A Case of Generalized Interstitial Granuloma Annulare

Granuloma annulare (GA) is a common non-infectious, self-limiting granulomatous disease. Granuloma annulare is seen most commonly on the
skin of children, teenagers, or young adults. The generalised form is more likely to be found in older adults (mean age 50 years). There is a female
predominance of 2:1 over males. The generalized form of GA comprises 8% to 15% of cases and the majority of patients are adult. An increased
prevalence of dyslipidemia has been reported in this type. It is often associated with recalcitrant progression despite the treatment. An interstitial
histopathological pattern may be predominant in this form. The surface is smooth and the centre of each ring is often a little depressed. Localised
granuloma annulare usually affects the fingers or the backs of both hands, but is also common on top of the foot or ankle, and over one or both elbows.
We report a case of a 59-year female with generalized interstitial GA. She presented with a 6-month history of widespread papules over the whole
body, some of which coalesce to form small annular plaques. Her medical history was marked by hypertension and dyslipidemia. Histopathologic
findings showed interstitial, nonpalisaded pattern of inflammation with histiocytes infiltrating among fragmented collagen bundles. The patient is
being treated with systemic glucocorticoid, systemic alitretinoin, and topical glucocorticoid with the waxing and waning course. Thus, we introduce
this as a typical case of generalized interstitial GA.