Solitary Granuloma Annulare: The First Case of Development on a Healthy Child's Palm

• DOI: 10.5021/ad.2014.26.1.113
• Publication Date: 2014-03-10T00:39:43Z
• Authors: Chan Ho Na; Min Sung Kim; Sang Hyun Song; Bong Seok Shin
• Keywords: Granuloma Annulare; Stain; Skin biopsy

Dear Editor:

Granuloma annulare (GA) is a benign inflammatory skin disease that classically presents as annular, flesh-colored grouped papules. It most commonly develops on the dorsal aspect of hands, although cases palmar involvement are very rare1. We report rare case GA arising right palm 2-year-old healthy boy and review related literature.

A Korean aged 2 years came to our clinic with an asymptomatic solitary annular shaped plaque his palm. had started develop about 4 weeks ago was later accompanied by central depression. Physical examination revealed solitary, coin sized, colored, firm, non-tender concave surface (Fig. 1). His parents denied any previous history trauma, relevant past medical history, other dermatosis. The punch biopsy from showed perivascular infiltrations palisading granulomas collagen degenerations in dermis 2A). In addition, mucin were confirmed alcian blue stain faint 2B). Above these findings, we made diagnosis GA, then prescribed topical methylprednisolone aceponate.

Fig. 1

Solitary, mild hyperkeratotic, colored depression (arrows).

Fig. 2

(A) A specimen degeneration some cells (H&E, ×100). (B) Central mucinous area positive reaction materials (×200). ...

GA granulomatous shape, can also be self-limited disease. Clinically, it has several different subtypes, localized type common. acral regions such knuckles dorsum fingers involved frequently, rarely been reported1.

To knowledge, palms have reported1-5. 1994, Barksdale et al.2 announced 13 associated malignant lymphoma. their data, uncommon locations, including palms, sole, face, painful sensation (non-typical characteristic GA), occurred 3 patients. Such thought explain relevance generalized response lymphoma, therefore, unusual sites might systemic However, because patient normal development healthy, according guardians, meaningful at angle.

While reports described developed all multiple lesions2-4. Therefore, reported literature lesions extremely rare. 2008, Imamura al.5 long-standing dermatomyositis, which first description believe second palm, this English child.

A rare, occurrence boy. should included differential papules plaques. At same time, where child, dermatologist needs inform child's its clinical course.