Thursday, August 13, 2015

34 yo woman with micropapules

The patient is a 34 yo woman with a 1 year history of a slightly pruritic eruption on her upper arms, elbows, mid back.  Her health is good and she takes no meds p.o.  She commutes between Seoul, New York City and Paris for her work in fashion.

The lesions are symmetrically placed in these areas.

Pathology:  Two 3 mm punch biopsies taken.

There is an interstitial proliferation of lymphocytes and histiocytes forming granulomas with focally increased dermal mucin and central necrobiosis, and with islands of intervening normal dermal collagen and a mild superficial and mid perivascular lymphocytic infiltrate with occasional plasma cells. These findings support the histologic diagnosis of granuloma annulare.

Diagnosis: Granuloma annulare

The clinical picture is unusual, but in retrospect, it fits.  Perhaps, this is an example of generalized G.a.  The patient is otherwise healthy but we have no recent lab tests.  It may be prudent to obtain A1c, chemistry and lipid profile.

What are your thoughts?

1. Remission of generalized erythematous granuloma annulare after improvement of hyperlipidemia and review of the Japanese literature.
Watanabe S et.a.l  Dermatol Pract Concept. 2014 Jan 31;4(1):97-100.  Free Full Text Online

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