Publications

A 57-year-old woman with no known comorbidities presented to our dermatology clinic with a 6-month history of asymptomatic lesions on her upper back and upper limbs. Examination revealed well-defined, annular, non-scaly plaques with raised erythematous borders and central clearing over the dorsum of her hands, arms, forearms, and upper back in a predominantly photo-distributed pattern (Figure 1). Histopathology showed central necrobiotic collagen surrounded by dermal histiocytic infiltrate in a palisaded arrangement, with mucin deposition, indicative of generalized granuloma annulare. We prescribed topical clobetasol propionate (0.05%) cream and the lesions improved by around 50% after 8 weeks of treatment.

Granuloma annulare is an inflammatory dermatosis that affects people of all ages, particularly females, with an annual incidence of 37.9 per 100 000 people.1 Generalized granuloma annulare accounts for 15% of cases and typically manifests as erythematous or skin-coloured annular plaques with a raised, rope-like border and central clearing, predominantly affecting the trunk and extremities. Localized granuloma annulare is the most common variant. Other variants include perforating, subcutaneous, patch, papular, photo-distributed, and drug-induced granuloma annulare. Potential triggers include drug exposure and viral infections. Reported associations include diabetes, malignancy, dyslipidemia, hypothyroidism, and genetic predisposition (i.e., human leukocyte antigen [HLA] B35 in generalized variant).2 Patients should be investigated for these conditions as clinically indicated.