HISTORY
Chief complaint: presenting for diagnosis and therapeutic options.
History of Present Illness
A 29-year-old man presented with a new annular pink plaque on the hand, which was first noted 2 months prior and has since grown larger. Prior treatment: topical terbinafine and ketoconazole creams, which did not alleviate the problem. His primary symptom: mild itching. Prior biopsy: none.
IMAGE QUALITY ASSESSMENT
Fully satisfactory.
TELEDERMATOLOGY IMAGING READER REPORT*
One image was provided for Problem A (Figure 1). The image clearly shows an annular pink plaque with firm, shiny, pink granulomatous border and flat red-brown center. No scale is appreciated.
INTERPRETATION OF IMAGES
Findings
The morphology and distribution of the lesion are most consistent with the diagnosis of granuloma annulare (GA).
RECOMMENDATIONS
Skin Care and Treatment Recommendations
As GA may be self-limited, primary provider may offer reassurance and counsel the patient that observation may be most appropriate for asymptomatic, localized involvement. If treatment is desired, first-line therapy with high-potency topical corticosteroids may be initiated. Sun and ultraviolet light protection is also recommended.
RECOMMENDED FOLLOW-UP
Type of Visit
Return to the primary provider to discuss treatment. If the condition fails to resolve, consult dermatology for face-to-face evaluation, consideration for a punch biopsy to confirm the diagnosis, and/or consideration for intralesional corticosteroid injections.
CLINICAL PEARL
GA is seen most commonly as firm, smooth annular or arciform plaques with a raised border in children and young adults. Localized GA is the most common form, presenting with lesions up to 5 cm in diameter on acral sites (Ghadially, 2015). The etiology of GA is unknown. Spontaneous resolution occurs in 50% of patients within 2 years, but recurrence occurs in about 40% (Wells & Smith, 1963). If left untreated, lesions may persist from a few weeks to several decades. The clinical differential diagnosis for GA includes other annular eruptions; the annular plaques of dermatophytic infections (tinea) may be distinguished from GA by the characteristically scaly plaques and presence of pustules.
REFERENCES