granuloma anulare: therapy with vitamin E topically.

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SO - Dermatology 1992;184(4):308-9

AU - Burg G

AD - Department of Dermatology, University Hospital, Zurich, Switzerland.

MT - Case Report; Human

PT - JOURNAL ARTICLE

AB - Topical use fo vitamin E (E-Mulsin) is recommended as an alternative treatment modality in otherwise recalcitrant granuloma anulare.

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11.) Generalized elastophagocytic granuloma.

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SO - Cutis 1992 May;49(5):355-7

AU - Sina B; Wood C; Rudo K

AD - University of Maryland School of Medicine, Department of Dermatology, Baltimore 21201.

MT - Case Report; Female; Human

PT - JOURNAL ARTICLE

AB - The case of an eighty-three-year-old woman with the sudden onset of a generalized pruritic eruption is reported. The skin lesions resembled disseminated subacute lupus erythematosus on clinical examination, but actinic granuloma or annular elastolytic giant cell granuloma was seen in biopsy specimens of the lesions. Our case was differentiated from generalized granuloma annulare by the distinct zoning of elastolysis and the distribution of giant cells.

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12.) Recent advances in phototherapy and photochemotherapy of skin disease.

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SO - J Dermatol Sci 1990 May;1(3):141-7

AU - Morison WL

AD - Department of Dermatology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205.

PT - JOURNAL ARTICLE; REVIEW (21 references); REVIEW, TUTORIAL

AB - The therapeutic spectrum for ultraviolet radiation treatment of skin disease has continued to be broadened. Psoralen photochemotherapy is beneficial in chronic lichenoid graft-versus-host disease and disseminated granuloma annulare. This treatment is now being found more useful in atopic eczema and chronic photosensitivity with some modifications of the therapy. UV phototherapy has also been found useful in mild to moderate atopic eczema. The nature of these treatments is also changing with greater use of selective UV phototherapy and definition of the required schedule for maintenance treatment with UVB phototherapy. The mechanism of therapeutic benefit remains unknown although one possibility is selective phototoxicity for inflammatory cells in the dermis. Nonmelanoma skin cancer, premature aging of the skin and freckling are the main long-term adverse effects of these treatments.

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13.) Treatment of granuloma annulare with tranilast.

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SO - J Dermatol 1995 May;22(5):354-6

AU - Yamada H; Ide A; Sugiura M; Kurihara S; Tajima S

AD - Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.

MT - Case Report; Female; Human; Male

PT - JOURNAL ARTICLE

AB - Three cases of granuloma annulare which did not exhibit a self-limited course were treated with tranilast at the dose of 300 mg/daily. The treatment resulted in the resolution of skin lesions within three months of administration. Although spontaneous resolution is often observed in granuloma annulare, tranilast may provide an alternative therapy for the treatment of cases resistant to spontaneous healing.

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14.) Cyclosporine in the treatment of generalized granuloma annulare [letter; comment]

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CM - Comment on: J Am Acad Dermatol 1994 Mar; 30(3):487-8

SO - J Am Acad Dermatol 1995 Feb;32(2 Pt 1):298

AU - Ho VC

MJ - Cyclosporine [therapeutic use]; Granuloma Annulare [drug therapy]

MN - Administration, Oral; Adult; Cyclosporine [administration & dosage]; Middle Age

MT - Case Report; Female; Human; Male

PT - COMMENT; LETTER

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15.) Generalized granuloma annulare, mononucleosis, and positive rheumatoid factor.

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SO - Int J Dermatol 1995 Jan;34(1):40-1

AU - Person JR

AD - Fallon Clinic, Auburn, Massachusetts.

MT - Case Report; Female; Human

PT - JOURNAL ARTICLE

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16.) Successful treatment response of granuloma annulare and carpal 

tunnel syndrome to chlorambucil.

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SO - Mayo Clin Proc 1994 Dec;69(12):1163-5

AU - Winkelmann RK; Stevens JC

AD - Department of Dermatology, Mayo Clinic Scottsdale, Arizona.

MJ - Carpal Tunnel Syndrome [drug therapy]; Chlorambucil [therapeutic use]; Granuloma Annulare [drug therapy]

PT - JOURNAL ARTICLE

AB - We describe a 62-year-old woman in whom skin biopsies verified the clinical diagnosis of granuloma annulare and neurologic and electromyographic studies confirmed the neurologic diagnosis of carpal tunnel syndrome. Short-term treatment with a low dose of chlorambucil taken orally was prescribed. Within weeks, the granuloma annulare had disappeared, and the clinical symptoms of carpal tunnel syndrome had resolved. Electromyography showed variable improvement at the end of treatment and resolution at 9-month follow-up. Our case confirms that short-term treatment of granuloma annulare and associated carpal tunnel syndrome with low-dose chlorambucil is successful.

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17.) Granuloma annulare in patients with malignant lymphoma: clinicopathologic study of thirteen new cases.

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SO - J Am Acad Dermatol 1994 Jul;31(1):42-8

AU - Barksdale SK; Perniciaro C; Halling KC; Strickler JG

AD - Department of Dermatology, Mayo Clinic, Rochester, Minnesota.

MT - Female; Human; Male

PT - JOURNAL ARTICLE

AB - BACKGROUND: Reports of necrobiotic granulomas or granuloma annulare in patients with malignant lymphoma are rare. OBJECTIVE: Our intent was to determine any unique clinical or histopathologic features in patients with granuloma annulare and lymphoma. METHODS: We reviewed the medical records and biopsy material from 13 patients with granuloma annulare and lymphoma. RESULTS: Three patients had Hodgkin's disease and 10 had non-Hodgkin's lymphoma. The granuloma annulare lesions showed typical histopathologic features. However, the clinical pattern was frequently atypical, with painful lesions in unusual locations including the palms and soles. Three patients displayed granulomatous inflammation in noncutaneous sites, either within the malignant lymphoma or in uninvolved tissues, and all three had atypical clinical presentations of granuloma annulare. CONCLUSION: Granuloma annulare with atypical clinical presentations may be associated with an underlying hematopoietic malignancy and may be part of a generalized granulomatous reaction to malignant lymphoma.

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18.) Successful outcome of cryosurgery in patients with granuloma annulare.

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SO - Br J Dermatol 1994 Apr;130(4):494-7

AU - Blume-Peytavi U; Zouboulis CC; Jacobi H; Scholz A; Bisson S; Orfanos CE

AD - Department of Dermatology, University Medical Center Steglitz, Free University of Berlin, Germany.

MT - Female; Human; Male

PT - JOURNAL ARTICLE

AB - Several therapeutic methods have been employed in the management of localized granuloma annulare (GA), with varying degrees of success. We performed a prospective trial to evaluate the efficacy, cosmetic results, and safety of cryosurgical treatment in GA. Thirty-one patients with localized GA were treated by cryosurgery, using the contact method. Nitrous oxide (-86 degrees C) or liquid nitrogen (-196 degrees C) were used as refrigerants, and were applied with closed probes; each lesion was treated with one freeze-thaw cycle of 10-60 s per session. If necessary, treatment was repeated after 20-30 days. Resolution of the lesions was obtained in all patients, and in 25 of 31 patients (80.6%) they resolved after a single freeze-thaw cycle. Relapse occurred in only one of 11 patients who were followed for more than 2 years, and this occurred 16 months after treatment. Excellent cosmetic results were obtained in 14 of 28 patients who were eligible for evaluation (50%), and good results in 11 (39.3%). The cosmetic result obtained by cryosurgery with nitrous oxide was independent of the size of the lesion, whereas in the group of patients treated with liquid nitrogen a better cosmetic result was obtained with smaller lesions (comparison of lesions or = 2.40 cm2 with those 2.40 cm2; P = 0.04). The duration of the lesion, its location, previous treatment with another method, and the number of treatment sessions, did not have any influence on the cosmetic result. The treatment was generally well tolerated. Blister formation occurred in all patients.(ABSTRACT TRUNCATED AT 250 WORDS).

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19.) Ulcerated necrobiosis lipoidica diabeticorum in a patient with history of generalized granuloma annulare.

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SO - Cutis 1994 Feb;53(2):85-6

AU - Berkson MH; Bondi EE; Margolis DJ

AD - Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia 19104.

MT - Case Report; Female; Human

PT - JOURNAL ARTICLE

AB - Granuloma annulare and necrobiosis lipoidica diabeticorum have rarely been reported in the same patient. We describe the unusual case of a woman with diabetes and a history of generalized granuloma annulare who noted leg ulcers that clinically represented ulcerated necrobiosis lipoidica diabeticorum and had histologic features of necrobiosis lipoidica diabeticorum and granuloma annulare. Her condition responded to treatment with antiplatelet agents.

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20.) [Generalized granuloma annulare]

TT - [Granulome annulaire generalise.]

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SO - Ann Dermatol Venereol 1994;121(2):170-4

AU - Krasovec M; Frenk E

AD - Service de Dermatologie, Centre Hospitalier Universitaire Vaudois, Lausanne.

MC - English Abstract

PT - JOURNAL ARTICLE

AB - The generalized or atypical granuloma annulare represents 8.5-15 p. 100 of all cases of granuloma annulare (GA). It differs from the localized GA variant by its morphology, its localization, a later age of onset, its protracted course, a poor response to therapy and its facultative association to diabetes mellitus. We present a typical case of generalized GA associated with eczematous dermatitis.

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21.)Granuloma annulare perforans in herpes zoster scars.

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SO - J Am Acad Dermatol 1993 Nov;29(5 Pt 2):859-62

AU - Krahl D; Hartschuh W; Tilgen W

AD - Universitats-Hautklinik, Ruprecht-Karls-University, Heidelberg, Germany.

MT - Case Report; Female; Human

PT - JOURNAL ARTICLE

AB - Granuloma annulare perforans limited to a thoracic dermatome that was previously involved by herpes zoster occurred in a 51-year-old woman who also had Lennert's lymphoma. Of the various local granulomatous infiltrates described after herpes zoster, granuloma annulare perforans is unique, although ordinary granuloma annulare has been described in a few patients. A high incidence of specific and nonspecific reaction patterns in herpes zoster scars has been described in patients with malignant lymphoma. In contrast to previous patients, all of whom had chronic lymphatic leukemia, our patient had Lennert's lymphoma.

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22.) Association of generalized granuloma annulare with autoantibodies.

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SO - J Dermatol 1993 May;20(5):293-7

AU - Tada J; Seno A; Ueda M; Arata J; Nagao Y

AD - Department of Dermatology, Okayama University Medical School, Japan.

MT - Case Report; Female; Human; Male

PT - JOURNAL ARTICLE

AB - Granuloma annulare is a degenerative disease of the skin histopathologically characterized by focal degeneration of collagen with a surrounding infiltrate of lymphoid cells, histiocytic cells, and multinucleated giant cells. Immunological abnormalities such as delayed-type hypersensitivity and vasculitic origin are suspected in the pathogenesis. We describe three patients with generalized granuloma annulare, in whom autoantibodies, including antinuclear antibody, antithyroid stimulating hormone receptor antibody, and immune complex, were detected.

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23.) Generalised granuloma annulare successfully treated with pentoxifylline.

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SO - Australas J Dermatol 1993;34(3):103-8

AU - Rubel DM; Wood G; Rosen R; Jopp-McKay A

AD - Department of Dermatology, Prince of Wales Hospital, Randwick, NSW.

MT - Case Report; Human; Male

PT - JOURNAL ARTICLE

AB - Generalised granuloma annulare (GA) is a chronic disease of unknown aetiology and is recalcitrant to many treatment regimes. Some investigators have suggested that an immune medicated vasculitis may be involved in the pathogenesis of GA. We describe a patient with a ten year history of generalised GA, who showed dramatic clearing of the majority of papules after four weeks of treatment with pentoxifylline. This drug has shown promising results in the treatment of many dermatologic disorders including necrobiosis lipoidica diabeticorum, leukocytoclastic vasculitis and Raynaud's phenomenon. Pentoxifylline is thought to reduce blood viscosity via effects on all major blood components, and its clinical effectiveness in generalised GA lends support to a model of immune-medicated vasculitis in the pathogenesis of this disorder. Thus, pentoxifylline offers a well-tolerated and effective alternative to the treatment options available for patients with granuloma annulare.

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24.) Widespread granuloma annulare and cervical adenocarcinoma [letter; comment]

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CM - Comment on: Int J Dermatol 1991 Apr; 30(4):281-3

SO - Int J Dermatol 1992 Nov;31(11):819

AU - Vassileva S; Krasteva M; Marina S; Tsankov N

MJ - Adenocarcinoma [complications]; Cervix Neoplasms [complications]; Granuloma Annulare [complications]

MN - Adult

MT - Case Report; Female; Human

PT - COMMENT; LETTER

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25.) Generalized perforating granuloma annulare.

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SO - J Am Acad Dermatol 1992 Aug;27(2 Pt 2):319-22

AU - Samlaska CP; Sandberg GD; Maggio KL; Sakas EL

AD - Dermatology Service, Tripler Army Medical Center, Honolulu, Hawaii.

MT - Case Report; Female; Human

PT - JOURNAL ARTICLE

AB - Generalized perforating granuloma annulare is characterized by 1 to 4 mm umbilicated papules on the extremities, and is most commonly seen in children and young adults. Transepithelial elimination of mucinous, degenerating collagen fibers and surrounding palisading lymphohistiocytic granulomas are important histologic features. Perforating sarcoidosis and perforating granuloma annulare may be difficult to differentiate because of a similar clinical appearance and the presence of sarcoidal granulomas in biopsy specimens. A particularly high incidence of perforating granuloma annulare has been reported in the Hawaiian Islands.

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26.) Psoriasis, necrobiosis lipoidica, granuloma annulare, vitiligo and skin infections in the same diabetic patient.

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SO - J Dermatol 1990 Jul;17(7):440-7

AU - Abraham Z; Lahat N; Kinarty A; Feuerman EJ

AD - Department of Dermatology, Reish Policlinic, Haifa, Israel.

MT - Case Report; Female; Human

PT - JOURNAL ARTICLE

AB - A diabetic patient is described presenting psoriasis, necrobiosis lipoidica diabeticorum, granuloma annulare, and vitiligo and with a history of recurrent erysipelas and mycotic infections. Scrupulous physical examination excluded further systemic or cutaneous involvement. The immunological workup revealed both phenotypic and functional defects in cellular immunity.

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27.) Photochemotherapy of generalized granuloma annulare.

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SO - Arch Dermatol 1990 Mar;126(3):359-61

AU - Kerker BJ; Huang CP; Morison WL

AD - Department of Dermatology, Johns Hopkins Medical Institutions, Baltimore, Md. 21205.

MT - Female; Human

PT - JOURNAL ARTICLE

AB - Various forms of treatment for generalized granuloma annulare have been employed with little success. The results of treatment with topical and intralesional corticosteroids, as well as systemic therapy with corticosteroids, salicylates, aspirin, niacinamide, and chloroquine, have been generally disappointing. We describe five patients with generalized granuloma annulare of several years' duration who were treated with oral psoralen plus ultraviolet A irradiation. Lesions were present on the extremities, buttocks, and trunk in the form of macules, papules, and plaques. One patient also had perforating lesions on her thighs. Flattening of the lesions with decreased erythema and pigmentation was noted as early as 1 month after initiation of treatment. Complete clearance was achieved in all patients. Maintenance therapy has been required, resulting in prolonged disease-free intervals. Although the mechanism of action of oral psoralen plus ultraviolet A irradiation in granuloma annulare is unclear, one possibility is selective elimination of the cells that are responsible for initiating the disease.

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28.) Generalized granuloma annulare in a patient with temporal arteritis--are these conditions associated?

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SO - Clin Exp Dermatol 1990 Jan;15(1):70-2

AU - Fukai K; Ishii M; Kobayashi H; Someda Y; Hamada T; Tsujino S

AD - Department of Dermatology, Osaka City University Medical School, Japan.

MT - Case Report; Human; Male

PT - JOURNAL ARTICLE

AB - A case of generalized granuloma annulare associated with temporal arteritis is described. The patient, a 79-year-old man, noticed numerous asymptomatic lesions on his trunk and extremities for 3 months. Four months later, he suffered from headache and loss of vision. Both were successfully treated by oral administration of prednisolone.

EM - 9006

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29.) Elastic tissue changes in generalized granuloma annulare.

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SO - Am J Dermatopathol 1989 Oct;11(5):429-33

AU - Friedman-Birnbaum R; Weltfriend S; Kerner H; Lichtig C

AD - Department of Dermatology, Rambam Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa.

MT - Comparative Study; Female; Human; Male

PT - JOURNAL ARTICLE

AB - The histological picture in granuloma annulare (GA) is well defined. The types of infiltrate and the changes in collagen and elastic tissue have been repeatedly described. This is a preliminary study focused on the elastic tissue changes in lesions of generalized GA. Biopsies from four patients were studied. Specimens of involved and uninvolved skin from both exposed and unexposed parts of the body were compared. Changes of actinic elastosis in the papillary dermis in each patient in different stages were observed only in the exposed skin. The typical GA infiltrate was located beneath, in the upper mid-dermis. In the zone of the infiltrate in all specimens--exposed and unexposed--with no regard to the severity of actinic elastotic changes, absence or a marked reduction of elastic material was noted with engulfment of elastic remnants in giant cells. Giant cells with phagocytosis of elastotic material were mostly located on the periphery of the granuloma in the upper as well as in the deeper portion, where elastic fibers were still present. This might support the suggestion that degenerating elastic fibers promote the granulomatous reaction that leads to the formation of granuloma annulare.

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30.) Generalized granuloma annulare: histopathology and immunopathology. Systematic review of 100 cases and comparison with localized granuloma annulare.

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SO - J Am Acad Dermatol 1989 Jan;20(1):28-39

AU - Dabski K; Winkelmann RK

AD - Department of Dermatology, Mayo Clinic, Rochester, MN 55905.

MT - Comparative Study; Human

PT - JOURNAL ARTICLE

AB - Some form of collagen alteration (necrobiosis) was observed in 53% of patients with generalized granuloma annulare and in 79% of patients with localized granuloma annulare. Fragmentation of collagen bundles was the most common single type of collagen abnormality in both groups. Collagen sclerosis, accompanied by a strong palisading pattern of histiocytes, was more frequent in localized granuloma annulare. Results of microdroplet lipid staining were positive in 80% of annulare cases and 39.3% of nonannulare cases of generalized granuloma annulare. Inflammatory cells were confined to peripheral perivascular lymphocytes; bandlike granuloma below the epidermis was observed. Positive results of direct immunofluorescence tests in 12 of 23 patients with generalized granuloma annulare suggested that fibrin deposition in areas of altered collagen is less frequent in the generalized than in the localized form, a possible reflection of the lower rate of histologic collagen alteration in that group. Lymphohistiocytic granuloma with various degrees of collagen degeneration, microdroplet lipid accumulation, and mucin deposition form the basic pathologic description of granuloma annulare.

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31.) Agranulocytosis caused by dapsone therapy for granuloma annulare.

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SO - J Am Acad Dermatol 1989 Jan;20(1):87-8

AU - Potter MN; Yates P; Slade R; Kennedy CT

AD - Department of Haematology, Southmead Hospital, Bristol, U.K.

MT - Case Report; Female; Human

PT - JOURNAL ARTICLE

AB - Dapsone has been suggested as a useful drug in the treatment of granuloma annulare; however, adverse reactions include a potentially life-threatening agranulocytosis. We report the case of a 50-year-old woman in whom agranulocytosis and septicemia developed after 7 weeks of therapy with dapsone for granuloma annulare. Full recovery followed cessation of this drug, but caution is advised in prescribing dapsone for relatively benign skin conditions.

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32.) Generalized granuloma annulare: clinical and laboratory findings in 100 patients.

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SO - J Am Acad Dermatol 1989 Jan;20(1):39-47

AU - Dabski K; Winkelmann RK

AD - Department of Dermatology, Mayo Clinic, Rochester, MN 55905.

MT - Female; Human; Male

PT - JOURNAL ARTICLE

AB - Clinical and laboratory records of 100 biopsy-proved cases of generalized granuloma annulare seen at the Mayo Clinic between 1966 and 1986 were reviewed. The skin eruption involved predominantly annular lesions in 67 patients and predominantly nonannular papules in 33. The ratio of female-to-male patients was 2.9:1 in the annular group and 1.4:1 in the nonannular group. The mean age at onset was 51.7 years. The eruption was symptomatic in 34 patients, and specific precipitating factors could be implicated in 16 patients. No consistently associated systemic disorders were identified. Diabetes mellitus was diagnosed in 21% of our referral group of generalized granuloma annulare cases, compared with 9.7% in 1350 cases of localized granuloma annulare and 10.3% in 1383 cases of all forms of granuloma annulare seen at the Mayo Clinic in the same period. Serum lipid abnormalities were more common in the generalized annular group. Follow-up data indicated a chronic, relapsing course in most patients.

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33.) Antibodies to the Borrelia burgdorferi flagellum in patients with scleroderma, granuloma annulare and porphyria cutanea tarda.

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SO - Acta Derm Venereol 1989;69(2):116-9

AU - Halkier-Sorensen L; Kragballe K; Hansen K

AD - Department of Dermatology, Marselisborg Hospital, Aarhus, Denmark.

MT - Case Report; Female; Human; Male

PT - JOURNAL ARTICLE

AB - It is generally accepted that cutaneous Lyme borreliosis comprises erythema chronicum migrans, lymphadenosis benigna cutis, and acrodermatitis chronica atrophicans. In recent years the tick-borne spirochete Borrelia burgdorferi has been associated with a number of other cutaneous disorders. We therefore investigated sera from 175 patients with localized scleroderma (morphea) (n = 64), systemic sclerosis (n = 74), granuloma annulare (n = 16) and porphyria cutanea tarda (n = 21) with the new, highly sensitive and specific Borrelia burgdorferi flagellum ELISA assay. As controls (n = 297) served normal healthy volunteers and patients with other skin diseases. It was found that the distribution of individual antibody values and the median antibody levels were identical in controls and in patients with scleroderma, granuloma annulare and porphyria cutanea tarda. These data do not support the hypothesis of an etiological association between Borrelia burgdorferi infection and scleroderma, granuloma annulare or porphyria cutanea tarda.

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34.) Familial granuloma annulare. Report of two cases and review of the literature.

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O - J Am Acad Dermatol 1987 Mar;16(3 Pt 1):600-5

AU - Friedman SJ; Winkelmann RK

MT - Case Report; Female; Human

PT - JOURNAL ARTICLE

AB - We report two sisters with granuloma annulare who possessed identical histocompatibility antigens. The occurrence of granuloma annulare in families and the demonstration of particular human lymphocyte antigens (HLA) with granuloma annulare may indicate that hereditarily predisposed individuals could develop this specific cell-mediated immune reaction in response to an unknown antigen (e.g., connective tissue or infectious or toxic substances).

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35.) Octopus bite resulting in granuloma annulare.

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SO - South Med J 1986 Nov;79(11):1434-6

AU - Fulghum DD

MT - Case Report; Human; Male

PT - JOURNAL ARTICLE

AB - The cause of granuloma annulare is unclear. I have reported the development of characteristic clinical and histologic lesions of granuloma annulare at the site of an octopus bite, with early signs following the bite by two weeks.

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36.) Visceral and skin granuloma annulare, diabetes, and polyendocrine disease.

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SO - Br Med J (Clin Res Ed) 1986 Oct 18;293(6553):977-8

AU - Thomas DJ; Rademaker M; Munro DD; Levison DA; Besser GM

MT - Case Report; Human; Male

PT - JOURNAL ARTICLE

AB - A middle aged man suffered with insulin dependent diabetes, autoimmune Addison's disease, myxoedema, and severe ulcerative colitis, for which he had undergone subtotal colectomy with formation of an ileostomy. Granuloma annulare confined to the anterior abdominal wall was diagnosed in 1981. In 1983 an episode of severe colicky pain and excessive working of the ileostomy occurred associated with severe hyperglycaemia and increased irritation of the granuloma annulare. Laparotomy disclosed adhesions and numerous white nodules over bowel, mesentery, and peritoneum histologically identical with the skin lesions. Two further episodes of subacute small bowel obstruction occurred, and a repeat laparotomy showed widespread intra-abdominal granuloma annulare. Visceral granuloma annulare appears not to have been reported before, and in this patient exacerbation of the skin lesion was associated with poor diabetic control.

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37.) A study of HLA antigen association in localized and generalized granuloma annulare.

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SO - Br J Dermatol 1986 Sep;115(3):329-33

AU - Friedman-Birnbaum R; Gideoni O; Bergman R; Pollack S

MT - Female; Human; Male

PT - JOURNAL ARTICLE

AB - HLA-A and -B antigen frequencies were studied in 78 patients, 35 with localized granuloma annulare and 43 with generalized granuloma annulare (GA). Twenty-eight patients in each group were also typed for HLA-DR antigens. A group of 200 healthy age-matched subjects served as controls. HLA-A31 and B35 were increased significantly in patients with generalized GA, but not in the localized form. HLA-DR antigen distribution showed no significant variation.

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38.) Comparative ultrastructural study of generalized and localized granuloma annulare.

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SO - Am J Dermatopathol 1986 Aug;8(4):302-8

AU - Friedman-Birnbaum R; Ludatscher RM

MT - Comparative Study; Female; Human; Male

PT - JOURNAL ARTICLE

AB - The dermal changes in four cases of generalized granuloma annulare (GGA) and in four of localized granuloma annulare (LGA) were studied ultrastructurally, and the findings in the two groups were compared. The basic alterations were similar in both types, and showed varied stages of development. The cellular infiltrate was composed mostly of histiocytes. Cell debris was found in all lesions. The degenerative changes affected the collagen fibers, the elastic fibers, and the cellular infiltrate. Of special interest are the following findings in GGA: First, masses of intercellular fibrin material were seen only in the lesions of GGA. Second, thick and multilayered basal lamina around capillaries was apparently more common in the generalized form. These changes may suggest that a more pronounced immune reaction is responsible for the development of the generalized form of the disease.

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39.) Granuloma annulare arising in herpes zoster scars. Report of two cases and review of the literature.

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SO - J Am Acad Dermatol 1986 May;14(5 Pt 1):764-70

AU - Friedman SJ; Fox BJ; Albert HL

MT - Case Report; Female; Human; Male

PT - JOURNAL ARTICLE

AB - We present two patients who developed granuloma annulare in the scars from previous herpes zoster. The development of granuloma annulare in herpes zoster scars may represent an atypical delayed hypersensitivity immune reaction to herpes zoster/varicella virus antigen(s) or a tissue antigen altered by the virus.

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40.) The response of generalized granuloma annulare to dapsone.

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SO - Acta Derm Venereol 1986;66(1):82-4

AU - Czarnecki DB; Gin D

MT - Female; Human; Male

PT - JOURNAL ARTICLE

AB - Six patients with generalized granuloma annulare were successfully treated with Dapsone. Their ages ranged from 11 to 76. There were no serious side-effects and all were able to cease the drug.

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41.) Perforating granuloma annulare.

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SO - Int J Dermatol 1985 Nov;24(9):581-3

AU - Shimizu H; Harada T; Baba E; Kuramochi M

MT - Case Report; Female; Human; Male

PT - JOURNAL ARTICLE

AB - With more than 3 years' follow-up, dramatic clinical transfiguration of granuloma annulare was observed in a 59-year-old man with perforating granuloma annulare. The eruption was at first localized, then became generalized, developed perforations, and subsided in parallel with the improvement of associated diabetes mellitus. After reviewing 23 cases of perforating granuloma annulare from the literature, the authors divided the eruptions into two types according to their clinical features, naming one type papular perforating type (P-type) and the other ulcerative perforating type (U-type). U-type is strongly correlated with diabetes; patients with this type require detailed laboratory examination for the presence of diabetes mellitus.

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42.) Precipitating factors and associated diseases in 84 patients with granuloma 

annulare: a retrospective study.

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Studer EM; Calza AM; Saurat JH

Department of Dermatology, University Hospital of Geneva, Switzerland.

Dermatology (SWITZERLAND) 1996 193 (4) p364-8 ISSN: 1018-8665

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9705

Subfile: INDEX MEDICUS

In a retrospective study including 84 patients, we assessed precipitating factors 

of granuloma annulare (GA) and associated pathologies. Fifteen per-cent of the 

patients reported stress as an important trigger of GA, and in 10 patients (12%) we 

found an association between GA and diabetes mellitus: 3 latent, 4 type I and 3 type 

II. Eight of the diabetic patients presented multiple and 5 generalized GA. They 

suffered significantly more often from chronic relapsing GA than nondiabetic 

patients.

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43.) Mitotic granuloma annulare: a clinicopathologic study of 20 cases.

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Trotter MJ; Crawford RI; O'Connell JX; Tron VA

Department of Pathology (Anatomical Pathology), Vancouver Hospital and Health 

Sciences Centre, Canada.

J Cutan Pathol (DENMARK) Dec 1996 23 (6) p537-45 ISSN: 0303-6987

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9705

Subfile: INDEX MEDICUS

The finding of mitotic figures in granuloma annulare (GA) has not been emphasized 

in the literature. We describe 20 cases of a cellular, mitotically active variant of 

GA; we defined this group as cases having > or = 1 mitosis per 10 hpf. Clinically, 

the lesions could not be distinguished from typical, localized GA: there were 9 males 

and 11 females with a mean patient age of 49 +/- 15 years (mean +/- SD), compared to 

45 +/- 20 years in a randomly selected control group of 60 patients with GA, and no 

unusual sites of predilection were noted. Histologically, a classic, palisading 

granuloma pattern predominated (18/20 cases). Lesions were located in the mid-dermis 

and tended to be more cellular than typical GA. The histiocytes comprising the 

lesion often had enlarged nuclei and prominent nucleoli. The number of mitoses per 

10 hpf was 3.0 +/- 1.5 (range 1.0-7.2), control group 0.3 +/- 0.5; occasional 

atypical mitotic figures were observed. The proliferative nature of these lesions 

was confirmed using MIB-1 staining; the percentage of MIB-1 positive cells ranged 

from 5%-29% (mean 15 +/- 6%). Mitotic GA must be distinguished histologically from 

neoplastic processes, in particular epithelioid sarcoma. We conclude that 

histiocytes in clinically typical GA can exhibit an increased mitotic rate. 

Recognition of this variant is important in order to avoid overdiagnosis of a 

malignant condition.

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44.) Anti-oxidative therapy with oral dapsone improved HCV antibody positive annular elastolytic giant cell granuloma.

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Igawa K; Maruyama R; Katayama I; Nishioka K

Department of Dermatology, Tokyo Medical and Dental University School of Medicine, 

Japan.

J Dermatol (JAPAN) May 1997 24 (5) p328-31 ISSN: 0385-2407

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9709

Subfile: INDEX MEDICUS

A 72-year-old fisherman who was positive for the HCV antibody developed an annular, 

erythematous, infiltrated lesions on sun-exposed areas. The lesions were diagnosed 

as annular elastolytic giant cell granuloma both clinically and histologically. 

Topical corticosteroid and cryotherapy with liquid nitrogen for several months failed 

to improve the lesions. We then started dapsone, a known anti-oxidant, at 50 mg/day. 

A month later, the margins of the erythematous lesions faded, and the infiltration 

gradually decreased. No recurrence has been observed for one year after the start of 

the therapy. Anti-oxidative therapy appears to be effective for annular elastolytic 

giant cell granuloma and could be an alternate therapy for refractory granulomatous 

disease.

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45.) [First case of multiforme granuloma in Congo]

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TO: Premier cas congolais de granulome multiforme.

AU: Chandenier-B; Guillemette-J; Labussiere-JL; Quezede-P; Stanghellini-A; Gathse-A; Chandenier-J

AD: Service de dermatologie, CHU, Brazzaville, Congo.

SO: Sante. 1995 Jul-Aug; 5(4): 245-6

ISSN: 1157-5999

PY: 1995

LA: FRENCH; NON-ENGLISH

CP: FRANCE

AB: We report a case of multiform granuloma observed in a young woman of 28 years from Brazzaville, Congo. Extended lesions on the arms, back, face, legs and feet appeared over one month. They consisted of slightly squamous erythemato-oedematous plaques, with polycyclical margins and raised papular borders. The diagnosis was made histologically and recovery was spontaneous over a period of two months. We discuss clinical and histopathological aspects, which can sometimes lead to confusion with Hansen's disease.

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45.) Granuloma annulare and necrobiosis lipoidica tissue reactions as a manifestation of systemic disease.

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AU: Magro-CM; Crowson-AN; Regauer-S

AD: Department of Pathology, Beth Israel Hospital, Harvard Medical School, Boston, MA, USA.

SO: Hum-Pathol. 1996 Jan; 27(1): 50-6

ISSN: 0046-8177

PY: 1996

LA: ENGLISH

CP: UNITED-STATES

AB: Granuloma annulare (GA) and necrobiosis lipoidica (NL) are generally considered to be idiopathic cutaneous palisading granulomatous dermatitides. There are sporadic reports of such lesions occurring in patients with coexistent systemic diseases other than diabetes mellitus. Having encountered 49 patients whose skin biopsies showed GA or NL lesions in the setting of extracutaneous disease, the authors set out to assess their clinical and histopathological findings to determine if any parameters were predictive of underlying systemic disease. Fifty-two skin biopsies from 49 patients having either GA or NL in whom there was a clinical history of an associated systemic disease were analyzed by light microscopy. The main systemic disease associations were rheumatologic, endocrine, hematologic, infectious, and inflammatory bowel diseases, ANCA positive vasculitic syndromes, and sarcoidosis. The clinical and histomorphological features were compared with those of a control group of patients whose skin biopsies showed GA or NL and in whom there was no history of extracutaneous disease. For the systemic disease group, patients were selected either retrospectively or prospectively from 160,000 cases accessioned in a 24-month period in the dermatopathology databases of Pathology Services, Inc (Cambridge, MA) and Central Medical Laboratories (Winnipeg, Canada). All systemic disease cases from the former service were analyzed blindly by the second author and from the latter service were analyzed blindly by the first author. Patients in the control group were obtained retrospectively from the Pathology Services Inc. database by the authors. The location of the lesions was atypical in 30 of 34 biopsies from systemic disease patients with a GA tissue reaction versus 10 of 22 biopsies of GA in the control group (P = .001). Six of 18 biopsies from patients with NL tissue reactions in the systemic disease group showed an atypical location, versus only 1 of 9 biopsies of NL from the control group (P = .19). The clinical diagnostic considerations were much broader in the systemic disease group versus the control group and included vasculitis, panniculitis, and connective tissue diseases including morphea in the former. In 22 of 34 GA biopsies and 16 of 18 NL biopsies from the systemic disease group, an active vasculopathy of leukocytoclastic, granulomatous, or thrombogenic subtypes was demonstrable. None of the GA or NL biopsies from the control group showed a similar active vasculopathy. An active vasculopathy was predictive of systemic disease in patients having either a GA-like or an NL-like tissue reaction (P < .001). Fifteen of 34 GA and 7 of 18 NL biopsies in the systemic diseases group showed extravascular neutrophilia in contrast to 3 of 22 GA (P = .02) biopsies and 2 of 9 NL (P = .33) biopsies in the control group. The finding of an active vasculopathy in a skin biopsy specimen showing a GA- or NL-like tissue reaction, particularly in the setting of an atypical clinical presentation both with respect to the location and appearance of lesions, should prompt consideration of an underlying systemic disease, as should extravascular neutrophilia in a skin biopsy showing a GA-like tissue reaction.

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DATA-MEDICOS/DERMAGIC-EXPRESS No (24) 16/12/98 DR. JOSE LAPENTA R. DERMATOLOGO

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Produced by Dr. José Lapenta R. Dermatologist
Venezuela 1.998-2.024

Producido por Dr. José Lapenta R. Dermatólogo Venezuela 1.998-2.0024

Tlf: 0414-2976087 - 04127766810