September 2021 - Case of the Month
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 37 year old woman presented with slowly evolving lesions on the extensor surfaces of her fingers, and a couple on her elbows. They were a little uncomfortable if knocked, but were otherwise asymptomatic. There was no other skin history. The patient was otherwise well with no history of arthritis, and took no medications. There were no relevant hobbies.
Multiple deep seated nodules that were firm to palpate. Some has a slightly annular appearance. The overlying skin was normal.
What is the diagnosis?
The diagnosis is subcutaneous granuloma annulare (GA) - the diagnosis was confirmed by biopsy.
Subcutaneous GA is uncommon, and arises most commonly in children. Lesions are firm, ranging in size from 5 mm to several cm, and are found most commonly on the scalp, lower extremities and hands, although any site may be affected.
There is little in the way of effective treatment, although intralesional triamcinolone (a steroid) may help reduce the size of some lesions - such treatment would often be best avoided on the back of the hands in case of tendon damage.
The differential diagnosis for multiple deep-seated skin lesions includes rheumatoid nodules and tendon xanthomata.
Please refer to the chapter on granuloma annulare for more information.
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 52 year old man presented with a one year history of skin lesions predominantly on his hands, ears and scalp. He was also complaining of painful swollen fingers associated with morning stiffness. There was no family history of skin or joint problem...
A 72 year old man was referred with a rash, predominantly on the legs. The patient was systemically well and the lesions were only mildly symptomatic. The lesions presented as one to several at a time lasting several weeks. They had not res...
Welcome back to the new look PCDS website, and our first case. This lady was referred as a 2-week wait with a changing lesion on the right temple.
A 15 year old lady was referred for a diagnostic opinion for skin changes presenting in birth, affecting the right upper back, shoulder, antecubital fossa and dorsal wrist. The patient was asymptomatic and otherwise well.
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