Non-Infectious Granulomatous Diseases of the Skin and their Associated Systemic Diseases

Abstract

Non-infectious granulomatous diseases of the skin are a broad group of distinct reactive inflammatory conditions that share important similarities. As a group, they are relatively difficult to diagnose and distinguish both clinically as well as histologically. Many of these disorders have significant associations with systemic diseases that impact the patient's overall prognosis. In this update, we offer a discussion of emerging concepts and controversies in this field, as presented through evidence-based answers to seven important clinical questions regarding palisading and epithelioid granulomata. These questions offer an opportunity to review ten non-infectious granulomatous conditions that have implications for systemic disease: granuloma annulare, annular elastolytic giant cell granuloma, necrobiosis lipoidica, methotrexate-induced accelerated rheumatoid nodulosis, necrobiotic xanthogranuloma, interstitial granulomatous dermatitis, interstitial granulomatous drug reaction, palisaded neutrophilic granulomatous dermatitis, sarcoidosis, and metastatic Crohn disease. Recent clinical, epidemiologic, and laboratory studies have shed some light on these diseases, the association of these conditions with systemic disorders, and their overall prognoses.

Necrobiosis lipoidica and granuloma annulare: Part 2- Granuloma annulare

“…6 Hawryluk et al reviewed the evidence for the association of GA and malignant disease: although they concluded there was no causative relationship between malignancy and GA, atypical presentations or GA occurring in an elderly patient should prompt age-appropriate screening for malignancy and evaluation of immune state. 15 GA has also been reported in association with thyroid abnormalities and dyslipidaemia. 16 …”

Annular skin lesions in childhood. Review of the main differential diagnoses

“…Self-limiting inflammatory entity of unknown etiology, characterized by annular skin color or slightly erythematous plaques, with elevated periphery and depressed center (Fig 2a and 2b), possibly result of non-specific reactions from various agents [9][10][11].…”

Paraneoplastik özellik gösteren metabolik hastalıklar

“…Hastaların %50'sinde pitozis, propitozis, göz hareketlerinde kısıtlılık, sklerit, ektropiyon, üveit vb. oftalmolojik komplikasyonlar görülür 24 . Patogenez ile ilgili bilgiler sınırlıdır ancak Zelger ve arkadaşlarının yapmış oldukları histopatolojik çalışmada Borrelia cinsi spiroketlerin gösterilmesi, NKG gelişiminde spiroketlerin rolü olabileceğini düşündürmüştür 25 .…”

“…Bir diğer önemli konu da NKG'un deri dışında larinks, farinks, akciğer, kalp, böbrek, over ve barsaklar gibi çeşitli organlara yerleşebilmesidir 22 . Sistemik tutulum açısından MR, ekokardiografi ve akciğer filmi istenmelidir 24 . Tanı için histopatolojik inceleme ve paraproteinemiyi araştıran testler gereklidir.…”

“…Ayrıca, lenfoid folliküller de izlenebilir 30 . Tarama testi olarak idrar ve serumda protein elektroforezi yapılır ancak ileri değerlendirme için immünelektroforez gereklidir 24 . Tedavide kullanılan intralezyoner kortikosteroid enjeksiyonları, talidomid 31 , plazmaferez, metotreksat, azatioprin, melfalan, klorambusil, siklofosfamid, nitrojen mustard, prednisolon ve interferon alfa-2b ile ancak sınırlı bir cevap alınabilir 29 .…”