Granuloma annulare of the eyelid: a case report and review of the literature

Periocular granuloma annulare: a case report and review of literature

Granuloma annulare (GA) is a granulomatous dermatosis that rarely presents on the face and is extremely uncommon in the periocular region. We report our experience with the presentation and management of GA lesions on the eyelids of a 17-year-old girl. We performed a review of published literature and identified 13 cases of pediatric periocular GA. One additional case was identified upon review of all pediatric GA cases at the Cleveland Clinic Foundation. Review of these cases suggests that periocular GA is a benign condition that spontaneously regresses within a few months. GA nodules have a predilection for the upper eyelids. A greater incidence is noted in African American children. Awareness of the self-resolving nature of this condition can prevent unnecessary surgical excisions in affected children.

Periocular granuloma annulare in four children

Subcutaneous granuloma annulare is a skin condition that occurs on the lower extremities, hands, and scalp of healthy children. It rarely occurs in the periocular area, and when it does, the annular pattern is often absent. Histopathology is diagnostic and shows palisading histiocytes around areas of necrobiosis. Although benign in nature, the lesions tend to multiply, grow in size, and often recur. They usually resolve spontaneously and do not require treatment. Four cases of periocular subcutaneous granuloma annulare, from four different geographical areas, were identified through on-line postings on the worldwide mailing list of the Organization for Pediatric Ophthalmology and Strabismus (http://lists.ucsd.edu/mailman/listinfo/ped-ophth-1). These 4 patients are reported here, and a brief review of the literature is presented.

[Granuloma annulare of the eyelid in a child: an atypical localization]

BACKGROUND

Granuloma annulare is a common form of dermatosis in children and young adults. Lesions are typically found on the hands, the feet and the extensor surfaces of the limbs, and occasionally on the trunk. We report a case original in terms of its palpebral localization.

CASE-REPORT

A 5 year-old girl consulted for papular lesions on the eyelids. The clinical examination revealed papules on the right lower eyelid measuring 8 mm, on the left lower eyelid measuring 5 mm and on the right upper eyelid measuring 3 mm. Laboratory tests including serum glucose, lipids and calcium as well as a complete blood count proved normal. Biopsy showed granulomatous lesions: a region of central necrosis surrounded by a palisade of inflammatory cells confirmed the diagnosis of granuloma annulare. The lesions disappeared in a few weeks without treatment.

DISCUSSION

To our knowledge, 44 cases of granuloma annulare of the periorbital area have been reported, of which 19 concerned children. This presentation represents an atypical localization of granuloma annulare which must not be confused with many other palpebral disorders. Biopsy is necessary to confirm the diagnosis.

Low serum insulin values in children with multiple lesions of granuloma annulare: a prospective study

BACKGROUND

The relationship between granuloma annularae (GA) and diabetes mellitus (DM) is controversial.

OBJECTIVE

To investigate the relationship between multiple lesions of GA and carbohydrate metabolism in children.

SUBJECTS AND METHODS

Fifteen children (seven boys, eight girls, mean age 4.8 years) with five or more lesions of GA were evaluated. A personal and family history of DM or other autoimmune diseases was obtained and the glycaemic and insulin response during an oral glucose tolerance test (OGTT) was determined. Thirteen children with a negative personal and family history of DM served as controls for the OGTT and 100 other children as 'clinical controls'.

RESULTS

At the 30-min sampling of the OGTT the mean insulin values were comparable in GA children and controls (P=0.1), while the mean glucose values were significantly higher in GA children than in controls (P=0.005). All other insulin values during the OGTT were significantly lower in GA children than in controls, while all other glucose values were comparable in GA children and controls with all indices applied. Eleven out of 15 GA children had a positive family history of DM (73.3% vs. 16% of the clinical controls; P<0.0001).

CONCLUSION

Multiple lesions of GA in children are associated with significantly lower serum insulin values than in controls and mildly impaired glucose tolerance.