Summary

Generalized granuloma annulare is a relatively rare skin condition, which is distinguished by the appearance on the skin surface of elevated arcuate or annular lesions, preferentially disseminated on the extremities and trunk. We report a clinical case of a 63-year-old woman who presented with asymptomatic, erythematous, annular and arcuate plaques, disseminated on the trunk, upper and lower limbs, evolving for approximately 6 months. Histopathological examination revealed the presence of granulomas characterizmed by histiocytes arranged in a palisade around areas of collagen degeneration and mucin deposition. The patient is also known to have coronary bypass and vasculitis in the antecedents. Although various therapeutic options for generalized granuloma annulare are mentioned in the specialized literature, the lack of standardized guidelines is disappointing for both the physician and the patient, reflecting the rarity of reported cases. Anecdotally cited treatments include cryotherapy, laser ablation, PUVA, and photodynamic therapy. In our patient, after a session of liquid nitrogen cryotherapy that had a paradoxically unfavorable outcome, treatment with hydroxychloroquine and topical calcineurin inhibitors was initiated, resulting in a slight improvement of the lesions.