Granuloma annulare (GA) is a palisading granulomatous skin disease. It is a relatively common dermatosis typically characterized by an annular arrangement of erythematous or flesh-coloured papules. The aim of this study was to assess the epidemiological and clinical pattern of GA and its management.
A retrospective study dealing with 35 cases of GA collected during an 11-year period from 1995 to 2005 was carried out at the Dermatology Department of Charles Nicolle's Hospital of Tunis.
There were 24 females and 11 males including 13 children. Four clinical patterns were observed: localized GA with annular shaped lesions in 22 cases (62.8%), subcutaneous GA in 9 cases (25.7%) with 4 children, combination of localized and subcutaneous patterns in one child (2.8%), generalized GA in one adult-patient (2.8%) and combination of generalized and subcutaneous patterns in 2 cases (5.7%). Associated diabetes mellitus was seen in 9 adults (25%) and thyroid diseases in 2 other adults (5.7%). Topical steroids were proposed in 9 cases with partial resolution in 6 of them. Four patients were treated by hydroxychloroquine with an improvement in 3 of them. Two patients (generalized GA with subcutaneous form and subcutaneous GA) were treated by dapsone with partial clearing.
In these series, GA has the same epidemiological and clinical pattern as other series of the literature. Subcutaneous form had a pseudo-rheumatoid presentation in adults and an exclusive involvement of children when it is localized on the scalp. Associated systemic diseases, especially diabetes mellitus, are frequent in the series here observed.