Granuloma annulare as first clinical manifestation of diabetes mellitus in children: A case report

Spicuzza, Lucia; Salafia, Stefania; Capizzi, Antonino; Vitaliti, Giovanna; Rotolo, Novella; Leonardi, ﻿Salvatore; Rosa, Mario La

doi:10.1016/j.diabres.2011.11.015

Cited by 14 publications

(16 citation statements)

References 8 publications

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“…Numerous diseases have been associated with GGA, most importantly diabetes mellitus, dyslipidemia, thyroid disease, malignancy and infections. Despite initial reports on the association of diabetes mellitus and GA, contradictory results with both supporting and refuting data have been published [13][14][15][16]. In our cohort, diabetes mellitus was present in 6 of 57 patients (10.5%).…”

Section: Discussioncontrasting

confidence: 80%

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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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Section: Discussioncontrasting

confidence: 80%

“…• Exclusion of patients with no follow-up visits (n = 0) 14) and severe pruritus in 7% (n = 4) of all patients. In 19% no data could be retrieved ( Table 2).…”

Section: Baseline Characteristicsmentioning

confidence: 99%

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

et al. 2020

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“…Little is known about generalized GA association with T1D and other autoimmune diseases. 8 SGA was recently reported in the case of an 8-yearold child who subsequently developed T1D, with partial resolution of the skin lesions after 6 months of treatment 9 and should be considered in the differential diagnosis with necrobiosis lipoidica diabeticorum. 5 In another case report, SGA lesion, in association with T1D, was described for the first time not only as a superficial skin lesion but also as an infiltrative and multifocal in the underlying muscle.…”

Section: Discussionmentioning

confidence: 96%

A Rare Case of Granuloma Annulare in a 5-Year-Old Child With Type 1 Diabetes and Autoimmune Thyroiditis

Maschio

Marigliano²,

Sabbion³

et al. 2013

The American Journal of Dermatopathology

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Granuloma annulare (GA) has rarely been reported in childhood, and its etiology still remains unclear. Its association with type 1 diabetes (T1D) and other chronic systemic diseases such as autoimmune thyroiditis (AT) or rheumatoid arthritis has been reported. There is no description in the literature of pediatric cases and the simultaneous association of GA and multiple autoimmune diseases in the same subject. We report the case of a 5-year-old girl who presented onset signs and symptoms of T1D. The diagnosis of T1D was confirmed by the presence of autoimmune T1D antibodies. Moreover, AT was also diagnosed by autoantibodies and positive ultrasound. One month later, coin-size erythematous lesions appeared initially on the trunk but soon spread over the body. Once dermatophytosis had been excluded, a skin biopsy confirmed a diagnosis of GA. Although a clear mechanism remains still unknown, clinicians must take into consideration an association of GA in patients with T1D or AT to avoid unnecessary medical investigations and/or inadequate pharmacological treatment.

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“…IL-10, TGF-β, 1,25 vitamin D3, estrogen, dexamethasone, VIP, hepatocyte growth factor, binding immunoglobulin protein, and glucocorticoids are among the used molecules. [28][29][30] The interaction between DCs and Treg cells is a two-way interaction. Treg cells downregulate the expression of CD80 and CD86 on DCs through cytotoxic T lymphocyte antigen-4 (CTLA-4) (CD152) and thus prevent their maturation and effects on effector T cells.…”

Section: Dendritic Cells In Autoimmunity and Tolerancementioning

confidence: 99%

The Role of Dendritic Cells in Central Nervous System Autoimmunity: Focusing on Multiple Sclerosis and Emerging Therapeutics Targeting Dendritic Cells

Matin¹,

Falsaperla

Tabatabaie³

et al. 2016

J Pediatr Biochem

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Dendritic cells (DCs) are the sentinel innate immune cells that initiate antigen-specific adaptive immune responses. On the one hand, DCs have been extensively analyzed because of their roles in immune response against pathogens, and on the other hand, there are numerous other studies that have investigated their role in immune tolerance of autoimmune disorders such as type 1 diabetes, systemic lupus erythematosus, multiple sclerosis (MS), and psoriasis. The presence, recruitment, and activation of DCs in the cerebral spinal fluids of experimental allergic encephalomyelitis and MP models, initiated the long array of studies of pathogenic and the potential therapeutic role of DCs in MS. Many classic disease-modifying therapies that are employed have used strategies to alter the maturation and function of DCs; several other novel therapeutic strategies are currently under investigations, which we aim to briefly review in this article. We have focused on reviewing the role of DCs in the central nervous system (CNS), underlying their pathogenesis involvement, and proposing targeting therapies for autoimmune CNS disorders.

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Granuloma annulare as first clinical manifestation of diabetes mellitus in children: A case report

Cited by 14 publications

References 8 publications

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

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

A Rare Case of Granuloma Annulare in a 5-Year-Old Child With Type 1 Diabetes and Autoimmune Thyroiditis

The Role of Dendritic Cells in Central Nervous System Autoimmunity: Focusing on Multiple Sclerosis and Emerging Therapeutics Targeting Dendritic Cells

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