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Subcutaneous granuloma annulare of the extremities in children
M Letts1, B Carpenter, P Soucy
1Division of Orthopaedics, Children's Hospital of Eastern Ontario, 401 Smyth Rd., Ottawa, ON K1H 8L1.
Insights
Granuloma annulare in children often presents as multiple lesions on the lower legs and can recur. While biopsy confirms diagnosis, this benign skin condition typically resolves without intervention.
Area of Science:
- Dermatology
- Pediatric Surgery
- Pathology
Background:
- Granuloma annulare is a benign inflammatory skin condition.
- Subcutaneous granuloma annulare (SGA) is a less common variant.
- Understanding its presentation in children is crucial for accurate diagnosis and management.
Purpose of the Study:
- To describe the natural history of subcutaneous granuloma annulare in children.
- To familiarize surgeons with the clinical presentation and treatment of SGA in pediatric patients.
- To analyze recurrence rates and common sites of involvement.
Main Methods:
- Retrospective case review of 27 children diagnosed with SGA via pathological biopsy.
- Follow-up conducted through appointments and questionnaires.
- Data collected on lesion incidence, location, and recurrence.
Main Results:
- The anterior pretibial area was the most common site (16 lesions), followed by the ankle (6) and long finger (4).
- Six children had multiple lesions (total 46), and 5 experienced recurrence (total 7 lesions).
- The condition predominantly affected girls, with a mean age of 8.3 years at presentation.
Conclusions:
- Subcutaneous granuloma annulare is a benign, inflammatory pediatric skin lesion.
- It frequently presents on the anterior pretibial area, often as multiple lesions with a high recurrence rate.
- Biopsy is necessary for diagnosis, but lesions typically resolve spontaneously without treatment.
Objective:
To familiarize surgeons to the natural history and treatment of granuloma annulare of the extremities in children.
Design:
Case review and follow-up by appointment and questionnaire.
Setting:
The Children's Hospital of Eastern Ontario, a tertiary referral centre.
Patients:
Twenty-seven children (23 girls, 4 boys) seen between 1983 and 1998 with subcutaneous granuloma annulare, proven pathologically. The mean age at initial presentation was 8.3 years (range from 1.8 years to 16.7 years). The mean follow-up was 45 weeks (range from 1 week to 5 years).
Intervention:
Biopsy excision of the lesions.
Outcome Measures:
The incidence multiple lesions, the commonest site of occurrence and the incidence of recurrence.
Results:
Six children presented with multiple lesions for a total of 46 lesions. The anterior pretibial area was the most frequently affected site (16 lesions), followed by the ankle (6 lesions) and the long finger (4 lesions). Five patients suffered recurrence of the lesion, with a total of 7 lesions recurring.
Conclusions:
Subcutaneous granuloma annulare is a benign inflammatory skin lesion occurring most frequently in the anterior pretibial area in children, predominantly girls. The incidence of recurrence and of multiple lesions is high. Biopsy is required for definitive diagnosis. The lesion resolves spontaneously without treatment.