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Subcutaneous granuloma annulare.

Luis Requena1, María Teresa Fernández-Figueras

  • 1Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain. lrequena@fjd.es

Seminars in Cutaneous Medicine and Surgery
|June 5, 2007
PubMed
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Subcutaneous granuloma annulare is a rare panniculitic condition presenting as deep nodules, often in young individuals. Its exact cause is unknown, but it involves collagen degeneration and granuloma formation in the subcutis.

Area of Science:

  • Dermatopathology
  • Rheumatology
  • Pediatrics

Background:

  • Subcutaneous granuloma annulare (SGA) is a rare variant of granuloma annulare.
  • It presents as subcutaneous nodules, distinct from typical dermal lesions.
  • The pathogenesis of this deep form remains unclear.

Purpose of the Study:

  • To describe the clinicopathologic features of subcutaneous granuloma annulare.
  • To differentiate SGA from other subcutaneous conditions.
  • To highlight key histopathological findings of SGA.

Main Methods:

  • Review of clinicopathologic and histopathologic features of SGA.
  • Comparison with classic dermal granuloma annulare.
  • Differential diagnosis considerations including rheumatoid nodule, necrobiosis lipoidica, and epithelioid sarcoma.

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Main Results:

  • SGA predominantly affects children and young adults, with lesions on lower legs, hands, head, and buttocks.
  • Histopathology reveals basophilic collagen degeneration with palisading granulomas in the subcutis, often with larger necrobiotic areas than dermal counterparts.
  • Eosinophils are more frequent in SGA, and it typically presents as a pure panniculitis, though dermal involvement occurs in 25% of cases.

Conclusions:

  • Subcutaneous granuloma annulare is a distinct entity characterized by deep-seated, non-inflammatory nodules.
  • Its histopathological features, including extensive necrobiosis and specific inflammatory cell infiltrates, aid in diagnosis.
  • Accurate differentiation from other subcutaneous lesions is crucial for appropriate patient management.