Papular granuloma annulare of palms and soles: case report of a rare presentation.

Abstract

We report the case of a 44-year-old Indian male patient who presented with mildly tender isolated papular lesions confined to the palms of the hands and soles of the feet. The histopathology was characteristic of granuloma annulare. There was an excellent response with 4-week treatment with a potent topical steroid ointment and no recurrence was reported at the follow-up one year later. This report is interesting because of the rare presentation of a common disease.

Granuloma annulare on the palms in an elderly patient

“…It is believed that an immune-mediated reaction, namely a type IV delayed hypersensitivity response, occurs in relation to precipitating factors such as trauma, insect bite, viral infection, sun exposure or use of medications. 4 In the case in question, a precipitating factor justifying the development of the cutaneous lesions was not identified. Granuloma annulare occurs mainly in young women under 30 years of age, but can occur in all age groups, without ethnic or racial propensities.…”

“…The classic histopathological findings of granuloma annulare include hyperkeratosis, presence of fragmented collagen with necrobiotic foci, palisaded interstitial lymphohistiocytic infiltrate, and increased mucin deposition, all of which were found in this case. 4 , 5 Granuloma annular of the palms seems to be rare, but must be included in the differential diagnosis of palmar papules and plaques. A careful assessment is recommended for the exclusion of diagnoses that can resemble granuloma annulare, such as interstitial granulomatous dermatitis, neutrophilic granulomatous disease, rheumatoid nodule, Churg-Strauss disease, erythema elevatum diutinum , acral Sweet's syndrome, dermatofibroma and drug-induced granulomatous eruptions.…”

“…A careful assessment is recommended for the exclusion of diagnoses that can resemble granuloma annulare, such as interstitial granulomatous dermatitis, neutrophilic granulomatous disease, rheumatoid nodule, Churg-Strauss disease, erythema elevatum diutinum , acral Sweet's syndrome, dermatofibroma and drug-induced granulomatous eruptions. 4 There is a condition called “nodosity accelerated by the use of methotrexate”, which is an adverse reaction to the use of methotrexate, characterized by the accelerated appearance of small, hardened nodules mainly on the fingers. This condition occurs at a prevalence of 8% to 11% of methotrexate users, mostly in rheumatoid arthritis patients who use the medication.…”

“…Our patient was prescribed topical clobetasol propionate 0.05% under occlusion, once daily for 30 consecutive days, with satisfactory response. 4 q…”

Necrobiosis lipoidica and granuloma annulare: Part 2- Granuloma annulare

“…It is frequently thought to occur as a response to various external stimuli. These include insect 2 and animal bites, vaccination reactions and trauma. 3,4 A variety of infectious agents have been implicated, including tuberculosis, Borrelia, varicella, EBV, hepatitis B and C and HIV.…”