Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:11

Gordon Syndrome Granuloma Annulare 645

follow-up

■Frequent follow-up to follow blood pressure

complications and prognosis

■Dependent on blood pressure control

Granuloma Annulare.................................

KAREN GOULD, MD and JEFFERY P. CALLEN, MD

history & physical

■Asymptomatic

■Commonly presents as annular flesh-colored or red plaques

■Subcutaneous nodules are a rare manifestation.

■Lesions are often multiple, and occur more frequently on the extrem-

ities.

■Generalized eruptions may occur.

■Children and young adults are typically affected.

tests

■Skin biopsy is usually diagnostic but may not always be needed.

■Potassium hydroxide preparation if any scale is present

differential diagnosis

■necrobiosis lipoidica – more often on the anterior legs

■Sarcoidosis – may be difficult, but biopsy should be helpful

■Annular lichen planus – often pigmented lesion, biopsy is helpful

■erythema elevatum diutinum – over bony prominences

■erythema annulare centrifugum – usually has trailing scale

■Hansen’s disease (leprosy) – may be anesthetic

management

Localized disease

■Potent topical corticosteroids or intralesional corticosteroids

■Cryosurgery

specific therapy

■Treatment for generalized granuloma annulare includes dapsone,

oral psoralen and ultraviolet A light, hydroxychloroquine, chloro-

quine, niacinamide, cyclosporine, pentoxyfylline, and isotretinoin.

follow-up

■Patient should be seen on a regular basis until lesions resolve.