10.5826/dpc.1304a207
text/xml
2160-9381
3231
en
Bianca Maria Piraccini
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Papular Granuloma Annulare Mimicking Viral Warts
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-10-31
2023-02-08
2023-10-31
2024-01-15
e2023207
Dermatol Pract Concept
Bianca Maria Piraccini
2023/10/31
10.5826/dpc.1304a207
e2023207
Dermatology Unit- IRCCS Azienda Ospedaliero-Universitaria di Bologna; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy
2160-9381
en
e2023207
Papular Granuloma Annulare Mimicking Viral Warts
https://dpcj.org/index.php/dpc/article/download/3231/2364
 Papular Granuloma Annulare Mimicking Viral Warts
             Carlotta Gurioli1,2, Cosimo Misciali1,2, Silvia Robuffo1,2, Carlotta Baraldi1,2,
                         Lindsay Brooke Boling3, Bianca Maria Piraccini1,2


1 Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
2 Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy
3 Allergy and Clinical Immunology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy



Citation: Gurioli C, Misciali C, Robuffo S, Baraldi C, Boling LB, Piraccini BM. Papular Granuloma Annulare Mimicking Viral Warts.
Dermatol Pract Concept. 2023;13(4):e2023207. DOI: https://doi.org/10.5826/dpc.1304a207
Accepted: March 19, 2023; Published: October 2023
Copyright: ©2023 Gurioli 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: Silvia Robuffo, IRCCS Azienda Ospedaliero-Universitaria di Bologna; Department of Medical and Surgical
Sciences, Alma Mater Studiorum University of Bologna, Italy; Via Massarenti 1, 40138 Bologna, Italy. Telephone number +390512144838
E-mail: silvia.robuffo@studio.unibo.it




Case Presentation                                                        vessels on a pink to white background (Figure 1C). A punch
                                                                         biopsy was performed for histological examination. The
We report the case of a 29-year-old Caucasian male that                  histopathology was compatible with granuloma annulare
presented to our clinic with a four-year history of having               (GA) of the hands, showing an area of palisading histiocytes
several small, shiny flesh-colored/erythematous papular le-              around both degeneration of collagen and mucin deposition
sions confined to the dorsal surfaces of his fingers and hands           (Figure 1D). Blood work (including a complete blood count,
bilaterally (Figure 1, A and B). There were no systemic symp-            plasma glucose levels, liver and renal function tests, and au-
toms, no smoking habit reported, and no history of diabetes              toimmunity screening) were performed and resulted within
mellitus or other chronic diseases. At the time of the visit, a          the normal limits [1]. After evaluating the different thera-
dermoscopic examination of the lesions was carried out that              peutic options that exist for GA, a 4-week treatment with a
showed circular areas of varied dotted and linear irregular              potent topical steroid ointment was prescribed [2].




Image Letter | Dermatol Pract Concept. 2023;13(4):e2023207                                                                           1
Figure 1. Papular granuloma annulare. (A, B) Morphology of cutaneous lesions on the dorsal aspects of the hands; (C) Dermoscopic exam-
ination displays varied irregular linear and dotted vessels over a pink to whitish background and (D) Cutaneous biopsy findings showing an
area of palisading histiocytes, degenerated collagen bundles, and mucin deposition (H&E, original magnification ×20).




Teaching Point                                                         References
GA is the most common non-infectious cutaneous granulo-                 1. Barbieri JS, Rosenbach M, Rodriguez O, Margolis DJ. As-
                                                                           sociation of Granuloma Annulare With Type 2 Diabetes,
matous disease and can manifest with many clinical variants,
                                                                           Hyperlipidemia, Autoimmune Disorders, and Hematologic Ma-
sometimes mimicking other conditions such as viral warts.
                                                                           lignant Neoplasms. JAMA Dermatol. 2021;157(7):817–823.
Considering the frequency with which dermatologists see vi-                DOI:10.1001/jamadermatol.2021.1805. PMID: 34106218;
ral warts, differential diagnoses and biopsy often may not                 PMCID: PMC8190702.
be considered. This case highlights the crucial importance of           2. Wang J, Khachemoune A. Granuloma Annulare: A Focused Re-
clinical and histopathological correlation for a definitive di-            view of Therapeutic Options. Am J Clin Dermatol. 2018(3):
                                                                           333-344. DOI: 10.1007/s40257-017-0334-5. PMID: 29230666.
agnosis, leading to an improved management of these inflam-
matory lesions and, above all, their atypical clinical variants.




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