The value of dermoscopy in generalized granuloma annulare: from time of diagnosis to successful treatment with acitretin and narrowband UV-B phototherapy

Authors: Marie Claudine Francesca B. Perlas, MD, Elisabeth Ryan, MD, Johannes F. Dayrit, MD, FPDS

Abstract

Introduction: Dermoscopy is traditionally used for diagnosis of cutaneous tumors and malignancies, but it has gained importance in the diagnosis of inflammatory skin diseases such as granuloma annulare (GA). Diagnosis and management of the disease is challenging due to its intractable and recurrent nature. There are few reports on the treatment of granuloma annulare with combination of acitretin and narrowband UV-B phototherapy.

Case Summary: A case of a 52-year-old female with a 4-year history multiple skin colored to erythematous pruritic papules and scaly annular plaques on the ears, face, trunk and extremities. Initial histopathological diagnosis was Hansen’s disease. Dermoscopy revealed peripheral, structureless yellow-orange borders with whitish scaling and branching or linear vessels. A skin punch biopsy of the lesion revealed necrobiotic collagen surrounded by histiocytes, multinucleated giant cells and lymphocytes, consistent with granuloma annulare. Patient was started on acitretin 20mg/day, with concurrent narrowband ultraviolet-B (NB-UVB) phototherapy 2 times per week for 3 months. Patient had 25 sessions with cumulative dose of 2321.580 J/cm2. There was noted decreased in number of lesions and flattening of plaques. Dermoscopy of resolved lesions show lightening of yellowish-orange areas and clearing of irregular borders and scales and disappearance of the linear blood vessels.

Conclusion: Dermoscopy should be utilized in the diagnosis of all stages of granuloma annulare and should be an adjunct in physical examination and in monitoring skin lesions during treatment.

 

Citation

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Keywords

Granuloma annulare, dermoscopy, acitretin, narrowband UV-B phototherapy

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