Granuloma annulare and necrobiosis lipoidica with sequential occurrence in a patient: report and review of literature

Abstract

Granuloma annulare (GA) and necrobiosis lipoidica (NL) are granulomatous diseases of undetermined etiology. Rarely, both dermatoses have been reported to occur concomitantly in patients. GA and NL are characterized histologically by areas of necrobiosis of collagen. The two diseases share some common characteristics, which may suggest that these dermatoses could occur as a spectrum in some patients or possibly share a similar pathogenesis. We report on a 67-year-old Caucasian woman with a history of NL on the anterior shins that later developed lesions of GA on the breasts, trunk, and wrist. We also review the literature and discuss the characteristics of patients with concomitant GA and NL.

Keywords: concomitant; diabetes; granuloma; granuloma annulare; necrobiosis lipoidica; occurrence; review; same; sequential; simultaneous.

Figure 1.

Lower legs with irregular, annular plaques with erythematous rim and yellow, atrophic centers. (Copyright: ©2015 Rupley et al.)

Figure 2A.

Left thigh with numerous erythematous papules and plaques. (Copyright: ©2015 Rupley et al.)

Figure 2B.

Lower chest and abdomen with erythematous, indurated papules. (Copyright: ©2015 Rupley et al.)

Figure 2C.

Right upper extremity with erythematous plaques and annular plaques. (Copyright: ©2015 Rupley et al.)

Figure 2D.

Right wrist with erythematous and brown indurated papules. (Copyright: ©2015 Rupley et al.)

Figure 3A.

Scanning view reveals necrobiotic collagen and dermal inflammation. (Copyright: ©2015 Rupley et al.)

Figure 3B.

Individual collagen fibers are swollen and intensely eosinophilic. Histiocytic infiltrate around collagen fibers and a circumferential lymphocytic infiltrate are apparent (40×). (Copyright: ©2015 Rupley et al.)

Figure 3C.

There is a heavy histiocytic infiltrate surrounding and separating collagen fibers (100×). (Copyright: ©2015 Rupley et al.)