A Monocentric, Retrospective Analysis of 61 Patients with Generalized Granuloma Annulare.
Disseminated granuloma annulare
Generalized granuloma annulare
Granuloma annulare
Granulomatous skin disease
Journal
Dermatology (Basel, Switzerland)
ISSN: 1421-9832
Titre abrégé: Dermatology
Pays: Switzerland
ID NLM: 9203244
Informations de publication
Date de publication:
2020
2020
Historique:
received:
27
02
2020
accepted:
11
03
2020
pubmed:
14
5
2020
medline:
27
4
2021
entrez:
14
5
2020
Statut:
ppublish
Résumé
Granuloma annulare is a chronic noninfectious granulomatous skin condition with variable clinical presentations. Generalized granuloma annulare, defined as widespread disease with >10 skin lesions, accounts for 15% of all cases. Numerous associated diseases have been controversially discussed, most importantly diabetes mellitus, dyslipidemia, thyroid disease, malignancy and systemic infections. The objective of our study is to describe disease characteristics, treatment outcome and associated diseases in patients treated at the Department of Dermatology of the University Hospital Zurich during the last 20 years. The hospital database was searched for patients with generalized granuloma annulare in the last 20 years (January 1, 1998, to December 31, 2017). Overall, 61 patients, 14 males and 47 females, were included in our study. The mean age was 58 years at first consultation. The diagnosis was verified clinically and histologically. Generalized granuloma annulare occurred at a mean age of 55 years, more commonly in females. Pruritus was absent in 51% of all patients. Metabolic diseases including diabetes mellitus, hypercholesterinemia and hypertriglyceridemia were present in 10.5, 8.2 and 4.9%, respectively. Thyroid disease was present in 9.8% and malignant disease in 23%, including colorectal cancer, lymphoproliferative disease, squamous cell carcinoma of the esophagus, basal cell carcinoma and gynecological malignancy. Therapy was initiated in 92%, while second- and third-line therapy was performed in 70 and 39%, respectively. Benefit during therapy (e.g., full and partial remission) was achieved in 39.3% during first-line, in 39.4% during second-line and in 33.8% during third-line treatment. Topical corticosteroids were the most commonly prescribed treatment, mostly leading to stable disease (46.6%). Combined full and partial remission occurred in a large proportion of patients receiving UVA1 (45%), PUVA (63.6%) and intralesional triamcinolone acetonide (100%). Generalized granuloma annulare is a mostly asymptomatic and benign disease with a strong tendency for treatment resistance. We suggest to screen all patients for dyslipidemia, thyroid disease and malignant disease. While randomized trials are needed, we suggest topical corticosteroids as the first-line treatment, intralesional triamcinolone acetonide for persistent solitary lesions and, if further treatment is needed, UVA1 or PUVA.
Sections du résumé
BACKGROUND
BACKGROUND
Granuloma annulare is a chronic noninfectious granulomatous skin condition with variable clinical presentations. Generalized granuloma annulare, defined as widespread disease with >10 skin lesions, accounts for 15% of all cases. Numerous associated diseases have been controversially discussed, most importantly diabetes mellitus, dyslipidemia, thyroid disease, malignancy and systemic infections.
OBJECTIVES
OBJECTIVE
The objective of our study is to describe disease characteristics, treatment outcome and associated diseases in patients treated at the Department of Dermatology of the University Hospital Zurich during the last 20 years.
METHODS
METHODS
The hospital database was searched for patients with generalized granuloma annulare in the last 20 years (January 1, 1998, to December 31, 2017). Overall, 61 patients, 14 males and 47 females, were included in our study. The mean age was 58 years at first consultation. The diagnosis was verified clinically and histologically.
RESULTS
RESULTS
Generalized granuloma annulare occurred at a mean age of 55 years, more commonly in females. Pruritus was absent in 51% of all patients. Metabolic diseases including diabetes mellitus, hypercholesterinemia and hypertriglyceridemia were present in 10.5, 8.2 and 4.9%, respectively. Thyroid disease was present in 9.8% and malignant disease in 23%, including colorectal cancer, lymphoproliferative disease, squamous cell carcinoma of the esophagus, basal cell carcinoma and gynecological malignancy. Therapy was initiated in 92%, while second- and third-line therapy was performed in 70 and 39%, respectively. Benefit during therapy (e.g., full and partial remission) was achieved in 39.3% during first-line, in 39.4% during second-line and in 33.8% during third-line treatment. Topical corticosteroids were the most commonly prescribed treatment, mostly leading to stable disease (46.6%). Combined full and partial remission occurred in a large proportion of patients receiving UVA1 (45%), PUVA (63.6%) and intralesional triamcinolone acetonide (100%).
CONCLUSIONS
CONCLUSIONS
Generalized granuloma annulare is a mostly asymptomatic and benign disease with a strong tendency for treatment resistance. We suggest to screen all patients for dyslipidemia, thyroid disease and malignant disease. While randomized trials are needed, we suggest topical corticosteroids as the first-line treatment, intralesional triamcinolone acetonide for persistent solitary lesions and, if further treatment is needed, UVA1 or PUVA.
Identifiants
pubmed: 32403113
pii: 000507247
doi: 10.1159/000507247
pmc: PMC7384347
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
369-374Informations de copyright
© 2020 The Author(s) Published by S. Karger AG, Basel.
Références
J Am Acad Dermatol. 2013 Feb;68(2):342-3
pubmed: 23317975
J Am Acad Dermatol. 2006 May;54(5 Suppl):S236-8
pubmed: 16631952
Australas J Dermatol. 2002 Feb;43(1):24-7
pubmed: 11869204
Rheumatol Int. 2019 Feb;39(2):353-357
pubmed: 30523477
Int J Dermatol. 1992 Nov;31(11):819
pubmed: 1296612
Br J Dermatol. 1994 Apr;130(4):494-7
pubmed: 8186116
Dermatol Clin. 2015 Jul;33(3):315-29
pubmed: 26143416
Dermatol Clin. 2019 Jan;37(1):49-64
pubmed: 30466688
Br J Dermatol. 1975 Jul;93(1):85-9
pubmed: 1191532
J Am Acad Dermatol. 2016 Sep;75(3):467-479
pubmed: 27543210
N Engl J Med. 2016 Sep 8;375(10):e21
pubmed: 27602682
J Am Acad Dermatol. 1989 Jan;20(1):39-47
pubmed: 2913080
Am J Dermatopathol. 2003 Apr;25(2):113-6
pubmed: 12652192
Ann Rheum Dis. 2008 Apr;67(4):567-70
pubmed: 17728330
Arch Dermatol. 2012 Oct;148(10):1131-6
pubmed: 22710282
Dermatology. 1996;193(4):364-8
pubmed: 8993973
Am J Clin Dermatol. 2018 Jun;19(3):333-344
pubmed: 29230666
BMJ Case Rep. 2014 Oct 28;2014:
pubmed: 25352383
Int J Dermatol. 2016 Apr;55(4):376-81
pubmed: 26474922
J Am Acad Dermatol. 2019 Jun;80(6):1799-1800
pubmed: 30826288
Clin Cosmet Investig Dermatol. 2017 Apr 26;10:141-145
pubmed: 28490896