Clinical cases

Introduction. Granuloma annulare represents a benign chronic dermatosis, whose clinical and histological aspect is a characteristic one (palisading granuloma).

Clinical case. We present the case of a 52-year old female patient, from the rural area, who was admitted to hospital for oval and arch plaques, with a diameter between 4 and 9 cm, with margins formed in coalescence by small firm, erythematous papules, with the plaque center slightly hypopigmented, with no skin atrophy, localized on the trunk (predominating on the chest) and on the arms, with a history of 18 months. Based on the anamnasesis, clinical examination, histopathological examination and laboratory tests, we confirmed the following diagnoses: disseminated granuloma annulare, dyslipidemia and asymptomatic billiary lithiasis. The patient received a treatment with antibiotics, antihistaminics, potent dermatocorticoids and physical agents, having a mildly favourable evolution.

Discussions. The etiopathogeny has not been yet elucidated.
Regarding the association to other diseases, the studies showed an association to diabetes mellitus, thyroid disorders, malignant conditions and dyslipidemia. In our case, the patient was diagnosed with dyslipidemia.

Conclusions. The changes of the lypidic profile (hypercholesterolemia, hypertrigliceridemia, or both) were present in 45% of the patients with disseminated granuloma annulare, thus the importance of investigating patients in this direction.

With no comparative studies, it is difficult to establish the efficiency of the treatment methods, as in 50-70% of the localized granuloma annulare cases there was observed spontaneous remission during the first two years of disease. The disseminated granuloma annulare is more resistant to the topical and systemic treatment, in comparison to the localized form of the disease.