Granuloma Annulare on Arms and Legs and Syringomas

January 2, 2009

For several months, a 59-year-old woman has had numerous asymptomatic lesions on her arms and legs. During this period, she has not been exposed to the sun and has taken no new medications.

Case 1:

For several months, a 59-year-old woman has had numerous asymptomatic lesions on her arms and legs. During this period, she has not been exposed to the sun and has taken no new medications.

What does this look like to you?

A. Granuloma annulare.
B. Subacute lupus erythematosus.
C. Tinea corporis.
D. Psoriasis.
E. Erythema annulare centrifugum.

(answer on next page)

Case 1: Granuloma annulare

The patient has granuloma annulare, A, a condition that has no known cause. The rash persists for months or years before spontaneously involuting, and it is refractory to most treatments. Subacute lupus erythematosus, tinea corporis, and psoriasis all present with scale and are usually pruritic. Erythema annulare centrifugum manifests with trailing scale.

Localized granuloma annulareAtypical granuloma annulareGeneralized granuloma annulare
 

Case 2:

For several years, a 43-year-old woman has noticed an increasing number of discrete, asymptomatic papules around her eyelids. Can you identify these lesions?

 

 

A. Sebaceous hyperplasia.
B. Milia.
C. Syringomas.
D. Seborrheic keratoses.
E. Warts.

(answer on next page)

Case 2: Syringomas

The papules are syringomas, C, benign sweat gland tumors that are generally confined to the eyelids. Typically, lesions first appear during the third or fourth decade and slowly become more numerous, as in the 63-year-old patient shown here. They have no malignant potential and may be removed surgically for cosmetic reasons.

The lesions of sebaceous hyperplasia are yellowish papules around a central punctum. Milia are discrete white papules that appear as small, closed comedones. Seborrheic keratoses have patulous follicles and, like warts, a characteristic verrucous appearance.