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Müller CSL, Vogt T. Granuloma anulare und maligne kutane Lymphome: Gibt es eine Assoziation beider Erkrankungen? J Dtsch Dermatol Ges 2021; 19:803-814. [PMID: 34139082 DOI: 10.1111/ddg.14401_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/11/2020] [Indexed: 10/21/2022]
Affiliation(s)
| | - Thomas Vogt
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum des Saarlandes, Homburg/Saar
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Müller CSL, Vogt T. Granuloma annulare - is it a paraneoplastic condition for malignant lymphoma? J Dtsch Dermatol Ges 2021; 19:803-812. [PMID: 33949780 DOI: 10.1111/ddg.14401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/11/2020] [Indexed: 11/26/2022]
Abstract
In recent years, an association between granuloma annulare and the occurrence of malignant cutaneous lymphomas in the sense of a facultative paraneoplasia has been observed several times. The aim of the present work is to provide an overview of the currently available literature on granuloma annulare as well as an analysis of its association with cutaneous lymphomas. Using the example of two patients with granuloma annulare and associated cutaneous lymphomas, we would like to sensitize clinically active dermatologists and dermatopathologists to the possible association between these two diseases. Characteristic features and clinicopathological signs are discussed, which should raise suspicion of an associated malignant lymphoma. It is recommended to rule out an underlying cutaneous and/or extracutaneous lymphoma in unusual clinical constellations (for instance distribution pattern, subjective complaints, age at first manifestation, lack of response to conventional therapy), especially in the absence of other known clinical triggers of granuloma annulare such as insect bites, trauma or varicella-zoster infections, among others. However, in individual cases the criteria mentioned here justify lymphoma screening.
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Affiliation(s)
| | - Thomas Vogt
- Department of Dermatology, Allergology and Venereology, Saarland University Hospital, Homburg/Saar
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Ehret M, Lenormand C, Scrivener JN, Gusdorf L, Lipsker D, Cribier B. [Generalized granuloma annulare: A clinicopathological study]. Ann Dermatol Venereol 2020; 147:271-278. [PMID: 32171551 DOI: 10.1016/j.annder.2019.09.617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 02/13/2019] [Accepted: 09/06/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Granuloma annulare (GA) is a benign granulomatous skin disorder that is generalized (GGA) in 15 % of cases. Although many case reports describe a relationship between GGA and systemic diseases, few large series have been published, and their association is debated. We present herein a series of GGA in order to describe their clinical and histological features. PATIENTS AND METHODS We included all biopsy-proven cases of GA presenting at the dermatopathology laboratory of Strasbourg where generalized (i.e. over 10 lesions). Clinical features were obtained from patients' medical files. RESULTS We included 35 GGA, with a sex ratio of 0.5. The mean age was 54 years. Lesions were annular or non-annular in equal measure and were symptomatic in 25 % of cases. Most patients (77 %) had an associated disease, already known in 60 % of cases, including dyslipidemia (27 %), diabetes mellitus (20 %), immunosuppressive drugs (17 %), atopy (17 %), auto-immune disease (17 %), hematological disease (14 %), and cancer (9 %). Histological analysis revealed the predominant pattern to be interstitial (54 %) rather than palisading (20 %), having no correlation with clinical type. Eosinophils were frequent (46 %) in GA but were not correlated with systemic disease or drug taking. Among the 40 % of patients treated, 50 % had a successful outcome on topical corticosteroids, doxycycline, antimalarial drugs or phototherapy. DISCUSSION GGA differs from localized GA, which is mostly associated with an already known systemic disease, whether metabolic, infectious or neoplastic, uncorrelated with clinical or histological features, and screening is necessary.
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Affiliation(s)
- M Ehret
- Clinique dermatologique, université de Strasbourg et hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
| | - C Lenormand
- Clinique dermatologique, université de Strasbourg et hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - J-N Scrivener
- Clinique dermatologique, université de Strasbourg et hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - L Gusdorf
- Clinique dermatologique, université de Strasbourg et hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - D Lipsker
- Clinique dermatologique, université de Strasbourg et hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - B Cribier
- Clinique dermatologique, université de Strasbourg et hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
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Lo Schiavo A, Ruocco E, Gambardella A, O'Leary RE, Gee S. Granulomatous dysimmune reactions (sarcoidosis, granuloma annulare, and others) on differently injured skin areas. Clin Dermatol 2015; 32:646-53. [PMID: 25160106 DOI: 10.1016/j.clindermatol.2014.04.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Granulomatous disorders are chronic cell-mediated immune responses histologically characterized by collections of macrophages, epithelioid cells, and multinucleated giant cells. This disease spectrum often has an infectious origin, but sometimes neither an infective agent nor an inciting antigenic stimulus can be identified. The skin may be a preferential target for these disorders, especially in the areas that have been damaged by various forms of skin injury (eg, herpetic infections, trauma, thermal or solar burns, vaccinations, tattoos). These damaged skin sites frame the new concept of an immunocompromised cutaneous district (ICD), which defines a skin area with acquired immune dysregulation that can pave the way for the local onset of opportunistic disorders, such as infections, tumors, and granulomatous disorders. Sarcoidosis, granuloma annulare (GA), and forms of granulomatous vasculitis, such as Churg-Strauss syndrome (CSS) and Wegener's granulomatosis (WG), are the most common granulomatous disorders that occur in an ICD and may share common pathogenic mechanisms. Recent studies have found clinical and pathologic overlapping features across noninfectious granulomas. Although no unifying etiology exists, the development of granulomatous processes in the ICD has often been reported and the literature contains various hypotheses to explain it: (1) overactive immune response in a previously injured region with or without loss of immune tolerance; (2) overall reduced immune response; (3) retention of an exogeneous antigen or foreign body; (4) altered neural signaling; and (5) a combination of all the aforementioned processes. T helper cells, T regulatory cells, and macrophages, as well as a number of antigenic proteins, have been identified as potential contributing factors. In addition, a genetic predisposition and an intact systemic immune system are both instrumental for the persistence of local granuloma formation in the ICD.
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Affiliation(s)
- Ada Lo Schiavo
- Department of Dermatology, Second University of Naples, via Sergio Pansini, 5, 80131 Naples, Italy.
| | - Eleonora Ruocco
- Department of Dermatology, Second University of Naples, via Sergio Pansini, 5, 80131 Naples, Italy
| | - Alessio Gambardella
- Department of Dermatology, Second University of Naples, via Sergio Pansini, 5, 80131 Naples, Italy
| | - Ryan E O'Leary
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sarah Gee
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Boudhir H, Bouhllab J, Rimani M, Senouci K, Hassam B. [Generalized annular granuloma]. Presse Med 2014; 43:1299-301. [PMID: 24857587 DOI: 10.1016/j.lpm.2014.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 02/17/2014] [Indexed: 11/17/2022] Open
Affiliation(s)
- Houda Boudhir
- Centre hospitalier universitaire Ibn Sina, service de dermatologie vénéréologie, BP 6527, Rabat, Maroc.
| | - Jamila Bouhllab
- Centre hospitalier universitaire Ibn Sina, service de dermatologie vénéréologie, BP 6527, Rabat, Maroc
| | - Meriem Rimani
- Centre d'anatomie pathologie Hassan, 10000 Rabat, Maroc
| | - Karima Senouci
- Centre hospitalier universitaire Ibn Sina, service de dermatologie vénéréologie, BP 6527, Rabat, Maroc
| | - Badredine Hassam
- Centre hospitalier universitaire Ibn Sina, service de dermatologie vénéréologie, BP 6527, Rabat, Maroc
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Lagier L, Dunoyer E, Estève E. Le topiramate : un nouvel inducteur de granulome annulaire ? Ann Dermatol Venereol 2011; 138:141-3. [DOI: 10.1016/j.annder.2010.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 09/15/2010] [Accepted: 11/17/2010] [Indexed: 10/18/2022]
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Martin JE, Wagner AJ, Murphy GF, Pinkus GS, Wang LC. Granuloma annulare heralding angioimmunoblastic T-cell lymphoma in a patient with a history of epstein-barr virus-associated B-cell lymphoma. J Clin Oncol 2009; 27:e168-71. [PMID: 19770367 DOI: 10.1200/jco.2009.23.0409] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Julie E Martin
- Department of Dermatology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
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Dadban A, Slama B, Azzedine A, Lepeu G. Widespread granuloma annulare and Hodgkin's disease. Clin Exp Dermatol 2008; 33:465-8. [DOI: 10.1111/j.1365-2230.2008.02730.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sioud Dhrif A, Dalle S, Balme B, Jullien D, Thomas L. [Diffuse papular lesions]. Ann Dermatol Venereol 2008; 135:74-7. [PMID: 18342081 DOI: 10.1016/j.annder.2007.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Accepted: 11/13/2007] [Indexed: 10/22/2022]
Affiliation(s)
- A Sioud Dhrif
- Service de dermatologie, hôpital de l'Hôtel-Dieu, hospices civils de Lyon, université Claude-Bernard Lyon I, 1, place de l'Hôpital, 69288 Lyon cedex 02, France
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Torrelo A, Vera A, Portugués M, de Prada I, Sanz A, Colmenero I, Zulaica A, de Lucas R, Fraga J, Pedraz J, Fontán S, Zambrano A. Perforating neutrophilic and granulomatous dermatitis of the newborn--a clue to immunodeficiency. Pediatr Dermatol 2007; 24:211-5. [PMID: 17542866 DOI: 10.1111/j.1525-1470.2007.00388.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report two newborns with a widespread cutaneous eruption consisting of discrete papules which evolved into vesicles, pustules, crusts, and ulcers. These healed over a 2-week period with scarring. Histopathology showed three main features--histiocytic granulomas, neutrophilic infiltration, and transepidermal elimination of degenerated collagen and debris through hair follicles. Both patients had congenital immunodeficiency. This skin condition of the newborn, with distinct clinical and histopathologic features, is a manifestation of immunodeficiency that has not been previously described.
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Affiliation(s)
- Antonio Torrelo
- Department of Dermatology, Hospital del Niño Jesús, Madrid, Spain.
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Affiliation(s)
- Leonid Izikson
- Department of Dermatology, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, 195 Lothrop Street, Suite 145 Lothrop Hall, Pittsburgh, PA 15213, USA
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