An Unusual Form of Generalized Granuloma Annulare in a Patient Insulin-dependent Diabetes Mellitus

Abstract

The generalized form of granuloma annulare may be associated with systemic disorders, including diabetes mellitus. We describe here an unusual form of generalized granuloma annulare in a patient with complicated insulin-dependent diabetes mellitus. The cutaneous eruption had been present for decades as non-pruritic, persistent, violet-brown patches with raised edges. There were flexion deformities of the small joints of the hands and feet associated with thickening of the skin over dorsa of the fingers. The patient is currently on isotretinoin therapy, with partial resolution of lesions at 3 months follow-up.

Juvenile, insulin‐dependent diabetes mellitus, type 1‐related dermatoses

“…It is usually localized but may become generalized. The prevalence of diabetes is reported to be 4%–10% in patients with GA 59 . Classically, it occurs in middle‐aged, almost invariably obese patients with NIDDM; however, there is evidence linking granuloma annulare and autoimmune thyroiditis/type 1 diabetes.…”

“…There is only one reported case in the literature linking the association of granuloma annulare (which involved the skin and viscera) with Addison’s disease but the patient had type 1 diabetes and myxoedema 60 . A disordered carbohydrate metabolism, with abnormal glucose tolerance tests or overt diabetes, appears to occur particularly in the generalized and perforating forms of the disease 59 . Histopathologically, necrobiotic granuloma is seen in three patterns: necrobiotic paliasding granulomas, an interstitial form, and granulomas of sarcoidal or tuberculoid type.…”

The granulomatous reaction pattern

“…,298 The itis,359,360 uveitis, 361 hepatitis B 362 and C infection, 363 parvovirus B19 infection, 364 BCG, 365 hepatitis B, 366 and antitetanus vaccination, 367,368 waxing-induced pseudofolliculitis, 369 tuberculosis, 370,371 tattoos, 372 granulomatous mycosis fungoides, 373 a monoclonal gammopathy, 374 hypercalcemia, 375 myelodysplastic syndrome, 376 chronic myelomonocytic leukemia,…”

Generalized granuloma annulare in a patient with type II diabetes mellitus: successful treatment with isotretinoin

“…A clinical relationship between GGA and diabetes mellitus has already been described 2,8,9 . Other related processes include thyroid pathology, atopy, hyperuricaemia, carcinogenic processes, and diseases of the connective tissue 4 …”