Materiały źródłowe

• #1 Granuloma Annulare | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/22400

  The prevalence of granuloma annulare is estimated to be 0.1% to 0.4%, and the estimated incidence is 0.1% to 0.4%. Women are affected more commonly than men, and the disease can affect persons of any age. More than two-thirds of patients are 30 years of age or younger. […] More research is needed to better determine the epidemiology, disease associations, pathophysiology, and treatment of this disease.

• #2

  https://link.springer.com/article/10.1007/s13671-024-00430-2

  Since the 1960s, most studies have estimated the annual incidence of granuloma annulare (GA) to range from 0.1% to 0.4%, with a female-to-male ratio of approximately 2:1. […] Most recent study conducted on 11,608 patients with incident GA and 17,862 patients with prevalent GA, found the incidence of GA to be 0.04% and prevalence to be 0.06%, with a female-to-male ratio of 3:1.

• #3

  https://www.nursingcenter.com/journalarticle?Article_ID=5494967&Journal_ID=849729&Issue_ID=5494960

  Granuloma annulare is relatively rare with a prevalence and incidence of approximately 0.1%-0.4% (Schmieder Schmieder, 2019). Greater than two thirds of patients are aged 30 years or younger, and granuloma annulare has a higher incidence among female patients (Rubin Rosenbach, 2019; Schmieder Schmieder, 2019). […] Granuloma annulare is a benign, idiopathic disease with a broad clinical presentation. The aim of this evidence-based review is to bring awareness to the entity of granuloma annulare and highlight its clinical spectrum.

• #4 Granuloma Annulare: An Updated Review of Epidemiology, Pathogenesis, and Treatment Options

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8423598/

  A 2021 study by Barbieri et al. of 11,608 patients with incident GA and 17,862 patients with prevalent GA helps to establish the epidemiology of GA in the US. The study investigators report the incidence of GA to be 0.04% and note both the incidence and prevalence of disease to be most frequent during the fifth decade of life. Moreover, GA has a predilection for women, with a female-to-male ratio of 3:1. Incidence and prevalence also appears to be more common among Caucasians and individuals with a higher household income and educational attainment. Nevertheless, it is unclear whether this difference is due to genetic and environmental factors or merely due to a lower likelihood of racial minorities and individuals with lower educational attainment seeking medical attention […] A recent study of 180 GA patients in the All of Us Research Program, a National Institutes of Health database that includes groups that have been historically underrepresented in research, also reports GA to be more prevalent among White patients compared with non-White patients, suggesting that a genetic predisposition may indeed be likely, although further studies are still needed to establish such an association.

• #5 Study Reports on US Incidence, Prevalence of Granuloma Annulare

  https://www.hcplive.com/view/study-reports-us-incidence-prevalence-granuloma-annulare

  A new cross-sectional study detailed the prevalence of granuloma annulare in the United States, providing insight into its epidemiology and incidences. […] Few large-scale population-based studies have explored the prevalence and incidences of the rare disease, and the burden of it has not been well-established. […] Thus, the overall annualized incidence was 0.04%, or 37.9 per 100,000 (95% CI, 36.9-38.9) person-years. The overall annualized prevalence was 0.06%, or 58.3 per 100,000 (95% CI, 57.1-59.5) person-years. […] Barbieri and colleagues noted that the overall incidence of granuloma annulare was higher among women (female to male ratio, 2.8:1; P.001) and in those in the 5th decade of life. […] Furthermore, incidence was higher among White patients (48.2 [95% CI, 46.8- 49.7]) than Black patients (21.3 [95% CI, 18.8-23.9]; P .001).

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

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

  Granuloma annulare (GA) is an often self-limited disorder that can affect both children and adults. Localized GA is considered the most common form of GA, with generalized GA as the second most common variant. 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. 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.

• #7 Granuloma Annulare: Background, Pathophysiology, Etiology

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

  The frequency of GA is in the general population is unknown. Of the various subtypes, localized GA is the most common. The generalized subtype occurs in 9-15% of all patients with GA. Perforating GA has a reported prevalence of 5% among GA subtypes; reports suggest that this subtype may be more common in the Hawaiian Islands. […] Localized GA is most commonly found in children and in adults younger than 30 years. Generalized GA demonstrates a bimodal age distribution, occurring in patients younger than 10 years and in patients aged 30-60 years. Although subcutaneous GA can occur in adults, it is predominantly a disease of otherwise healthy children (typical age range, 2-10 y). Similarly, perforating GA most often affects children. […] Women are affected by GA twice as frequently as men are. […] GA has no known predilection for any particular race, ethnic group, or geographical area.

• #8 Granuloma annulare: Who gets and causes

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

  Medical records indicate that this skin condition is more common in females than males. […] It also seems that the perforating type of granuloma annulare develops most often in people who live in Hawaii. […] Some studies, however, have found that people with certain diseases, such as an HIV infection, may be more likely to develop granuloma annulare. […] Granuloma annulare may also be more common if someone has a disease, such as the human immunodeficiency virus (HIV), thyroid disease, or diabetes. Not everyone who has one of these diseases will develop granuloma annulare. Again, its possible that the skin is reacting to whats going on inside the body. […] Before we know for sure what causes granuloma annulare, more research is needed.

• #9 Granuloma Annulare | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688819/all/Granuloma_Annulare?q=Systemic+erythematosus+lupus

  GA is a relatively common, noninfectious granulomatous disease. Incidence is reported to be 0.04% per year within the United States (1). […] Prevalence is reported to be highest in the 5th decade of life (1).

• #10 Diagnosis and Management of Granuloma Annulare | AAFP

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

  Granuloma annulare affects patients of all ages. Most cases of localized granuloma annulare are diagnosed in patients before 30 years of age. Incidence is highest in women, with a ratio of 2.3 to 1.0 over men. Approximately 15 percent of all patients with granuloma annulare will have more than 10 lesions (i.e., disseminated granuloma annulare). These patients are usually children younger than 10 years or adults older than 40 years. Although uncommon, cases of granuloma annulare occurring in siblings, twins, and successive generations have been reported. Seasonal peaks of granuloma annulare in the spring and fall also have been described. […] The duration of the skin eruption varies. In more than one half of patients, it resolves spontaneously within two months to two years. However, cases of disseminated granuloma annulare may last three to four years or as long as 10 years. The eruption may recur as well, with 40 percent of children having recurrent lesions.

• #11 Treatment Options for Granuloma Annulare | Canadian Dermatology Today

  https://canadiandermatologytoday.com/article/view/1-2-karpman

  The epidemiology of GA is such that it affects patients of all ages. Most cases of localized granuloma annulare are diagnosed in patients before 30 years of age. Incidence is highest in women, with a ratio of 2.3 to 1.0 over men. Approximately 15 percent of all patients with granuloma annulare will have more than 10 lesions (i.e. disseminated granuloma annulare). These patients are usually children younger than 10 years or adults older than 40 years. […] Although uncommon, cases of granuloma annulare occurring in siblings, twins, and successive generations have been reported. Seasonal peaks of granuloma annulare in the spring and fall also have been described. The duration of the skin eruption varies. In more than one half of patients, it resolves spontaneously within two months to two years. However, cases of disseminated granuloma annulare may last three to four years or as long as 10 years. The eruption may recur as well, with 40% of children having recurrent lesions.

• #12 Granuloma Annulare: Causes, Symptoms, Treatment | Doctor

  https://patient.info/doctor/granuloma-annulare-pro

  How common is granuloma annulare? (Epidemiology) It is a not uncommon condition but UK figures on incidence are not available. Granuloma annulare has an incidence of 0.04% in the USA, and has shown to be significantly associated with autoimmune disease, diabetes mellitus, and hyperlipidemia. […] Localised is the most common type, accounting for around three quarters of all cases. This type is usually found in those under 30 years old. […] The generalised form includes generalised annular, disseminated papular and atypical generalised subtypes. It represents about 10-15% of cases. […] Subcutaneous granuloma annulare is most often seen in children, particularly between the ages of two and five. […] Perforating granuloma annulare is the least common type. It occurs most often in children and young adults.

• #13 SciELO Brazil – Case for diagnosis. Patch granuloma annulare* Case for diagnosis. Patch granuloma annulare*

  https://www.scielo.br/j/abd/a/8YxC54NL7NPm9yQKcTshWqk/?lang=en

  Patch granuloma annulare (GA) was first reported in 1932 by Monach1 as a new macular clinical variant, which was later also named macular GA or erythematous GA. This disease is a rare variant, of unknown incidence, which is typically observed in women from 40 to 74 years of age. […] Associations with diabetes, dyslipidemia, malignancies, infections, thyroid diseases and drugs are all reported in the literature, but they require further study in order to be confirmed. […] Histologically, studies suggest that the diffuse interstitial pattern is most common in patch GA, unlike the focal palisading granuloma seen in the majority of other clinical forms.

• #14 Granuloma Annulare | Plastic Surgery Key

  https://plasticsurgerykey.com/granuloma-annulare-4/

  Granuloma annulare is a relatively common disorder. It occurs in all age groups, but is rare in infancy. The localized annular and subcutaneous forms occur more frequently in children and young adults. The generalized variant is more common in adults. Many studies report a female preponderance, but some have found a higher frequency in males. Granuloma annulare does not favor a particular race or geographic area, with the possible exception of the perforating type, which may be more common in Hawaii. […] Most cases of granuloma annulare are sporadic. Occasional familial cases are described with occurrence in twins, siblings, and members of successive generations. Attempts to identify an associated HLA subtype have yielded disparate results in different population groups.

• #15 Epidemiology – GPnotebook

  https://gpnotebook.com/en-IE/pages/diabetes-and-endocrinology/granuloma-annulare/epidemiology

  patients of all age can be affected by granuloma annulare […] Incidence is higher in females than males( (females are affected about 2 times more than males) […] seasonal peaks during spring and fall can be seen […] about 40% of cases will have recurrence of lesions (1).

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

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

  A majority of patients with GA are children and young adults (2/3 of cases), although the generalized form tends to favor adults. Historically, GA was thought to be more common in females, although there are conflicting data. […] A link to type I diabetes has been shown; from 12% to 21% of patients (especially those with the generalized form) have this disorder. There is little correlation with type II diabetes. […] HLA-Bw35 has been associated with generalized GA, and HLA-B8 has been associated with the localized form, suggesting a hereditary component. Indeed, familial cases have been reported.

• #17

  https://dpcj.org/index.php/dpc/article/view/2173

  Granuloma annulare (GA) has been reported as associated with multiple diseases, mainly diabetes mellitus (DM), thyroid diseases, and dyslipidemia. […] Our objective was to analyse the clinical features of our GA patients and the possible associations. […] Diabetes was diagnosed in 40 GA patients (18%) (34 in the control group, 15%) and hypothyroidism in 33 (15%) (22 in the control group 9.8%); the differences were not significant. […] We also did not detect any association with uveitis, sarcoidosis, necrobiosis lipoidica, Sweet’s syndrome, HIV infection, hepatitis B, or haematological malignancies. […] We only detected a possible association with hepatitis C (6 GA patients, 2.7%, versus 0 controls, p = 0.03), and hypercholesterolemia (108 GA patients, 48%, versus 79 controls, 35%, p = 0.007).

• #18 Granuloma annulare

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

  Granuloma annulare is seen most commonly on the skin of children, teenagers, or young adults. The generalised form is more likely to be found in older adults (mean age 50 years). There is a female predominance of 2:1 over males. […] 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. […] Generalised granuloma annulare usually presents in adults, as widespread skin-coloured, pinkish or slightly mauve-coloured patches. […] This is the commonest form associated with HIV. […] Atypical granuloma annulare describes granuloma annulare in unusual sites, such as the face, palms, and ears. […] Systemic therapy may be considered in widespread granuloma annulare. The following treatments have been reported to help at least some cases of disseminated granuloma annulare. […] Individual lesions of localised granuloma annulare tend to clear within a few months or years, although they may recur even at the same site. Generalised and atypical variants are more persistent, sometimes lasting decades.

• #19

  https://dpcj.org/index.php/dpc/article/view/2173

  The possible pathogenic explanations for the association with hepatitis C and hypercholesterolemia seem unlikely. […] We consider that the association of GA with other diseases, including hypercholesterolemia and hepatitis C, is doubtful and that it there is no justification rule out possible associated diseases in patients with GA.

• #20 Post-COVID Granuloma Annulare in Rheumatoid Arthritis

  https://athenaeumpub.com/post-covid-19-infection-diffuse-patch-granuloma-annulare-in-a-female-patient-with-rheumatoid-arthritis-a-case-report/

  Granuloma Annulare (GA) is a benign, usually self-limited, inflammatory granulomatous skin disorder of unknown etiology and with a diversity of clinical variants. […] Until now, only a few cases triggered by SARS-CoV-2 virus have been reported, in particular localized, generalized and subcutaneous forms. […] There have also been only a few reports of GA attributed to recent SARS-CoV-2 infection, mainly localized and subcutaneous forms. […] There have also been reports of localized and generalized forms of GA having occurred after COVID -19 vaccine. […] Taken together, it seems that the occurrence of GA lesions reported after SARS-CoV-2 infection as well as after vaccination against SARS-CoV-2 might be associated with an immune reaction triggered by such stimuli rather than with the direct role of the virus on the skin. […] Dermatologists should be aware of such GA lesions especially in patients with background of autoimmune disorders when infected by SARS-CoV-2 or even vaccinated against the virus, considering this kind of rashes as immunologic reactions rather than a direct effect of the virus on the skin.

• #21 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 (GA) is a noninfectious inflammatory granulomatous skin disease characterized by an erythematous or skin colored annulare plaque. GA can also present in a generalized fashion, with disseminated GA being defined as at least ten widespread annular plaques. GA is often a self-limited disorder that can affect both children and adults in all age groups, with more women affected than men. GA has four variations presenting as either localized, generalized, subcutaneous, or perforating and patch GA. The localized form of GA is the most common form that presents as an asymptomatic, erythematous, or skin-colored annular lesion with a border that is described as rope like with a central clearing. The generalized form, which occurs in the upper and lower extremities and in the trunk, accounts for 15% of the cases and presents as papules and plaques. The less common forms of GA include patch, perforating, and subcutaneous variants. The history on the discovery of GA started with Tomas Colcott Fox, who first drew attention to the persistent ringed erythema. The exact cause on why a patient gets GA is not exactly known. However, GA has been associated with diabetes, thyroid disease hyperlipidemia, infections, and mild trauma. Other reported potential triggers could be related to drug eruptions, an infection, such as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other viral infections, subcutaneous injections for desensitization, vaccinations against hepatitis B, Bacillus Calmette-Guerin (BCG), human papilloma virus, diphtheria, and tetanus. The diagnosis of GA may be challenging owing to its diverse morphology. The approach to diagnosing GA depends on the clinical presentation. 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 infection and chronic disease can worsen the prognosis of this uncommon condition. Although in some cases the diagnosis of GA may be clinically straightforward, in other cases the initial clinical impressions can be either ambiguous or misleading making diagnosis difficult. The latter was the case in our patient. GA can resemble other granulomatous skin conditions. 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. The scientific strengths of our case report include laboratory testing to rule out diagnoses, as well as confirmatory histologic skin samples to confirm the diagnosis of GA. In the past, when active tuberculosis was more common, researchers believed that granuloma annulare was associated with or even caused by tuberculosis. Since tuberculin PPD is an inactivated purified protein fraction obtained from Mycobacterium tuberculosis, perhaps a similar relationship exists between PPD exposure and GA in our case, like that found between active tuberculosis and GA in prior studies.

• #22 Photoinduced Granuloma Annulare Confirmed by Experimental Exposure to UVA Light | Actas Dermo-Sifiliográficas

  http://www.actasdermo.org/en-photoinduced-granuloma-annulare-confirmed-by-articulo-S157821902030398X

  GA is a benign and self-limiting inflammatory dermatosis of uncertain origin.1,2 It is characterized by the presence of dermal papules with no appreciable epidermal component and a tendency to coalesce to form mainly asymptomatic arcuate or annular plaques.1,3 The specific etiology of GA is unknown, although it has been linked to a multitude of comorbidities, including malignant neoplasms,3 viral infections, and drug treatment.2 Although most resolve spontaneously, even after biopsy, some lesions can leave permanent scars.4 […] Disseminated GA has been more specifically related to systemic conditions such as diabetes mellitus1,5 and, in rare cases, sun exposure.6 Actinic granuloma, described by OBrien, is characterized by the presence in photo-exposed areas of lesions that are suggestive of GA7 but exhibit degeneration of elastic fibers, which are phagocytosed by histiocytes present in the infiltrate (elastophagocytosis).8

• #23 Photoinduced Granuloma Annulare Confirmed by Experimental Exposure to UVA Light | Actas Dermo-Sifiliográficas

  http://www.actasdermo.org/en-photoinduced-granuloma-annulare-confirmed-by-articulo-S157821902030398X

  There are few published cases of GA induced by light radiation.4,9,10 According to some studies, solar radiation is considered one of the potential causes of GA. Attempts have been made to reproduce GA lesions using ultraviolet light, without success.1 We believe that this is the first reported case of photoinduced granuloma annulare in experimental conditions in the context of a photobiological study. […] Treatment of this entity is often unsatisfactory. Various treatment options have been used, including oral retinoids, antimalarials, and phototherapy.5,9 Our patient was recommended exhaustive topical photoprotection with a high sun protection index, including UVA and infrared photoprotection, as well as oral photoprotection. After 9 months of follow-up, the patient has not presented any new lesions and all existing lesions have stabilized.

• #24 Photoinduced Granuloma Annulare Confirmed by Experimental Exposure to UVA Light | Actas Dermo-Sifiliográficas

  https://actasdermo.org/en-photoinduced-granuloma-annulare-confirmed-by-articulo-S157821902030398X

  GA is a benign and self-limiting inflammatory dermatosis of uncertain origin. It is characterized by the presence of dermal papules with no appreciable epidermal component and a tendency to coalesce to form mainly asymptomatic arcuate or annular plaques. The specific etiology of GA is unknown, although it has been linked to a multitude of comorbidities, including malignant neoplasms, viral infections, and drug treatment. Although most resolve spontaneously, even after biopsy, some lesions can leave permanent scars. […] Disseminated GA has been more specifically related to systemic conditions such as diabetes mellitus and, in rare cases, sun exposure. […] There are few published cases of GA induced by light radiation. According to some studies, solar radiation is considered one of the potential causes of GA. Attempts have been made to reproduce GA lesions using ultraviolet light, without success. We believe that this is the first reported case of photoinduced granuloma annulare in experimental conditions in the context of a photobiological study. […] Treatment of this entity is often unsatisfactory. Various treatment options have been used, including oral retinoids, antimalarials, and phototherapy.

• #25 Granuloma Annulare: An Updated Review of Epidemiology, Pathogenesis, and Treatment Options

  https://digitalcommons.library.tmc.edu/uthgsbs_docs/3042

  Granuloma annulare (GA) is an inflammatory granulomatous skin disease that can be localized (localized GA) or disseminated (generalized GA), with patch, perforating, and subcutaneous subtypes being less common variants of this benign condition. […] Recently, new research has emerged that further elucidates GA epidemiology and etiopathogenesis; importantly, new therapeutic options for GA have also been described, although there remains a paucity of randomized controlled studies. […] In this review, we summarize recent updates on GA epidemiology and etiopathogenesis and offer an updated review of the therapeutic options for GA currently reported in the literature.

• #26 Granuloma Annulare: A Retrospective Series of 133 Patients | MDedge

  https://www.mdedge.com/cutis/article/194137/mixed-topics/granuloma-annulare-retrospective-series-133-patients

  Although granuloma annulare (GA) is a relatively common dermatologic condition, little is known about its epidemiology and pathogenesis. […] The findings solidify our understanding of the epidemiology of GA and diseases that can be associated with GA. […] Few data exist regarding the epidemiology of GA. […] The purpose of this retrospective study was to determine the number of cases of GA seen annually at the Department of Dermatology at the University of Pennsylvania (Philadelphia, Pennsylvania) from 2008 to 2014.

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