Advances in Inflammatory Granulomatous Skin Diseases

Imadojemu, Sotonye; Rosenbach, Misha

doi:10.1016/j.det.2018.08.001

Cited by 34 publications

(46 citation statements)

References 96 publications

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“…Sarcoidosis lesions may arise on preexisting scars. The various cutaneous manifestations of sarcoidosis include lupus pernio and sarcoidal panniculitis (Darier‐Roussy sarcoid) as specific manifestations as well as erythema nodosum as nonspecific manifestation .…”

Section: Granulomatous Dermatoses In Systemic Diseasementioning

confidence: 99%

Non‐infectious granulomatous dermatoses

Schmitt¹,

Völz

2019

J Deutsche Derma Gesell

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Summary Granulomatous dermatoses comprise a wide range of etiologically and clinically distinct skin diseases that share a common histology characterized by the accumulation of histiocytes include macrophages. While the pathogenesis of these disorders is not fully understood, the underlying mechanism is thought to involve a reaction pattern caused by an immunogenic stimulus. Antigen‐presenting cells and the effect of various cytokines play a key role. Our understanding of granulomatous reaction patterns has been advanced by insights drawn from observations of such reactions in patients on immunomodulatory therapy and in individuals with genetic immunodeficiency. Traditionally, a distinction is made between infectious and non‐infectious granulomatous dermatoses. The present CME article addresses granulomatous skin diseases for which there is no evidence of a causative infectious agent. Common representatives include granuloma annulare, necrobiosis lipoidica and cutaneous sarcoidosis. Granulomatous dermatoses may be part of the clinical spectrum of various systemic disorders or may be associated therewith. Some neoplastic disorders may mimic granulomatous dermatoses histologically. Given the pathogenetic diversity involved, the clinical presentation, too, is quite varied. Overall, however, each disorder is characterized by typical clinical features. The diagnosis always requires thorough clinicopathologic correlation. Treatment is preferably based on the underlying pathogenesis and frequently involves anti‐inflammatory agents. In most cases, however, there is insufficient study data. The dermal nature of these disorders frequently poses a therapeutic challenge, especially with respect to topical treatment.

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Section: Granulomatous Dermatoses In Systemic Diseasementioning

confidence: 99%

Non‐infectious granulomatous dermatoses

Schmitt¹,

Völz

2019

J Deutsche Derma Gesell

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“…Granuloma annulare (GA) is a noninfectious, granulomatous skin condition with variable clinical presentation [1]. Localized GA (LGA) is the most common form, presenting as erythematous, nonscaling, annular plaque mostly on distal extremities.…”

Section: Introductionmentioning

confidence: 99%

A Monocentric, Retrospective Analysis of 61 Patients with Generalized Granuloma Annulare

et al. 2020

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Background: Granuloma annulare is a chronic noninfectious granulomatous skin condition with variable clinical presentations. Generalized granuloma annulare, defined as widespread disease with >10 skin lesions, accounts for 15% of all cases. Numerous associated diseases have been controversially discussed, most importantly diabetes mellitus, dyslipidemia, thyroid disease, malignancy and systemic infections. Objectives: The objective of our study is to describe disease characteristics, treatment outcome and associated diseases in patients treated at the Department of Dermatology of the University Hospital Zurich during the last 20 years. Methods: The hospital database was searched for patients with generalized granuloma annulare in the last 20 years (January 1, 1998, to December 31, 2017). Overall, 61 patients, 14 males and 47 females, were included in our study. The mean age was 58 years at first consultation. The diagnosis was verified clinically and histologically. Results: Generalized granuloma annulare occurred at a mean age of 55 years, more commonly in females. Pruritus was absent in 51% of all patients. Metabolic diseases including diabetes mellitus, hypercholesterinemia and hypertriglyceridemia were present in 10.5, 8.2 and 4.9%, respectively. Thyroid disease was present in 9.8% and malignant disease in 23%, including colorectal cancer, lymphoproliferative disease, squamous cell carcinoma of the esophagus, basal cell carcinoma and gynecological malignancy. Therapy was initiated in 92%, while second- and third-line therapy was performed in 70 and 39%, respectively. Benefit during therapy (e.g., full and partial remission) was achieved in 39.3% during first-line, in 39.4% during second-line and in 33.8% during third-line treatment. Topical corticosteroids were the most commonly prescribed treatment, mostly leading to stable disease (46.6%). Combined full and partial remission occurred in a large proportion of patients receiving UVA1 (45%), PUVA (63.6%) and intralesional triamcinolone acetonide (100%). Conclusions: Generalized granuloma annulare is a mostly asymptomatic and benign disease with a strong tendency for treatment resistance. We suggest to screen all patients for dyslipidemia, thyroid disease and malignant disease. While randomized trials are needed, we suggest topical corticosteroids as the first-line treatment, intralesional triamcinolone acetonide for persistent solitary lesions and, if further treatment is needed, UVA1 or PUVA.

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“…56,62 Input from specialists in pulmonary, cardiology, ophthalmology, ENT, neurology, and endocrinology among others may be necessary to investigate and manage extracutaneous manifestations of sarcoidosis. 63 Workup includes a chest X-ray, pulmonary function testing to evaluate for interstitial lung disease, ophthalmologic exam, and an electrocardiogram (ECG). Laboratory analysis should include a complete blood count, comprehensive metabolic panel, urinalysis, vitamin D (both 25-hydroxyvitamin-D and 1,25-dihydroxyvitamin D3), and thyroid testing.…”

Section: Histologic Findingsmentioning

confidence: 99%

Cutaneous Sarcoidosis

Caplan

Rosenbach

Imadojemu

2020

Semin Respir Crit Care Med

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Sarcoidosis is a chronic, multisystem, inflammatory disorder of unknown etiology that is characterized by noncaseating granulomas that impair normal organ functioning. Sarcoidosis predominantly affects the lungs, but the skin is often cited as the second most frequently involved organ. Cutaneous manifestations of sarcoidosis are highly variable and ongoing research seeks to better understand the relationship between clinical morphology and disease prognosis. Skin findings in patients with sarcoidosis can be “specific,” in which sarcoidal granulomas infiltrate the skin, or they can represent a “nonspecific” reactive inflammatory process, as is seen in calcinosis cutis and erythema nodosum. Cutaneous sarcoidosis can be the initial presenting sign or develop later in the course of the disease. In some patients, the skin will be the most involved and impactful organ system and will drive therapy. In other cases, the skin will be an incidental or minor finding, but may be easily accessible for biopsy to confirm the diagnosis. There are many potential therapies for sarcoidosis, though no one therapy is universally effective.

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Advances in Inflammatory Granulomatous Skin Diseases

Cited by 34 publications

References 96 publications

Non‐infectious granulomatous dermatoses

Non‐infectious granulomatous dermatoses

A Monocentric, Retrospective Analysis of 61 Patients with Generalized Granuloma Annulare

Cutaneous Sarcoidosis

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