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December 2001

Papules on the Hands

Author Affiliations


Arch Dermatol. 2001;137(12):1647-1652. doi:

Punch biopsy material revealed palisaded granulomas composed of uninucleate and multinucleate histiocytes surrounding denatured collagen and abundant dermal mucin. Mucin stained strongly with alcian blue–periodic acid–Schiff.

The patient elected to have no treatment. The majority of the lesions had completely resolved within 6 weeks after the biopsy.

Granuloma annulare was first described by Colcott Fox in 1895 and was named by Radcliffe-Crocker in 1902.1 There are several forms, including localized, generalized, subcutaneous, and perforating types. Localized GA is the most common clinical form.14 The lesions are characterized by erythematous or flesh-colored papules or plaques in an annular configuration or arrangement. Although the disease has the potential to present anywhere on the body, it most commonly involves hands and feet and is least commonly found on the face. Our case is somewhat unusual in that the presentation over the joints was much less dramatic than the presentation over the lateral aspect of both index fingers. Generalized GA, or disseminated GA, tends to be distributed primarily over the trunk. The pathogenesis of GA is obscure, although there is some evidence of an immunologic mechanism, possibly a delayed-type hypersensitivity.2,3 Stress has been reported as a precipitating factor for GA in up to 15% of patients. Diabetes mellitus is the most frequently reported disease associated with GA, particularly the generalized form.2 The incidence of diabetes mellitus in patients with GA is double that in the general population.

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