Department of Dermatology, University of Pittsburgh, 200 Lothrop St., Presby South Tower Suite 3880, Pittsburgh, PA 15213, USA.
Am J Clin Dermatol. 2013 Aug;14(4):279-90. doi: 10.1007/s40257-013-0029-5.
Granuloma annulare (GA) is a common cutaneous disorder classically presenting as annular groups of skin-colored to erythematous papules without epidermal change localized to the dorsal hands and/or feet. In addition to the localized form, there are variants including generalized (including generalized annular GA, disseminated papular GA, and atypical generalized GA), subcutaneous, and perforating GA, providing for a wide spectrum of clinical lesions. The etiology of GA remains unknown and several systemic associations have been proposed but not proven, including diabetes mellitus, malignancy, thyroid disease, and dyslipidemia. The diagnosis of GA relies on clinicopathological correlation, with a skin biopsy confirming the histological features of the disease, including palisading granulomas, collagen degeneration, mucin, and a lymphohistiocytic infiltrate. Localized GA is often asymptomatic and self-limited within 2 years; however, the patient may desire treatment for cosmetic reasons, with topical and intralesional corticosteroids as the mainstays of therapy. When GA is generalized, disseminated, or atypical, a more thorough medical workup for underlying diseases may be considered depending on the physical examination, a thorough review of systems, comorbidities, and clinical suspicion. Treatment is often challenging for generalized GA, especially because of its recalcitrant nature and a lack of evidence-based therapy. Over 30 different treatments have been described for GA with variable results; however, the majority of these have been single case reports, small case series, or retrospective studies. Reported treatments for GA include topical, intralesional, intramuscular, and oral medications (steroidal vs. non-steroidal); biologic agents; surgical interventions; phototherapy; and laser treatments. When selecting a systemic therapy for a patient with GA, multiple variables must be considered, such as baseline blood evaluations, comorbidities, drug interactions, compliance, adverse effect profiles, prior treatments, and reproductive status. This evidence-based review will focus on the advances made in the twenty-first century regarding the etiology, diagnosis, and therapeutic management of GA.
环状肉芽肿（GA）是一种常见的皮肤疾病，其特征为皮肤色至红斑色丘疹呈环状排列，无表皮改变，主要发生于手背和/或足背。除局限性形式外，还有多种变体，包括全身性（包括泛发性环状 GA、播散性丘疹性 GA 和非典型全身性 GA）、皮下和穿通性 GA，从而具有广泛的临床病变。GA 的病因仍不清楚，已提出但尚未证实几种全身性关联，包括糖尿病、恶性肿瘤、甲状腺疾病和血脂异常。GA 的诊断依赖于临床病理相关性，皮肤活检可证实疾病的组织学特征，包括栅栏状肉芽肿、胶原变性、黏蛋白和淋巴组织细胞浸润。局限性 GA 通常无症状且 2 年内可自行限制；然而，患者可能出于美容原因需要治疗，局部和皮损内皮质类固醇是主要的治疗方法。当 GA 为全身性、播散性或非典型时，根据体格检查、全面系统回顾、合并症和临床怀疑，可能需要考虑对潜在疾病进行更全面的医学检查。全身性 GA 的治疗通常具有挑战性，尤其是因为其难治性和缺乏基于证据的治疗方法。已有 30 多种不同的治疗方法用于 GA，其结果各不相同；然而，大多数为单一病例报告、小病例系列或回顾性研究。已报道的 GA 治疗方法包括局部、皮损内、肌肉内和口服药物（甾体与非甾体）；生物制剂；手术干预；光疗；和激光治疗。在为 GA 患者选择系统性治疗时，必须考虑多种变量，例如基线血液评估、合并症、药物相互作用、依从性、不良影响谱、既往治疗和生殖状态。本循证综述将重点介绍 21 世纪在 GA 的病因、诊断和治疗管理方面取得的进展。
