Annulare and Pyogenic Granuloma
- Author: Richard Lichenstein, MD; Chief Editor: Steven C Dronen, MD, FAAEM more...
Background
Granuloma annulare (GA) is a benign self-limited dermatosis characterized by a raised annular configuration.
Pyogenic granuloma (PG) is misnamed, being neither pyogenic nor granuloma. It is a benign, acquired, vascular tumor of the skin and mucous membrane that appears as a rapidly growing vascular papule or nodule. Sometimes it appears at the site of a previous penetrating injury. PG is often observed in infancy and childhood but also may be observed in adults, particularly in pregnant women.
Pathophysiology
Granuloma annulare may be localized, generalized, perforating, or subcutaneous. Lesions of the first 3 presentations have similar appearances, but each one follows a distinctive clinical course. Subcutaneous granuloma annulare appears differently, as it is a disease of childhood in which deep dermal or subcutaneous nodules lie on or near the periosteum and are distributed on the feet, lower legs, fingers, hands, forearms, scalp, and forehead.
Pyogenic granuloma is a disorder of angiogenesis whose underlying etiology remains unknown. A predilection exists for the head and neck, although lesions may appear on any part of the body. Purplish, pulpy, vascular lesions of pyogenic granuloma often involve the gum and other mucous membranes of the mouth.
Epidemiology
Frequency
United States
Granuloma annulare is most common in children and young adults.
Solitary pyogenic granuloma is common and represents 0.5% of all skin nodules in children.
Mortality/Morbidity
- Granuloma annulare is a self-limited cosmetic disease without any systemic medical complications. On rare occasions, it may involve fascia and tendons and may cause sclerosis, lymphedema, and deformities such as joint ankylosis. Granuloma annulare has been epidemiologically linked to diabetes mellitus, necrobiosis lipoidica diabeticorum, and rheumatoid nodules.
- Pyogenic granuloma is a benign vascular tumor, mostly occurring in childhood. Lesions may bleed and ulcerate.
Race
- Granuloma annulare is believed to affect patients without respect to racial heritage.
- Pyogenic granuloma may affect white populations more than other racial groups, but this is not well proven and the observation may reflect sampling bias.
Sex
Granuloma annulare has a slight tendency toward females.
- In granuloma annulare, females are slightly more affected than males.
- In pyogenic granuloma, the male-to-female ratio is 3:2.
Age
- More than two thirds of patients with granuloma annulare experience disease onset when younger than 30 years. In pediatric patients with granuloma annulare, the age of onset ranges from 1-14 years, with a mean of 4 years. The localized type of granuloma annulare occurs primarily in young children, whereas the generalized form is seen in patients younger than 10 years or older than 40 years.
- Approximately one half of cases of pyogenic granuloma occur within the first 5 years of life.
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