10.5826/dpc.1302a172
text/xml
2160-9381
3267
en
Emir Q. Haxhija
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Subcutaneous Granuloma Annulare in an Atypical Age Group in Immediate Post-Covid-19 Phase
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Letter to the Editor
2023-04-29
2023-02-18
2023-04-29
2023-06-05
e2023172
Dermatol Pract Concept
Emir Q. Haxhija
2023/04/29
10.5826/dpc.1302a172
e2023172
Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
2160-9381
en
e2023172
Beqo BP, Gasparella P, Flucher C, Tschauner S, Brcic I, Haxhija EQ. Subcutaneous Granuloma Annulare vs. Subcutaneous Vascular Malformations in Children: A Diagnostic Challenge. Children (Basel). 2023;10(2):362. DOI: 10.3390/children10020362. PMID: 36832491. PMCID: PMC9955411.
Subcutaneous Granuloma Annulare in an Atypical Age Group in Immediate Post-Covid-19 Phase
https://dpcj.org/index.php/dpc/article/download/3267/2112
   Subcutaneous Granuloma Annulare in an Atypical
     Age Group in Immediate Post-Covid-19 Phase
                                            Besiana P. Beqo1, Emir Q. Haxhija1


1 Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria



Citation: Beqo BP, Haxhija EQ. Subcutaneous Granuloma Annulare in an Atypical Age Group in Immediate Post-Covid-19 Phase.
Dermatol Pract Concept. 2023;13(2):e2023172. DOI: https://doi.org/10.5826/dpc.1302a172
Accepted: March 20, 2023; Published: April 2023
Copyright: ©2023 Beqo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Emir Haxhija MD PhD FEBPS, Department of Paediatric and Adolescent Surgery, Medical University of Graz,
Auenbruggerplatz 34, A-8036 Graz, Austria. Phone: +43-(0)316 – 38513762 Fax: +43-(0)316 – 38513775 Email: emir.haxhija@medunigraz.at




Dear Editor,                                                             including infectious diseases, have been reported [4], which
                                                                         could have been the case in the report presented by Kaur et al.
We are writing in response to the article “Subcutaneous                       In contrast, SGA is almost exclusively seen in children and
Granuloma Annulare in an Atypical Age Group in Immedi-                   presents as immobile, solid, non-tender, non-inflammatory
ate Post-Covid-19 Phase” (DOI: https://doi.org/10.5826/                  subcutaneous lumps that often appear as single or multiple
dpc.1204a156) that was recently published in your es-                    lesions with rare overlying cutaneous abnormalities. These
teemed journal [1]. As the topic of subcutaneous granuloma               lumps are asymptomatic and attached to the deep fascia with
annulare (SGA) is of particular interest to us, we would                 a clear epifascial extension, and they spontaneously regress
like to ­offer our comments regarding the case presented in              without any treatment over a period of 1-2 years [5]. The
the article.                                                             histopathologic images presented in the report by Kaur et al
    Upon review of the clinical and histopathological fea-               do not appear to reveal typical SGA histopathology as it is
tures described, we respectfully suggest that the case pre-              classically seen in children but rather suggest GGA with a
sented in the article appears to be more compatible with the             patchy pattern of small granulomatous islands.
diagnosis of generalized granuloma annulare (GGA), rather                     Our recent research has shown that SGA can be recog-
than SGA.                                                                nized by the epifascial cap shape of the subcutaneous lesions
    GGA is characterized by the presence of 10 or more skin              on ultrasound and MR imaging, which can aid in the accu-
plaques with a circular appearance “affecting at least the               rate diagnosis of SGA [5]. This new imaging sign may help
trunk and either upper or lower, or both extremities” [2],               avoid unnecessary examinations and specialist consultations
with smaller or larger subdermal extensions of the granulo-              for children with SGA and enable accurate diagnosis through
mas beneath these skin lesions, sometimes seen in a patchy               imaging alone (Figure 1).
pattern [3]. GGA is more common in adults. Although its                       Finally, it is worth noting that SGA lumps typically
etiology is still unknown, various triggering mechanisms,                self-resolve in up to 2 years, while lesions described by Kaur




Letter to Editor | Dermatol Pract Concept. 2023;13(2):e2023172                                                                         1
Figure 1. This composite figure shows a clinical picture of the frontal location of multiple subcutaneous granuloma annulare (SGA) lumps
(A). Note the epifascial cap sign in the ultrasound image of two SGA lesions marked with multiple white arrows (B), and in another
­ultrasound image showing mild peripheral hypervascularization (C). The histopathology of the SGA lesions is characterized by pathogno-
 monic mucin positive staining of necrobiotic collagen (stars) which is surrounded by inflammatory histiocytes and lymphocytes, ordered in
 palisades (black arrows).




et al disappeared within 15 days after intralesional injection             2016;75(3):457-465. DOI: 10.1016/j.jaad.2015.03.054. PMID:
of triamcinolone acetonide (10 mg/ml), as commonly ob-                     27543209.
                                                                        3. Tsuruta D, Sowa J, Hiroyasu S, Ishii M, Kobayashi H. Con-
served in patients with localized or generalized variants of
                                                                           comitant occurrence of patch granuloma annulare and classical
granuloma annulare.
                                                                           granuloma annulare. J Dermatol. 2011;38:(5):482-485. DOI:
                                                                           10.1111/j.1346-8138.2010.01070.x. PMID: 21352310.
References                                                              4. Piette EW, Rosenbach M. Granuloma annulare: Pathogene-
                                                                           sis, disease associations and triggers, and therapeutic options.
1. Kaur L, Chakraborty D, Dayal S, Singh S, Yadav K. Subcu-                J Am Acad Dermatol. 2016;75(3):467-479. DOI: 10.1016/j.jaad
   taneous Granuloma Annulare in an Atypical Age Group in                  .2015.03.055. PMID: 27543210.
   Immediate Post-Covid-19 Phase. Dermatol Pract Concept.               5. Beqo BP, Gasparella P, Flucher C, Tschauner S, Brcic I, Haxhija EQ.
   2022;12(4):e2022156. DOI: 10.5826/dpc.1204a156. PMID:                   Subcutaneous Granuloma Annulare vs. Subcutaneous ­Vascular
   36534560. PMCID: PMC9681236.                                            Malformations in Children: A Diagnostic Challenge. Children
2. Piette EW, Rosenbach M. Granuloma annulare: Clinical and his-           ­(Basel). 2023;10(2):362. DOI: 10.3390/children10020362. PMID:
   tologic variants, epidemiology, and genetics. J Am Acad Dermato.l        36832491. PMCID: PMC9955411.




2                                                                           Letter to Editor | Dermatol Pract Concept. 2023;13(2):e2023172
