Jankowski Pawel P, Krishna Phari H, Rutledge Joseph C, Waldhausen John, Avellino Anthony M
Department of Neurological Surgery, University of Washington School of Medicine, Seattle Children's Hospital and Regional Medical Center, Seattle, Washington 98105, USA.
Neurosurgery. 2008 Nov;63(5):E1002; discussion E1002. doi: 10.1227/01.NEU.0000333264.11514.FE.
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.
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.
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.
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.
皮下环状肉芽肿（SGA）是一种良性炎症性疾病，很少累及头皮。我们报告5例患有SGA头皮病变的儿童病例，并讨论我们的临床经验、特征性表现、诊断评估、治疗方法及疾病进程。
5例患者在头皮上的单个或多个部位出现多个皮下结节。对这5例患者的医疗、手术及病理记录进行了回顾性分析。
所有头皮病变均被切除，组织学检查证实为SGA结节。5例患者中有4例结节无压痛且不可移动。病变的平均数量为4.2个。患者就诊时的平均年龄为3.8岁。5例患者中有4例在同一部位或不同部位至少出现1次孤立性病变复发。在经历复发的80%的患者中，除1例患者在72个月时病变持续出现消失和复发外，所有病变均在术后1年内复发。所有病变的最终诊断均通过活检及随后的显微镜评估确定。未观察到术后并发症。
每当观察到头皮皮下浅表结节时，环状肉芽肿应列入鉴别诊断。尽管对SGA结节采用了多种治疗方式，但即使手术切除后复发也很常见。
