Comorbidities Associated with Granuloma Annulare: A Cross-Sectional, Case-Control Study

Abstract

Background: Granuloma annulare (GA) is a cutaneous granulomatous disorder of unknown etiology. There are conflicting data on the association between GA and multiple systemic conditions. As a result, we aimed to clarify the reported associations between GA and systemic conditions. Methods: A retrospective, cross-sectional, case-control study was performed in which the medical records of biopsy-confirmed GA patients ≥18 years of age, who presented to the Johns Hopkins Hospital System between 1 January 2009 and 1 June 2019, were reviewed. GA patients were compared to controls matched for age, race, and sex. Results: After adjusting for confounders, GA patients (n = 82) had higher odds of concurrent type II diabetes (odds ratio (OR) = 5.27; 95% confidence interval (CI), 1.73–16.07; p < 0.01), non-migraine headache (OR = 8.70; 95% CI, 1.61–46.88; p = 0.01), and a positive smoking history (OR = 1.93; 95% CI, 1.10–3.38; p = 0.02) compared to controls (n = 164). Among GA patients, women were more likely to have ophthalmic conditions (p = 0.04), and men were more likely to have cardiovascular disease (p < 0.01) and type II diabetes (p = 0.05). No differences in systemic condition associations were observed among GA subtypes. Conclusions: Our results support the reported association between GA and type II diabetes. Furthermore, our findings indicate that GA may be associated with cigarette smoking and non-migraine headache disorders.

Association of Granuloma Annulare With Type 2 Diabetes, Hyperlipidemia, Autoimmune Disorders, and Hematologic Malignant Neoplasms

“…In this large, population-based cohort study, we identified associations between GA and diabetes and hyperlipidemia as well as between GA and autoimmune conditions. Consistent with several other studies, we did not identify any association between GA and increased risk of hematologic malignant neoplasms …”

“…Although GA may occur as an isolated disease limited to the skin, several potential associations have been described, including diabetes and hyperlipidemia, autoimmune conditions such as thyroid disease, and hematologic malignant neoplasms . However, other studies have found no association between these conditions and GA .…”

“…Although GA may occur as an isolated disease limited to the skin, several potential associations have been described, including diabetes and hyperlipidemia, autoimmune conditions such as thyroid disease, and hematologic malignant neoplasms . However, other studies have found no association between these conditions and GA . In addition, these studies have often been limited by small sample sizes, single-center designs, and suboptimal control groups such as patients with psoriasis, which is known to be associated with several of these conditions .…”

Incidence and Prevalence of Granuloma Annulare in the United States

“…The most common form of granuloma annulare is the localized variant, but it is thought that approximately 15% to 25% of patients who seek care will have generalized disease . Although granuloma annulare may occur as an isolated skin-limited disease, several potential associations have been described, including diabetes and hyperlipidemia, as well as autoimmune conditions, such as thyroid disease . Although there are no US Food and Drug Administration–approved treatments for granuloma annulare, commonly described treatment approaches include topical corticosteroids, topical calcineurin inhibitors, and intralesional corticosteroids.…”

Generalized Granuloma Annulare: A Retrospective Study From Southern Ontario, Canada

“…3 The prevalence of T2DM and hypothyroidism in our study were higher than previous retrospective studies of patient populations in the United States and Europe, with a lower prevalence of malignancy. 4,5 Although associations between GGA and these systemic diseases are controversial, additional screening and preventative care measures may be helpful for these patients. Further large-scale studies are needed to better elucidate these potential relationships.…”