THE THERAPEUTIC CHALLENGES OF A „LARGE IMITATOR“ – THE GENERALIZED RING GRANULOMA

Abstract

Granuloma annulare (GA) is a benign skin condition of unknown etiology. It can manifest itself in several clinical forms: localized, generalized, subcutaneous or perforating. The association between GI and diabetes, dyslipidemia or neoplasms is not yet elucidated. Although the diagnosis is clinical in most cases, a histopathological examination may be necessary. We presented the case of a 52 years old patient, diabetic, hypertensive, who reffered to our clinic, with a rash or macular-papular, pruritic, eruption, localization on the lower limbs and abdomen, in the evolution of 6 months. We performed skin biopsy with histopathological examination, which revealed: dermal nodular infiltrates consisting of palisadiate histiocytes, in several mucin collections and signified by lymphocytes with perivascular arrangement, typical modifications for an annular granuloma lesion. We have initiated systemic treatment with isotretinoin, associated with dermatocorticoids, with favorable evolution. Diagnosis, aș well aș the management of a patient with generalized GI, can sometimes be difficult. The histopathological examination, in combination with a suggestive clinical picture, makes the diagnosis. Treatment is indicated in severe cases, with multiple, symptomatic, persistent lesions.

Keywords

• granuloma annulare
• isotretinoin
• dermatocorticoids
• dapsone