DISSEMINATED GRANULOMA ANNULARE: 3 CLINICAL CASES GRANULOM INELAR DISEMINAT: 3 CAZURI CLINICE

Virgil Patrascu, Alexandra Georgiana Bocîrnea, Marius Eugen Ciurea, Raluca Niculina Ciurea

Abstract


Introduction: Granuloma annulare (GA) is a chronic, benign inflammatory dermatosis that appears in all group ages, but it is
less frequent in childhood and prevails in women. The condition
is clinically characterized by multiple annular or aciform plaques, with coalescence of small, firm, skin-colored or erythematous papules on the edges.We present 3 patients with disseminated granuloma annulare (DGA), with emphasis on the clinical aspects, the comorbidities associated with the disease and the therapeutic response.
Patients and Methods: We present 3 cases diagnosed with DGA both clinically and histologically. In two of the cases the treatment was Ofloxacin (400 mg/day), Doxycycline (100 mg/day) and Rifampicin (600 mg/day) 3 consecutive days per month for 4 months and topically with Tacrolimus 0.1%, one application daily, in the evening. The third patient received Pentoxiphylinum 1200 mg/day, Hydroxychloroquine 400 mg/day and corticosteroid class III topically. We evaluated our patients 2 months and 4 months after initiating the treatment.
Results: The following comorbidities were present: dyslipidemia (2 cases), diabetes (1 case), high blood pressure (2 cases), overweight (1 case), obesity (1 case). Histopatological exam established:
lesions located in the middle and superficial dermis, characterized by the presence of granulomas with sparsely arranged histiocytes, surrounding necrobiotic collagen, with rare multinucleated cells and a perivascular lymphocytic infiltrate. The treatment of the 3 patients led to improvement of clinical appearance without significant differences between the two treatment schemes.
Conclusions: Further research is needed to establish the optimal therapy for the patients with DAG.


Introducere : Granulomul inelar este o dermatoză cronică inflamatorie benignă care apare la toate grupele de vârstă, dar cu o frecvenţă mai scăzută în copilărie, predomină la femei (sex/ ratio 6/1) şi este caracterizat clinic de multiple plăci inelare, arciforme cu margini formate din coalescenţa unor mici papule de culoarea tegumentului sau uşor eritematoase. Prezentăm 3 bolnavi cu GID având ca obiectiv evidenţierea aspectelor clinice, a comorbidităţilor şi a răspunsului terapeutic.
Pacienţi şi metode: Prezentăm 3 cazuri diagnosticate clinic și histopatologic cu GID. În două cazuri tratamentul s-a făcut cu Ofloxacină (400 mg/zi), Doxiciclină (100 mg/zi) şi Rifampicină (600 mg/zi), 3 zile consecutiv pe lună timp de 4 luni, iar local Tacrolimus 0,1%, o aplicaţie pe zi seara. Cel de-al treilea
bolnav a primit pe cale generală pentoxiphylinum 1.200 mg/
zi, Hydroxychloroquine 400 mg/zi şi local dermatocorticoizi clasa a III-a. Am evaluat cazurile la 2 și la 4 luni după inițierea tratamentului.
Rezultate: Am întâlnit următoarele comorbidităţi: dislipidemie
(2 cazuri), diabet zaharat (1 caz), HTA (2 cazuri), suprapondere
(1 caz), obezitate (1 caz). Examenul histopatologic a arătat: leziuni prezente în dermul mijlociu și superficial, caracterizate prin granuloame histiocitare, care inconjoară arii de colagen dergenerat, cu rare celule multinucleate și un infiltrat limfocitar distribuit perivascular. Tratamentul celor 3 bolnavi a condus la ameliorarea aspectului clinic fară diferenţe semnificative între rezultatele celor două scheme de tratament.
Concluzii: Sunt necesare noi cercetări pentru stabilirea terapiei optime a bolnavilor cu GID. 



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—Print : ISSN 2392–7461, ISSN-L 2392–7461 
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