Lapidus Adam H, Lee Sangho, Khandewal Tanishq, Liu Zhao Feng, Ip Ken Hiu-Kan, Lin Lawrence, Chew Christopher Y
Department of Dermatology, Alfred Health, Melbourne, Vic., Australia.
Department of Dermatology, Monash Health, Melbourne, Vic., Australia.
Int J Dermatol. 2025 Feb;64(2):246-255. doi: 10.1111/ijd.17419. Epub 2024 Aug 1.
Subcutaneous granuloma annulare (SGA) is a rare clinicopathologic subtype of granuloma annulare characterized by the presence of subcutaneous nodules. There are no present reviews synthesizing the clinical features and treatment modalities in SGA. We conducted a systematic review following PRISMA guidelines [CRD42022344672] on all peer-reviewed English-language studies that reported one or more cases of SGA. A total of 97 studies, comprising 26 case series and 71 case reports with 324 patients, were included for analysis. Most cases were predominantly pediatric, with 78.9% of the cases identified being age 16 or lower and a median age of diagnosis of 6. There was no overall gender predisposition. Although over two-thirds of patients did not have any comorbidities, diabetes mellitus was the most common comorbidity present in 4% of cases. The most common feature of SGA was nodules, which were present in 99.6% of patients. Pain or tenderness was reported in 15.4%, and erythema of overlying skin in 11.0% of cases. Surgical excision was performed in 96/141 (68.1%) patients. Among the 27/141 (18.0%) patients who were conservatively managed, 87.0% spontaneously improved, including 60.0% who completely self-resolved. Topical and intralesional steroids were used in 3.40% and 1.85% of patients, respectively, resulting in complete or partial resolution in 54.6% and 100%. Among patients who were followed up, 83/324 (25.6%) patients experienced recurrence after a median duration of 26 weeks. SGA is predominantly a pediatric disease that frequently occurs on the limbs and the head. Juxta-articular lesions are more commonly observed in adults than in children. Surgical excision is common and effective in most patients. Spontaneous improvement occurs in most untreated cases, and intralesional steroids but not topical steroids may be beneficial for non-resolving cases and to reduce time to resolution.
皮下环状肉芽肿（SGA）是环状肉芽肿的一种罕见临床病理亚型，其特征为存在皮下结节。目前尚无综合SGA临床特征和治疗方式的综述。我们按照PRISMA指南[CRD42022344672]对所有报告了1例或更多例SGA的同行评审英文研究进行了系统综述。共纳入97项研究进行分析，其中包括26个病例系列和71篇病例报告，涉及324例患者。大多数病例主要为儿童，78.9%的病例年龄在16岁及以下，诊断时的中位年龄为6岁。无总体性别倾向。虽然超过三分之二的患者没有任何合并症，但糖尿病是最常见的合并症，在4%的病例中出现。SGA最常见的特征是结节，99.6%的患者有结节。15.4%的患者报告有疼痛或压痛，11.0%的病例有皮肤表面红斑。141例患者中有96例（68.1%）接受了手术切除。在141例接受保守治疗的患者中，有27例（18.0%），其中87.0%的患者自发改善，包括60.0%完全自愈的患者。分别有3.40%和1.85%的患者使用了外用和皮损内注射类固醇，完全或部分缓解率分别为54.6%和100%。在接受随访的患者中，324例中有83例（25.6%）在中位随访26周后复发。SGA主要是一种儿童疾病，常见于四肢和头部。成人比儿童更常观察到关节旁病变。手术切除在大多数患者中常见且有效。大多数未经治疗的病例会自发改善，皮损内注射类固醇而非外用类固醇可能对未缓解的病例有益，并可缩短缓解时间。
