Materiały źródłowe

• #1 Granuloma annulare

  https://dermnetnz.org/topics/granuloma-annulare

  Granuloma annulare is usually diagnosed clinically because of its characteristic appearance. […] Skin biopsy usually shows necrobiotic degeneration of dermal collagen surrounded by an inflammatory reaction. […] Granuloma annulare is often initially misdiagnosed as tinea because of the annular appearance; the lack of surface scale should lead away from this and other scaly rashes such as discoid eczema or psoriasis.

• #1 Granuloma annulare: Diagnosis and treatment

  https://www.aad.org/public/diseases/a-z/granuloma-annulare-treatment

  If you may have granuloma annulare, your dermatologist will exam your skin and ask some questions. […] The skin exam and information you provide are often enough to diagnose granuloma annulare. […] If it looks like you may have another condition, you may need medical testing. To test for another condition, your dermatologist may remove a bit of skin, so that it can be examined under a microscope. This is called a skin biopsy. […] Medical tests, such as a blood test or CT scan, can also help rule out other diseases. […] Testing is important because some research studies show that people with granuloma annulare have a higher risk of developing a few other diseases, such as diabetes, thyroid disease, or HIV (human immunodeficiency virus). Not all research studies have found this to be true. Until we know for sure, it can be helpful for some people to get tested for these diseases.

• #1 Diagnosis and Management of Granuloma Annulare | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1115/p1729.html

  Granuloma annulare is a benign, asymptomatic, self-limited papular eruption found in patients of all ages. […] The two most common types of granuloma annulare are localized, which typically is found on the lateral or dorsal surfaces of the hands and feet; and disseminated, which is widespread. […] Localized disease generally is self-limited and resolves within one to two years, whereas disseminated disease lasts longer. […] There are no well-designed randomized controlled trials of the treatment of granuloma annulare. […] Diagnosis is made with an excisional biopsy. […] Often, a diagnosis can be made without a punch biopsy, but in clinically confusing situations it may be helpful, especially with the subcutaneous variant of granuloma annulare. […] The presence of epithelioid histiocytes palisading around an anuclear dermis with mucin deposition is characteristic of granuloma annulare. […] If a biopsy is performed, the results typically will show focal degeneration of collagen with reactive inflammation and fibrosis.

• #1 Granuloma Annulare & Neutrophilic Dermatosis – Dermatology Advisor

  https://www.dermatologyadvisor.com/ddi/granuloma-annulare-neutrophilic-dermatosis/

  Granuloma annulare (GA) is a common, usually benign condition that most often presents as an annular, brownish-red papule, nodule, or plaque seen on the dorsal aspects of extremities of young women (especially children). […] In this patient, the lesions appearance and circumstances were so classic that a confirmatory biopsy was not needed. […] Had that procedure been done, it would have demonstrated foci of degenerative collagen associated with palisaded granulomatous inflammation, all highly suggestive of a diagnosis of GA. […] The typical plaques of GA are often mistakenly thought to be of fungal origin, but unlike the basic epidermal nature of the latter, GA is an intradermal process with little, if any, epidermal component. […] Skin biopsy helps distinguish Sweets syndrome from other such diagnostic considerations as granuloma annulare, erythema multiforme, erythema nodosum, herpes simplex, pyoderma gangrenosum, and drug eruptions.

• #1 Granuloma annulare – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/granuloma-annulare/diagnosis-treatment/drc-20351323

  Your health care provider may diagnose granuloma annulare by looking at the affected skin and taking a small skin sample (biopsy) to examine under a microscope. […] Skin biopsy.

• #1 Granuloma Annulare Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/1123031-workup

  Biopsy is recommended for a subcutaneous lesion and for a presentation that is atypical with respect to the history (ie, rapid enlargement, pain) or location of the lesion. […] Early interstitial or incomplete GA lesions show an interstitial pattern characterized by lymphocytes around vessels of the superficial and deep plexuses and by macrophages scattered between reticular dermal collagen bundles that are separated by mucin, within which mast cells may be found. […] Thus, AG can be distinguished histologically from GA by a preponderance of giant cells in relation to elastotic tissue, by absence of mucin, and, occasionally, by absence of palisading histiocytes around granulomas.

• #1

  https://link.springer.com/article/10.1007/s40257-013-0029-5

  Granuloma annulare (GA) is a common cutaneous disorder classically presenting as annular groups of skin-colored to erythematous papules without epidermal change localized to the dorsal hands and/or feet. […] The diagnosis of GA relies on clinicopathological correlation, with a skin biopsy confirming the histological features of the disease, including palisading granulomas, collagen degeneration, mucin, and a lymphohistiocytic infiltrate. […] When GA is generalized, disseminated, or atypical, a more thorough medical workup for underlying diseases may be considered depending on the physical examination, a thorough review of systems, comorbidities, and clinical suspicion. […] This evidence-based review will focus on the advances made in the twenty-first century regarding the etiology, diagnosis, and therapeutic management of GA.

• #1 Granuloma annulare and possible relation to purified protein derivative administration: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-024-04598-w

  Granuloma annulare is a noninfectious inflammatory granulomatous skin disease characterized by an erythematous or skin colored annulare plaque. The diagnosis of granuloma annulare may be challenging owing to its diverse morphology. […] The diagnosis of GA can sometimes be made on the basis of the classic clinical features of GA. In cases that are harder to diagnose, a correlation between the clinical findings and histologic findings are necessary. […] The presence of mucin is an important histologic feature that favors the diagnosis of GA, since other granulomatous skin diseases, such as sarcoidosis and necrobiosis lipoidica, do not reveal mucin deposition. […] Although GA is a benign self-limited disease, definitive diagnosis is important to rule out other pathologies with similar clinical appearances, such as cancer or human immunodeficiency virus (HIV) infection. Diagnostic confirmation is best made through skin biopsy.

• #1 Granuloma annulare (Pseudorheumatoid nodule) – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/granuloma-annulare-pseudorheumatoid-nodule/

  Subacute cutaneous lupus can have a similar annular appearance, but can be differentiated by a photodistribution, scale-crust, and positive antinuclear antibody (ANA) and anti-Ro antibodies. […] Tinea corporis also can assume an annular-plaque-like appearance, but typically has a scaly border, which demonstrates hyphae on potassium hydroxide (KOH) examination. […] Annular elastolytic giant cell granuloma should be considered when arciform lesions are observed in photoexposed sites; this diagnosis can be confirmed histologically. […] Increased mucin is a helpful diagnostic clue and can be visualized with colloidal iron or acian blue stains. IgM, fibrin, and C3 can occasionally be found in vessel walls by using immunofluorescence. Magnetic resonance imaging (MRI) has been reported to be helpful in assessing subcutaneous GA if a diagnosis cannot be made on clinical grounds, but the findings are not entirely specific.

• #1 Granuloma Annulare Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/1123031-workup

  Laboratory studies are largely noncontributory in patients with granuloma annulare (GA). With a classic history and unremarkable physical examination findings (other than the presenting lesion or lesions), no additional workup is necessary. […] If, however, a thorough history is not available or systemic disease is considered likely, appropriate laboratory evaluations should be performed to exclude other diagnostic possibilities. For example, in subcutaneous GA, a complete blood count (CBC) count, an erythrocyte sedimentation rate (ESR), and a rheumatoid factor (RF) study may assist in excluding other possible causes for nodules. […] Imaging studies are not generally necessary in diagnosing GA. However, radiography, computed tomography (CT), or magnetic resonance imaging (MRI) may be helpful in the evaluation of atypical subcutaneous lesions.

• #1 Granuloma annulare – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/622?q=Granuloma%20annulare&c=suggested

  Other diagnostic factors: flesh-coloured, pink, or brown macules or small papules, soft-tissue nodules, perforating papules, crusting or ulcerated lesions, erythematous patches. […] 1st investigations to order: clinical diagnosis. […] Investigations to consider: skin biopsy, fasting blood sugar, thyroid function tests, lipid screening, hepatitis screen, HIV testing.

• #1 Granuloma annulare (Pseudorheumatoid nodule) – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/granuloma-annulare-pseudorheumatoid-nodule/

  Granuloma annulare (GA) generally presents as asymptomatic papules that may coalesce to form plaques with an annular configuration. […] A diagnosis of GA can be made on clinical grounds alone. Histopathologic examination of a biopsy specimen from a suspected lesion is the only useful diagnostic study for GA and can be pathognomonic. […] The main histological differential diagnosis is necrobiosis lipoidica. […] The differential diagnosis includes other granulomatous diseases such as sarcoidosis (which tends to involve the face and is less likely to have an annular configuration), necrobiosis lipoidica (plaques on the shins of diabetics with more telangectasias than GA), and rheumatoid nodules (typically over joints). […] Lichen planus can have a similar presentation to the papules of GA, but only rarely assumes an annular configuration.

• #1 Granuloma Annulare – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459377/

  Granuloma annulare is diagnosed by correlating clinical presentation (see above) with the histologic features found on biopsy (see above). […] This activity explains when granuloma annulare should be considered in the differential diagnosis, articulates how to evaluate for this condition properly, and highlights the role of the interprofessional team in caring for patients with this condition. […] Despite being a benign disease, it can be associated with more serious conditions such as HIV or malignancy. […] Experts believe that a clinician should screen for malignancy in a patient with granuloma annulare under the following circumstances: older age, atypical or widespread presentation, and recalcitrant disease. […] Patients with new-onset granuloma annulare who have risk factors for HIV should be screened for HIV.

• #1 Generalized Granuloma Annulare and Non-Hodgkin’s Lymphoma | HTML | Acta Dermato-Venereologica

  https://www.medicaljournals.se/acta/content/html/10.2340/00015555-1510

  Granuloma annulare (GA) is a common, inflammatory disorder, which is usually considered to have a benign progression. […] Generalized (or disseminated) GA is thought to account for approximately 15% of cases of GA, and has been reported in association with diabetes, HIV and some malignant neoplasias, such as breast, cervical, lung, prostate, stomach and ovarian carcinoma. […] Generalized GA lesions in conjunction with malignant lymphomas seem to be a very rare and not well-recognized association. […] To our knowledge, the association of generalized GA with Hodgkins disease (HD) has been reported previously in only 7 patients. […] Dermatologists should be aware of this association and refer patients to a haematologist or an oncologist for appropriate work-up, especially in cases with rapid physical decay associated with generalized GA.

• #1 Granuloma annulare: Epidemiology, clinical manifestations, and diagnosis – UpToDate

  https://www.uptodate.com/contents/granuloma-annulare-epidemiology-clinical-manifestations-and-diagnosis

  Granuloma annulare (GA) is an often self-limited disorder that can affect both children and adults. Localized GA, which classically presents as an erythematous or skin-colored, annular plaque without scale, is the most common form of GA. The generalized form of GA, which accounts for approximately 15 percent of cases, typically presents with numerous papules and plaques on the trunk and extremities. Less common forms of GA include subcutaneous, perforating, and patch variants. Many cases of GA resolve spontaneously within a few years. The epidemiology, pathogenesis, clinical manifestations, and diagnosis of GA will be reviewed here. […] The exact prevalence of GA is unknown. In a United States cross-sectional study that analyzed patient data from a medical claims database obtained from 2017 to 2018, the annualized incidence and prevalence of GA were 0.04 percent (38 per 100,000) and 0.06 percent (58 per 100,000), respectively. Localized GA is considered the most common form of GA, with generalized GA as the second most common variant. In one retrospective study of 407 patients with GA, 303 had localized GA and 104 had generalized GA. Localized and generalized GA occur in both adults and children. Generalized GA appears to occur more frequently in adults than in children.

• #1 Patch-Type Granuloma Annulare: A Therapeutic and Diagnostic Challenge

  https://www.onlinescientificresearch.com/articles/patchtype-granuloma-annulare-a-therapeutic-and-diagnostic-challenge.html

  Granuloma annulare (GA) is a common, benign, chronic inflammatory disorder, which is characterized by grouped papules in an annular shape. […] The diagnosis of patch-type granuloma annulare was made, and the patient was treated with tacrolimus ointment twice daily for 8 weeks with no improvement. […] Granuloma annulare (GA) is an idiopathic benign, granulomatous skin disease characterized by skin-coloured or erythematous annular dermal papules and plaques with female predominance. […] Flat patches of granuloma annulare are rare and may be challenging to distinguish between other conditions, such as mycosis fungoides, interstitial drug reaction, erythema anulare centrifugal, reticular erythema mucinosis, and lupus erythematosus profundus. […] It is reported that patch granuloma annulare will respond to the same therapy as other types of granuloma annulare.

• #1 Granuloma annulare

  https://www.pcds.org.uk/clinical-guidance/granuloma-annulare

  GA is usually diagnosed clinically, however, where there is diagnostic uncertainty a skin biopsy may be required. […] The most characteristic histological lesion in GA is the necrobiotic granuloma, but there are three histological patterns that may occur: (i) necrobiotic palisading granulomas; (ii) an interstitial form; and (iii) granulomas of sarcoidal or tuberculoid type. […] An association between generalised GA and diabetes mellitus remains controversial.

• #1 Granuloma Annulare – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/hypersensitivity-and-reactive-skin-disorders/granuloma-annulare

  Diagnosis of granuloma annulare is usually clinical but can be confirmed by skin biopsy. […] Diagnose granuloma annulare clinically (eg, by the characteristic rings with central clearing and absence of scaling). […] If symptoms are bothersome, consider various topical or systemic medications, cryotherapy, or phototherapy.

• #2 Diagnosis and Management of Granuloma Annulare | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1115/p1729.html

  Granuloma annulare is a benign, asymptomatic, self-limited papular eruption found in patients of all ages. […] The two most common types of granuloma annulare are localized, which typically is found on the lateral or dorsal surfaces of the hands and feet; and disseminated, which is widespread. […] Localized disease generally is self-limited and resolves within one to two years, whereas disseminated disease lasts longer. […] There are no well-designed randomized controlled trials of the treatment of granuloma annulare. […] Diagnosis is made with an excisional biopsy. […] Often, a diagnosis can be made without a punch biopsy, but in clinically confusing situations it may be helpful, especially with the subcutaneous variant of granuloma annulare. […] The presence of epithelioid histiocytes palisading around an anuclear dermis with mucin deposition is characteristic of granuloma annulare. […] If a biopsy is performed, the results typically will show focal degeneration of collagen with reactive inflammation and fibrosis.

• #2 Granuloma annulare

  https://dermnetnz.org/topics/granuloma-annulare

  Granuloma annulare is usually diagnosed clinically because of its characteristic appearance. […] Skin biopsy usually shows necrobiotic degeneration of dermal collagen surrounded by an inflammatory reaction. […] Granuloma annulare is often initially misdiagnosed as tinea because of the annular appearance; the lack of surface scale should lead away from this and other scaly rashes such as discoid eczema or psoriasis.

• #2 Granuloma annulare – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/622?q=Granuloma%20annulare&c=suggested

  Typically asymptomatic, and presents as small grouped papules in an annular configuration. […] Localised disease is the most common subtype; patients are often women in their 30s. […] Most cases are self-limiting, with at least 50% resolving within 2 years. […] A possible association with underlying malignancy has been postulated, particularly in older patients with atypical or generalised clinical presentation such as palmar plaques or erythroderma. […] Although evidence is limited, may be associated with thyroid disease, hyperlipidaemia, and diabetes. […] Granuloma annulare (GA) is an uncommon benign condition of unknown aetiology. […] Histology is characteristic. Most cases are self-limiting. […] Key diagnostic factors: asymptomatic grouped annular pink or flesh-coloured dermal papules.

• #2 Granuloma annulare (Pseudorheumatoid nodule) – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/granuloma-annulare-pseudorheumatoid-nodule/

  Granuloma annulare (GA) generally presents as asymptomatic papules that may coalesce to form plaques with an annular configuration. […] A diagnosis of GA can be made on clinical grounds alone. Histopathologic examination of a biopsy specimen from a suspected lesion is the only useful diagnostic study for GA and can be pathognomonic. […] The main histological differential diagnosis is necrobiosis lipoidica. […] The differential diagnosis includes other granulomatous diseases such as sarcoidosis (which tends to involve the face and is less likely to have an annular configuration), necrobiosis lipoidica (plaques on the shins of diabetics with more telangectasias than GA), and rheumatoid nodules (typically over joints). […] Lichen planus can have a similar presentation to the papules of GA, but only rarely assumes an annular configuration.

• #2 Granuloma Annulare: Symptoms, Causes & Treatments

  https://my.clevelandclinic.org/health/diseases/17874-granuloma-annulare

  A healthcare provider will perform a physical examination of your skin. […] After a physical examination, they may perform a skin biopsy to confirm their diagnosis. Theyll remove a small sample of your skin. Then, theyll send the skin sample to a laboratory so other healthcare providers can examine it under a microscope to help determine whats causing your rash.

• #2 Granuloma Annulare Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/1123031-workup

  Biopsy is recommended for a subcutaneous lesion and for a presentation that is atypical with respect to the history (ie, rapid enlargement, pain) or location of the lesion. […] Early interstitial or incomplete GA lesions show an interstitial pattern characterized by lymphocytes around vessels of the superficial and deep plexuses and by macrophages scattered between reticular dermal collagen bundles that are separated by mucin, within which mast cells may be found. […] Thus, AG can be distinguished histologically from GA by a preponderance of giant cells in relation to elastotic tissue, by absence of mucin, and, occasionally, by absence of palisading histiocytes around granulomas.

• #2 Granuloma Annulare – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459377/

  Granuloma annulare is diagnosed by correlating clinical presentation (see above) with the histologic features found on biopsy (see above). […] This activity explains when granuloma annulare should be considered in the differential diagnosis, articulates how to evaluate for this condition properly, and highlights the role of the interprofessional team in caring for patients with this condition. […] Despite being a benign disease, it can be associated with more serious conditions such as HIV or malignancy. […] Experts believe that a clinician should screen for malignancy in a patient with granuloma annulare under the following circumstances: older age, atypical or widespread presentation, and recalcitrant disease. […] Patients with new-onset granuloma annulare who have risk factors for HIV should be screened for HIV.

• #2 Granuloma annulare: Diagnosis and treatment

  https://www.aad.org/public/diseases/a-z/granuloma-annulare-treatment

  If you may have granuloma annulare, your dermatologist will exam your skin and ask some questions. […] The skin exam and information you provide are often enough to diagnose granuloma annulare. […] If it looks like you may have another condition, you may need medical testing. To test for another condition, your dermatologist may remove a bit of skin, so that it can be examined under a microscope. This is called a skin biopsy. […] Medical tests, such as a blood test or CT scan, can also help rule out other diseases. […] Testing is important because some research studies show that people with granuloma annulare have a higher risk of developing a few other diseases, such as diabetes, thyroid disease, or HIV (human immunodeficiency virus). Not all research studies have found this to be true. Until we know for sure, it can be helpful for some people to get tested for these diseases.

• #2 Granuloma Annulare Differential Diagnosis Table

  https://symptomsky.com/help/granuloma-annulare/

  It is diagnosed on clinical examination, but a skin biopsy can also be performed. […] Diagnosis is usually made by looking at the lesion and alopecia. Skin biopsy is used to confirm the diagnosis. […] It is hard to diagnose, but blood and urine tests, CT scans, and biopsy can be done to assess the status of the disease. […] Syphilis is diagnosed on history, examination of sores, blood tests, and fluid examination of genital or oral sores. […] Diagnosis is based on the history of rheumatoid arthritis and examination of the nodule. Biopsy, blood tests, and antibody tests can also be performed. […] Biopsy is performed to distinguish necrobiosis lipoidica from granuloma annulare. […] It is diagnosed based on the history and examination of lesions, while biopsy is also useful.

• #2 Granuloma annulare (Pseudorheumatoid nodule) – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/granuloma-annulare-pseudorheumatoid-nodule/

  Subacute cutaneous lupus can have a similar annular appearance, but can be differentiated by a photodistribution, scale-crust, and positive antinuclear antibody (ANA) and anti-Ro antibodies. […] Tinea corporis also can assume an annular-plaque-like appearance, but typically has a scaly border, which demonstrates hyphae on potassium hydroxide (KOH) examination. […] Annular elastolytic giant cell granuloma should be considered when arciform lesions are observed in photoexposed sites; this diagnosis can be confirmed histologically. […] Increased mucin is a helpful diagnostic clue and can be visualized with colloidal iron or acian blue stains. IgM, fibrin, and C3 can occasionally be found in vessel walls by using immunofluorescence. Magnetic resonance imaging (MRI) has been reported to be helpful in assessing subcutaneous GA if a diagnosis cannot be made on clinical grounds, but the findings are not entirely specific.

• #2 Granuloma annulare – Wikipedia

  https://en.wikipedia.org/wiki/Granuloma_annulare

  Granuloma annulare may be divided into the following types: Localized granuloma annulare, Generalized granuloma annulare, Patch-type granuloma annulare, Subcutaneous granuloma annulare, Perforating granuloma annulare. […] Because granuloma annulare is usually asymptomatic and self-limiting with a course of about two years, initial treatment is generally topical steroids or calcineurin inhibitors; if unimproved with topical treatments, it may be treated with intradermal injections of steroids or phototherapy. If local treatment fails it may be treated with systemic corticosteroids. […] Treatment success varies widely, with most patients finding only brief success with the above-mentioned treatments. Most lesions of granuloma annulare disappear in pre-pubertal patients with no treatment within two years while older patients (50+) have rings for upwards of 20 years. The appearance of new rings years later is not uncommon.

• #2 Granuloma annulare: Epidemiology, clinical manifestations, and diagnosis – UpToDate

  https://www.uptodate.com/contents/granuloma-annulare-epidemiology-clinical-manifestations-and-diagnosis

  Granuloma annulare (GA) is an often self-limited disorder that can affect both children and adults. Localized GA, which classically presents as an erythematous or skin-colored, annular plaque without scale, is the most common form of GA. The generalized form of GA, which accounts for approximately 15 percent of cases, typically presents with numerous papules and plaques on the trunk and extremities. Less common forms of GA include subcutaneous, perforating, and patch variants. Many cases of GA resolve spontaneously within a few years. The epidemiology, pathogenesis, clinical manifestations, and diagnosis of GA will be reviewed here. […] The exact prevalence of GA is unknown. In a United States cross-sectional study that analyzed patient data from a medical claims database obtained from 2017 to 2018, the annualized incidence and prevalence of GA were 0.04 percent (38 per 100,000) and 0.06 percent (58 per 100,000), respectively. Localized GA is considered the most common form of GA, with generalized GA as the second most common variant. In one retrospective study of 407 patients with GA, 303 had localized GA and 104 had generalized GA. Localized and generalized GA occur in both adults and children. Generalized GA appears to occur more frequently in adults than in children.

• #2 Granuloma Annulare: Diagnosis, Causes, & Treatment – Toronto Dermatology Centre

  https://torontodermatologycentre.com/granuloma-annulare/

  Granuloma annulare is a benign skin condition, the exact cause of which remains unknown. […] Often your dermatologist is able to make the diagnosis of granuloma annulare just by examining the lesion with their eyes (Clinical diagnosis). A biopsy may be done to confirm the diagnosis. […] It is important to see a dermatologist and get the correct diagnosis and the appropriate therapy.

• #3 Granuloma Annulare – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459377/

  Granuloma annulare is diagnosed by correlating clinical presentation (see above) with the histologic features found on biopsy (see above). […] This activity explains when granuloma annulare should be considered in the differential diagnosis, articulates how to evaluate for this condition properly, and highlights the role of the interprofessional team in caring for patients with this condition. […] Despite being a benign disease, it can be associated with more serious conditions such as HIV or malignancy. […] Experts believe that a clinician should screen for malignancy in a patient with granuloma annulare under the following circumstances: older age, atypical or widespread presentation, and recalcitrant disease. […] Patients with new-onset granuloma annulare who have risk factors for HIV should be screened for HIV.

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