Case records of the Massachusetts General Hospital. Case 19-2006. A 22-month-old boy with the rapid growth of subcutaneous nodules

Common Annular Lesions in the Pediatric Population: Part 1

Dermatologic presentations can quickly become overwhelming for clinicians due to the vast number of causes for these conditions. Characteristics of a rash, such as shape, color, size, and distribution, can significantly narrow the differential diagnosis. A solid framework to organize these presentations is critical for correctly identifying and treating skin issues. The shape of a rash, for instance, can serve as a foundation from which to build complex differential diagnoses. Annular rashes in the pediatric population are common complaints requiring clinical evaluation. This article is the first part of a two-part review that discusses some of the most frequent causes of these annular lesions in the pediatric population. Knowledge of these rashes can drastically improve a physician's ability to manage dermatologic issues. [Pediatr Ann. 2019;48(2):e92-e96.].

Granuloma annulare: Clinical and histologic variants, epidemiology, and genetics

Granuloma annulare (GA) is a poorly understood condition characterized by a set of clinical morphologic variants with 2 predominant histopathologic patterns of inflammation. This review provides a comprehensive overview of the available information about the clinical variants and histopathologic features, current epidemiologic data, and potential genetic underpinnings of GA. Much of the current understanding of GA is based on retrospective studies, case series, and case reports; this review aims to synthesize the available information and present it clearly for practicing dermatologists.

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.

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.

Head and neck epithelioid sarcoma in a child: diagnostic dilemma and anterolateral thigh free flap reconstruction

The diagnostic dilemma is discussed of a child who presented with a granulomatous process of the external ear that was originally considered granuloma annulare and was later diagnosed as epithelioid sarcoma. We present the surgical treatment and the first report of reconstruction of a lateral skull base and cheek defect with an anterolateral thigh (ALT) free flap in a pediatric patient.