G-M

GRANULOMA ANNULARE (GA)

Common benign inflammatory granulomatous dermatosis of unknown etiology.

History: Usually asymptomatic; most pts. <30 yr

Physical: Papules and annular plaques with central depression; commonly on dorsae of hands, feet, elbows (acral).

Variants: Arcuate dermal erythema, localized, generalized, micropapular, patch, perforating, & subcutaneous. Generalized (15%; older pts.; poorer response to Tx) and perforating GA (5%; small umbilicated papules) may be associated with diabetes mellitus (controversial). Course: Usually self-limiting; resolves within 2 yr in 75% of patients; high recurrence rate.

Investigations: Biopsy to confirm diagnosis.

DDx: Erythema elevatum diutinum, lichen planus, sarcoidosis, tinea corporis.

Management

• Reassurance & clinical observation since benign & self-limited.

• Mainly for cosmetic purposes.

• Localized GA: intralesional or potent topical steroids, cryotherapy.

• Generalized GA: PUVA, prednisone, pentoxifylline, oral retinoids.

HAND, FOOT, AND MOUTH DISEASE

Self-limited (7—10 d) systemic infection usually caused by coxsackievirus A16 affecting young children. Highly contagious, and spreads by direct contact.

History: Often accompanied by low-grade fever, malaise, and sore mouth; refusal to eat.

Physical: Multiple small vesicles with red halo on fingers and toes, ulcerative oral lesions (90%).

Investigations: Clinical diagnosis; can culture virus from mucosal or cutaneous lesions.

DDx: Aphthous stomatitis, chickenpox, erythema multiforme, herpes simplex.

Management

• Symptomatic: Topical anesthetic gel (lidocaine).

• Antipyretics: E.g., acetaminophen, ibuprofen.

• Ensure adequate fluid intake.

HEMANGIOMAS (INFANTILE; “STRAWBERRY HEMANGIOMA”)

Benign vascular tumor of endothelial cells.

History: 40% present at birth; remainder develop within 8 wk; 60% on head & neck. Rapid growth phase at 4—8 wk until 6—9 mo; spontaneous regression begins at 18—24 mo; 50% involute by 5 yr, 90% by 9 yr.

Physical: Divided into 3 types—Superficial (red and papular), deep (blue-gray and nodular), and mixed; residua: hypopigmentation, telangiectases, scarring (if ulcerated), redundant tissue.

Complications: Obstruction depending on location (e.g., vision, breathing), ulceration, infection.

Investigations: Consider MRI or U/S if in beard, oral or periocular areas involved.

DDx: Congenital hemangioma, vascular or lymphatic malformation.

Management

• Indications for treatment: Kasabach-Merritt syndrome; high output failure, obstruction of vital function (feeding, respiration, passage of urine/stool); nasal, auditory, or ocular obstruction; ulceration; cosmetic disability.

• Observation and reassurance in most cases.

• Referral to subspecialist (e.g., ophthalmology, ENT) if local obstruction.

• Prednisone 2 mg—4 mg/kg/d until 1 yr; occasionally intralesional steroids.

• Laser (pulsed dye), especially if ulcerated.

• Less commonly, ...