Granuloma Annulare

What is the cause of this soft tissue swelling?

DAVID L. KAPLAN, MD—Series Editor
University of Missouri Kansas City, University of Kansas

DAVID L. KAPLAN, MD—Series Editor: Dr Kaplan is clinical assistant professor of dermatology at the University of Missouri Kansas City School of Medicine and at the University of Kansas School of Medicine. He practices adult and pediatric dermatology in Overland Park, Kan.

Volume 52 - Issue 5 - May 2012

Granuloma Annulare

A 12-year-old girl presents with an asymptomatic swelling on the dorsum of her left hand of a few months’ duration. The child is otherwise healthy and has no history of trauma. A radiograph shows only soft tissue swelling.

What is your next step?

A. Order an MRI scan. 

B. Aspirate for deep fungal infection. 

C. Aspirate for atypical mycobacterial infection. 

D. Perform a 3-mm punch biospy. 

E. Perform an excisional biopsy to include muscle.

(Answer on next page)

Answer - Granuloma annulare

 

This presentation is typical of deep granuloma annulare, an asymptomatic swelling near a joint that frequently
occurs in girls younger than 16 years. A 3-mm punch biopsy, D, confirmed the clinical impression. The lesion resolved in 2 weeks.

The absence of pain and inflammation eliminated an infectious cause. The biopsy encouraged resolution of the granuloma annulare in the patient; these lesions typically resolve spontaneously over months to years. No treatment is necessary.