Johnston Jesse James, Spelman Lynda
Specialist Connect, Brisbane, QLD, Australia.
Prosthet Orthot Int. 2017 Jun;41(3):311-313. doi: 10.1177/0309364616665733. Epub 2016 Sep 9.
Granuloma annulare is a benign, inflammatory skin disorder with no distinct aetiology or widely accepted pathogenic process. Case description and Methods: We report a case of a 71-year old female with a 4-year history of an erythematous annulopapular lesion to the lateral aspect of her right forearm from a pressure pleat ridge in a high-density polyethylene plastic elbow orthosis to immobilise a prior radial head fracture. Morphological and histopathological assessment was consistent for granuloma annulare. Findings and Outcomes: The granuloma annulare was ameliorated after 3 months of high-potency topical steroids under occlusive dressing.
This case highlights an atypical presentation of a pressure-induced patch of localised granuloma annulare persisting long-term after temporary use of a high-density polyethylene orthosis with a pleated point ridge. Special care should be taken when choosing the appropriate orthosis in patients with sensitive skin conditions. Moulded orthoses can have defects after manufacturing that can lead to localised skin irritation, inflammation and subsequent rash formation. Clinical relevance Appropriate casting and splint moulding should be taken into special consideration in patients with sensitive skin conditions. This prevents or diminishes the chance inducing or exacerbating skin conditions.
环状肉芽肿是一种良性炎症性皮肤病，病因不明，也没有被广泛接受的致病过程。病例描述及方法：我们报告一例71岁女性病例，其右前臂外侧因高密度聚乙烯塑料肘部矫形器中的压力褶皱脊出现红斑性环形丘疹病变，该矫形器用于固定先前的桡骨头骨折，病程已有4年。形态学和组织病理学评估与环状肉芽肿相符。结果：在封闭敷料下使用强效外用类固醇3个月后，环状肉芽肿得到改善。
本病例突出了压力诱导的局限性环状肉芽肿的非典型表现，在临时使用带有褶皱点脊的高密度聚乙烯矫形器后长期持续存在。对于皮肤敏感的患者，选择合适的矫形器时应格外小心。模制矫形器在制造后可能存在缺陷，可导致局部皮肤刺激、炎症及随后皮疹形成。临床意义：对于皮肤敏感的患者，应特别考虑合适的铸型和夹板模制。这可预防或减少诱发或加重皮肤疾病的可能性。
