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E-IJD® - QUIZ |
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| Year : 2022 | Volume
: 67
| Issue : 6 | Page : 839 |
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| Linear Granuloma Annulare (GA): A rare subtype |
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Ya-Kun Shao, Jian-Min Chang
Department of Dermatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| Date of Web Publication | 23-Feb-2023 |
Correspondence Address:
Ya-Kun Shao
Department of Dermatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing - 100 730
China
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijd.ijd_415_21
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How to cite this article:
Shao YK, Chang JM. Linear Granuloma Annulare (GA): A rare subtype. Indian J Dermatol 2022;67:839 |
 Quiz | |  |
A 50-year-old male developed a pruritic linear lesion along his clavicle a month ago. It was like a scratch or urticaria, with an erythematous halo around, which did not fade when pressed [Figure 1]. Calamine lotion was ineffective. Blood tests were normal. No history of trauma. | Figure 1: Clinical appearance. A linear, skin-coloured, raised lesion, approximately 10 cm in length, with erythematous halo around
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| Answer | | |
Histopathology results revealed intradermal palisading granulomas: an eosinophilic collagen fibres necrotic center surrounded by lymph-histiocytic and tissue cells in the upper dermis [[Figure 2], hematoxylin-eosin stain, original magnification × 40]. The gap between the collagen tissues widened with partly mucin deposition with lymphocytes and multinucleated histiocytes infiltration [[Figure 3], hematoxylin-eosin stain, original magnification × 100]. The final diagnosis was considered linear granuloma annulare (GA) due to clinical features and pathological correlations. Lesion disappeared after topical mometasone furoate cream (0.1%) treatment and no relapse signs were observed.GA is a benign, self-limiting granulomatous inflammatory skin disease, usually in cricoid or coin shape. Fölster-Holst[1] further classified localised GA depending on clinical characteristics, including linear GA, which is a rare subtype and may be associated with interstitial granulomatous dermatitis (IGD). Linear GA along Blaschko lines tends to occur in children, and generalised lesions may be related to defects in monogenic disorders.[2] Besides, a mutation in the gene and autosomal dominant theory may be the determinant of linear distribution.[2] Adult linear GA is rare, which can be manifested as a thin line or broad band-like papules, without any characteristic. It is easily misdiagnosed with lichen planus, epidermal nevi, urticaria, lichen striatus, and scratch, etc. Final diagnosis depends on typical histopathological results. The pathogeny is still unknown, it is assumed that a high dose of local interleukin-2 resulted in nonspecific T-cell attraction, which may be the main cause of localised lesion.[3] A total of three cases of adult linear GA were reported before, including two cases located on the finger and one on the midaxillary.[4] The longest was 22cm, while the shortest was only a few centimeters long, with symmetrical or asymmetrical distribution.[3] Among the fivereported cases, there were, one boy, one girl, two adult males, and 1 adult female.[4] The man we reported here will be the sixth case.[4] | Figure 2: Histopathology result. In the upper dermis, an eosinophilic collagen fibers necrotic center surrounded by lymph-histiocytic and tissue cells (hematoxylin-eosin stain, original magnification ×40)
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 | Figure 3: Histopathology result. Lymphocytes and multinucleated histiocytes in the granuloma with a gap between the collagen tissues widened with partly mucin deposition (hematoxylin-eosin stain, original magnification ×100)
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GA is a self-healing disease that usually resolves within 2 years.[4] Liquid nitrogen, topical or injected steroids are the most commonly used therapy for localised lesions to shorten the course, while systemic dapsone, retinoids, niacinamide, pimecrolimus and other drugs are used in the treatment of generalised GA.[5] Systemic use of steroids has a high recurrence rate.For localised linear GA, especially in adults, i.e., the topical steroids are first-line therapy. However, there is no therapeutic guidance for linear GA in children with early-onset, especially in those who conform to the genetic pattern along the Blaschko line.
The differential diagnosis of linear GA is also different from those of traditional GA. Diseases with a linear distribution include linear lichen planus, linear cutaneous lupus erythematosus, linear scleroderma, linear lichen nitidus, linear lichen striatus, linear Darier's disease, linear porokeratosis, linear atrophoderma of Moulin, inflammatory linear verrucous epidermal nevus, acquired Blaschko dermatitis, relapsing linear acantholytic dermatosis and many other special lesion deposition caused by the concept of genetic mosaicism. Therefore, it is important to understand the morphological and histopathological features of these lesions.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Fölster-Holst R, Kiene P, Christophers E. Ungewöhnliche zirzinäre Variante eines generalisierten Granuloma anulare [Unusual circinary variant of generalized granuloma anulare]. Hautarzt 1996;47:53-7. German.  |
| 2. | Morice-Picard F, Boralevi F, Lepreux S, Labrèze C, Lacombe D, Taïeb A. Severe linear form of granuloma annulare along Blaschko's lines preceding the onset of a classical form of granuloma annulare in a child. Br J Dermatol 2007;157:1056-8. |
| 3. | Mempel M, Musette P, Flageul B, Schnopp C, Remling R, Gachelin G, et al. T-cell receptor repertoire and cytokine pattern in granuloma annulare: Defining a particular type of cutaneous granulomatous inflammation. J Invest Dermatol 2002;118:957-66. |
| 4. | Gu A, Liang J, Zhang L, Xiao Y. Linear granuloma annulare localized to the finger. Indian J Dermatol Venereol Leprol 2020;86:314-6. [ PUBMED] [Full text] |
| 5. | Cyr PR. Diagnosis and management of granuloma annulare. Am Fam Physician 2006;74:1729-34. |
[Figure 1], [Figure 2], [Figure 3] |
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