Pressure-induced localised granuloma annulare following use of an elbow splint

Granuloma annulare is a benign, inflammatory skin disorder with no distinct aetiology or widely accepted pathogenic process. Case description and Methods: We report a case of a 71-year old female with a 4-year history of an erythematous annulopapular lesion to the lateral aspect of her right forearm from a pressure pleat ridge in a high-density polyethylene plastic elbow orthosis to immobilise a prior radial head fracture. Morphological and histopathological assessment was consistent for granuloma annulare. Findings and Outcomes: The granuloma annulare was ameliorated after 3 months of high-potency topical steroids under occlusive dressing.

This case highlights an atypical presentation of a pressure-induced patch of localised granuloma annulare persisting long-term after temporary use of a high-density polyethylene orthosis with a pleated point ridge. Special care should be taken when choosing the appropriate orthosis in patients with sensitive skin conditions. Moulded orthoses can have defects after manufacturing that can lead to localised skin irritation, inflammation and subsequent rash formation. Clinical relevance Appropriate casting and splint moulding should be taken into special consideration in patients with sensitive skin conditions. This prevents or diminishes the chance inducing or exacerbating skin conditions.