Granuloma Annulare generalizado, debemos explorar más...
Analysis of Patients With Generalized Granuloma Annulare
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In this retrospective review of 61 patients with generalized granuloma annulare, 23% were additionally found to have malignant disease. Thyroid disease (~10%), diabetes mellitus (~10%), hypercholesterolemia (~8%), and hypertriglyceridemia (~5%) were also seen. Of the total, 56 (92%) patients were started on first-line therapy, 70% required initiation of second-line therapy, and 39% required initiation of third-line therapy. Intralesional triamcinolone, PUVA, and UVA1 demonstrated the highest rates of benefit among all therapeutics utilized (100%, ~64%, and 45% patients respectively).
- Based on the results of this study, patients with generalized granuloma annulare should be screened for malignant disease, thyroid disease, and dyslipidemia. In those patients with refractory disease, intralesional corticosteroids or PUVA therapy could be considered, although additional larger studies are needed.
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
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
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
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
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.
A Monocentric, Retrospective Analysis of 61 Patients With Generalized Granuloma Annulare
Dermatology (Basel) 2020 May 13;[EPub Ahead of Print], TM Nordmann, JR Kim, R Dummer, F AnzengruberSkin Care Physicians of Costa Rica
Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574
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posted by dermatica at
June 30, 2020
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