Subcutaneous granuloma annulare: recognition and treatment
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Published on: May 26, 2023
J R Davids1, B H Kolman, G F Billman
1Department of Orthopaedics, Children's Hospital and Health Center, University of California, San Diego.
Insights
Subcutaneous granuloma annulare (SGA) in children presents as painless soft-tissue masses. Diagnosis requires biopsy, and recurrence is common, though the condition is benign.
Area of Science:
- Pediatric Dermatology
- Pediatric Pathology
Background:
- Subcutaneous granuloma annulare (SGA) is a benign inflammatory condition affecting children.
- It often presents as a rapidly growing, painless soft-tissue mass, mimicking malignancy.
Purpose of the Study:
- To review the clinical presentation, diagnosis, and management of pediatric SGA.
- To highlight diagnostic challenges and recurrence patterns.
Main Methods:
- Retrospective review of 12 pediatric patients diagnosed and treated for SGA.
- Analysis of clinical presentation, diagnostic workup, and treatment outcomes.
Main Results:
- Patients presented with soft-tissue masses on extremities or scalp (mean age 3.9 years).
- Diagnosis definitively required biopsy; no ancillary tests were specific.
- Excisional biopsy was diagnostic but not therapeutic, with 75% experiencing recurrence.
Conclusions:
- SGA in children can be misdiagnosed, leading to extensive testing.
- Biopsy is essential for diagnosis, and recurrence is frequent but typically self-limiting.
- No patients progressed to systemic illness, confirming the benign nature of SGA.
Abstract:
Subcutaneous granuloma annulare (SGA) is a benign inflammatory disorder that occurs in children. The profiles of 12 children with SGA who were diagnosed and treated at our institution were reviewed. The patients presented with a rapidly growing, painless soft-tissue mass of the extremities or scalp. Parental concerns of malignancy and lack of recognition of this condition by the physician led to excessive diagnostic testing and, on occasion, inappropriate therapy. The mean age at presentation was 3.9 years, and the mean follow-up after biopsy study was 3.4 years. The lesions were most commonly located about the elbow, knee, and scalp. While complete blood count, erythrocyte sedimentation rate, and plain radiographs were helpful in ruling out other conditions, no ancillary test was specific for this disorder. In all cases, definitive diagnosis required a biopsy sample. Excisional biopsy was diagnostic but not therapeutic, because 75% of the children had one or more recurrences of this condition at either local or distant sites. Two of the subsequent lesions resolved spontaneously, and no child within the study group has progressed to any recognized systemic illness or connective-tissue disorder.
