Penas P F, Jones-Caballero M, Fraga J, Sánchez-Pérez J, García-Díez A
Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain.
Int J Dermatol. 1997 May;36(5):340-8. doi: 10.1046/j.1365-4362.1997.00047.x.
Perforating granuloma annulare (PGA) is considered an histologic subtype of granuloma annulare (GA) and it is described as a very rare disease, usually of children, affecting the dorsum of the hands. Mechanisms leading to perforation are unknown. Our experience suggested a different clinical presentation, so we decided to review our patients and the cases published.
We present six cases of PGA and review 52 PGA cases reported in the literature. Data regarding sex, age, time of evolution of disease, clinical features, laboratory findings, treatment, and follow-up were collected. The significance level was determined by the chi 2 or Student t test when appropriate.
The prevalence of PGA could be up to 5% of GA. Pustular-like lesions can be found in 26% of cases, and scars in 37%; papular, umbilicated, and crusted lesions being the most common finding. While PGA appears as a single lesion in only 9% of cases, and half of the patients are older than 30 years. In GA 50% of cases present as a single lesion and 80% of patients are younger than 30 years.
PGA is different to GA not only histologically but also clinically. It is a disseminated disease, affecting both children and adults, which is characterized by the presence of multiple papules, most of them umbilicated and/or crusted, and characteristically pustular lesions and scars. Histology suggests that the superficial localization of the necrobiotic granuloma leads to the epidermal perforation. Treatment is disappointing.
穿通性环状肉芽肿（PGA）被认为是环状肉芽肿（GA）的一种组织学亚型，它被描述为一种非常罕见的疾病，通常发生于儿童，累及手部背部。导致穿孔的机制尚不清楚。我们的经验提示了一种不同的临床表现，因此我们决定回顾我们的患者以及已发表的病例。
我们报告6例PGA病例，并回顾文献中报道的52例PGA病例。收集有关性别、年龄、疾病演变时间、临床特征、实验室检查结果、治疗及随访的数据。在适当情况下，显著性水平由卡方检验或学生t检验确定。
PGA的患病率可能高达GA的5%。26%的病例可发现脓疱样损害，37%有瘢痕形成；丘疹、脐凹状及结痂性损害是最常见的表现。而PGA仅9%的病例表现为单个损害，且半数患者年龄超过30岁。在GA中，50%的病例表现为单个损害，80%的患者年龄小于30岁。
PGA不仅在组织学上与GA不同，在临床上也不同。它是一种播散性疾病，累及儿童和成人，其特征为存在多个丘疹，多数为脐凹状和/或结痂性，并有特征性的脓疱样损害和瘢痕。组织学提示坏死性肉芽肿的表浅定位导致表皮穿孔。治疗效果令人失望。
