Subcutaneous granuloma annulare of the scalp in a diabetic child

[Multiple cephalic deep granuloma annulare of children]

BACKGROUND

Deep granuloma annulare is a fairly rare variety of granuloma annulare. It is seen predominantly in children and mainly affects the anterior aspect of the legs and the top of the feet; cephalic presentation is rare. Below, we report three cases of deep granuloma annulare in children presenting solely at the cephalic extremity.

PATIENTS AND METHODS

Case 1: a six-year-old boy presented 7 cutaneous nodules measuring 1 to 2cm that were flesh-coloured, insensitive to palpation, of hard consistency and deeply attached. The lesions were grouped together on the anterior half of the left temporal fossa. While spontaneous regression of the three nodules was noted in the month following cutaneous biopsy, these nodules recurred a few months later. Case 2: a four-year-old girl with five deep cephalic nodules measuring around one centimetre and the colour of normal skin were seen on her right temporal fossa. The child was lost to follow-up after biopsy. Case 3: a four-month-old infant was presenting some 15 deep cutaneous nodules arranged in linear fashion on the forehead next to the left temporal fossa. These nodules regressed spontaneously one month after biopsy. In all three cases, histological examination confirmed the diagnosis of deep granuloma annulare.

DISCUSSION

There have been few published cases of multiple, cephalic, deep granuloma annulare at a single site in children. The condition has an extensive differential diagnosis that includes malignant tumours; in addition, histological confirmation is normally essential. Treatment is not qualified and therapeutic extension with clinical monitoring alone may frequently be recommended.

Granuloma annulare as first clinical manifestation of diabetes mellitus in children: a case report

Granuloma annulare has been widely described in adults in association with systemic diseases such as type 1 diabetes mellitus. However in childhood this relationship remains unclear. We report the case of an 8-year-old girl, with multiple granuloma annulare as first clinical manifestation of type one diabetes mellitus.

An unusual presentation of subcutaneous granuloma annulare in association with juvenile-onset diabetes: case report and literature review

Subcutaneous granuloma annulare (SGA) is a rarely reported subtype of granuloma annulare that occurs almost exclusively in children. The etiology of these lesions is unknown, although a possible relationship to insulin-dependent diabetes mellitus (IDDM) has been proposed in the literature. Here we present an unusual case of SGA on the right forearm in a 3-year-old girl. Unlike the typical lesions noted on the extremities, on magnetic resonance imaging her lesions involved the subcutaneous tissue and adjacent muscles in multiple locations. Histopathologically, the case was consistent with SGA but was unusual in its distribution involving multiple muscles, a finding that has not been previously reported. Weeks after incisional biopsy, she was readmitted with diabetic ketoacidosis (DKA) secondary to IDDM. After treatment of her DKA and control of her glycemia, the forearm SGA vanished, which supported the pathologic diagnosis and alleviated our concerns secondary to the unusual distribution.

Links between granuloma annulare, necrobiosis lipoidica diabeticorum and childhood diabetes: a matter of time?

Diabetes mellitus is associated with a range of dermatologic presentations, including granuloma annulare and necrobiosis lipoidica diabeticorum. Granuloma annulare occurs earlier than necrobiosis lipoidica diabeticorum and the association with diabetes mellitus is much weaker. We describe two children with diabetes who both developed granuloma annulare and later, necrobiosis lipoidica diabeticorum. We postulate that the early onset and transient nature of granuloma annulare, compared with the later onset and persistence of necrobiosis lipoidica diabeticorum, might account for the different apparent rates of association with diabetes mellitus.

Surgical management and outcome of scalp subcutaneous granuloma annulare in children: case report

OBJECTIVE

Subcutaneous granuloma annulare (SGA) is a benign inflammatory disorder that rarely affects the scalp. We report 5 cases of children with SGA scalp lesions and discuss our clinical experience and the characteristic findings, diagnostic evaluation, method of treatment, and course of the disease.

CLINICAL PRESENTATION

Five patients presented with multiple subcutaneous nodules at single or multiple sites overlying the scalp. A retrospective review of the medical, surgical, and pathology records of the 5 patients was conducted.

INTERVENTION

All scalp lesions were excised and were confirmed histologically to be SGA nodules. In 4 of the 5 patients, the nodules were nontender and nonmobile. The mean number of lesions was 4.2. The mean age of patients at presentation was 3.8 years. Of the 5 patients, 4 experienced at least 1 recurrence of a solitary lesion at either the same site or a different site. In the 80% of patients who experienced a recurrence, all lesions recurred less than 1 year postoperatively, except in the case of 1 patient who continued to experience a disappearance and reappearance of lesions at 72 months. The ultimate diagnosis of all lesions was established through biopsy and subsequent microscopic evaluation. No postoperative complications were noted.

CONCLUSION

Granuloma annulare should be included in the differential diagnosis whenever a scalp subcutaneous superficial nodule is observed. Although many modalities of treatment for SGA nodules are used, recurrence is common, even with surgical excision.

Maturity-onset diabetes of the young with necrobiosis lipoidica and granuloma annulare

We describe a 12-year-old white girl with granuloma annulare localized to both ankles since she was five, necrobiosis lipoidica in the left pretibial region since she was ten, and a recent history of weakness, migraine, and weight loss. After initial evaluation, high fasting blood glucose levels and high hemoglobin A1c were found. The family history for non-insulin-dependent diabetes was suggestive of maturity-onset diabetes of the young. Coexistence of necrobiosis lipoidica and granuloma annulare, together with a family history of non-insulin-dependent diabetes, the age of onset, and the absence of ketosis, are specific features making possible, a clinical diagnosis. Genetic confirmation may not be so easily accessible or necessary.

Diabetes mellitus e afecções cutâneas

O diabetes mellitus é doença metabólica que predispõe a diversas afecções, notadamente às doenças cutâneas. São de natureza variada, porém de etiologia infecciosa em sua maioria. Uma revisão detalhada sobre tais doenças, evidenciando suas características clínicas bem como uma adequada abordagem terapêutica é o tema do presente artigo.